Psychopathology

Chapter 4

Anxiety Disorders

Overview

Occasional anxiety is an expected part of life. You might feel anxious when
faced with a problem at work, before taking a test, or before making an
important decision. But anxiety disorders involve more than temporary
worry or fear. For a person with an anxiety disorder, the anxiety does not
go away and can get worse over time. The symptoms can interfere with
daily activities such as job performance, school work, and relationships.

There are several types of anxiety disorders, including generalized anxiety

disorder, panic disorder, and various phobia-related disorders.

Signs and Symptoms

Generalized Anxiety Disorder

People with generalized anxiety disorder (GAD) display excessive anxiety

or worry, most days for at least 6 months, about a number of things such
as personal health, work, social interactions, and everyday routine life
circumstances. The fear and anxiety can cause signi cant problems in
areas of their life, such as social interactions, school, and work.

Generalized anxiety disorder symptoms include:

Feeling restless, wound-up, or on-edge

Being easily fatigued

Having dif culty concentrating; mind going blank

Being irritable
Having muscle tension

Dif culty controlling feelings of worry

Having sleep problems, such as dif culty falling or staying asleep,

restlessness, or unsatisfying sleep

Panic Disorder

People with panic disorder have recurrent unexpected panic attacks.

Panic attacks are sudden periods of intense fear that come on quickly and
reach their peak within minutes. Attacks can occur unexpectedly or can
be brought on by a trigger, such as a feared object or situation.

During a panic attack, people may experience:

Heart palpitations, a pounding heartbeat, or an accelerated heartrate

Sweating

Trembling or shaking

Sensations of shortness of breath, smothering, or choking

Feelings of impending doom

Feelings of being out of control

People with panic disorder often worry about when the next attack will
happen and actively try to prevent future attacks by avoiding places,
situations, or behaviors they associate with panic attacks. Worry about
panic attacks, and the effort spent trying to avoid attacks, cause
signi cant problems in various areas of the person’s life, including the
development of agoraphobia

Phobia-related disorders
A phobia is an intense fear of—or aversion to—speci c objects or
situations. Although it can be realistic to be anxious in some
circumstances, the fear people with phobias feel is out of proportion to
the actual danger caused by the situation or object.

People with a phobia:

May have an irrational or excessive worry about encountering the feared

object or situation

Take active steps to avoid the feared object or situation

Experience immediate intense anxiety upon encountering the feared

object or situation

Endure unavoidable objects and situations with intense anxiety

There are several types of phobias and phobia-related disorders:

Speci c Phobias (sometimes called simple phobias): As the name

suggests, people who have a speci c phobia have an intense fear of, or
feel intense anxiety about, speci c types of objects or situations. Some
examples of speci c phobias include the fear of:

Flying

Heights

Speci c animals, such as spiders, dogs, or snakes

Receiving injections

Blood
Social anxiety disorder (previously called social phobia): People with social
anxiety disorder have a general intense fear of, or anxiety toward, social or
performance situations. They worry that actions or behaviors associated
with their anxiety will be negatively evaluated by others, leading them to
feel embarrassed. This worry often causes people with social anxiety to
avoid social situations. Social anxiety disorder can manifest in a range of
situations, such as within the workplace or the school environment.

Separation anxiety disorder: Separation anxiety is often thought of as

something that only children deal with; however, adults can also be
diagnosed with separation anxiety disorder. People who have separation
anxiety disorder have fears about being parted from people to whom
they are attached. They often worry that some sort of harm or something
untoward will happen to their attachment gures while they are
separated. This fear leads them to avoid being separated from their
attachment gures and to avoid being alone. People with separation
anxiety may have nightmares about being separated from attachment
gures or experience physical symptoms when separation occurs or is
anticipated.

Causal Factors

Researchers are nding that both genetic and environmental factors

contribute to the risk of developing an anxiety disorder. Although the risk
factors for each type of anxiety disorder can vary, some general risk factors
for all types of anxiety disorders include:

Temperamental traits of shyness or behavioral inhibition in childhood

Exposure to stressful and negative life or environmental events in early

childhood or adulthood

A history of anxiety or other mental illnesses in biological relatives

Some physical health conditions, such as thyroid problems or heart

arrhythmias, or caffeine or other substances/medications, can produce or
aggravate anxiety symptoms; a physical health examination is helpful in
the evaluation of a possible anxiety disorder
Therapy and techniques for Anxiety Management

Psychotherapy: CBT techniques, Graded Exposure therapy, Imaginal

Exposure, thought journaling, Situational Exposure, Exposure and
Response prevention, contextualise the physiological phenomena,
Support Group, and adapting healthy lifestyle

Medical treatment: SSRIs, Anxiolytics, Antidepressants, Sedatives.

Duas for anxiety.

Dua #1

‫ـﺖ ِﻣ َﻦ ﱢ‬
‫اﻟﻈـﺎﻟﻤﯿـﻦ‬ ُ ‫َﻻ إِﻟَ َﻪ إِﱠﻻ أ ْﻧـﺖ ُﺳـ ْﺒﺤﺎﻧَ َﻚ إِﻧﱢﻲ ُﻛ ْﻨ‬

“There is no deity except You; exalted are You. Indeed, I have been of the
wrongdoers.” [Qur’an, 21:87]

Dua #2

‫وﻏﻠَﺒَـ ِﺔ ﱢ‬
‫اﻟﺮﺟﺎل‬ َ ‫ـﻊ اﻟـ ﱠﺪ ْﯾ ِﻦ‬ ْ َ ،‫واﻟﺠـ ْﺒﻦ‬ ْ ‫ـﺰ واﻟ َﻜ َﺴ ِﻞ واﻟﺒ‬ ُ ‫اﻟﻠﱡﻬـ ﱠﻢ إﻧﱢﻲ أَ ْﻋ‬
ْ ‫ﻮذ ﺑِ َﻚ ِﻣ َﻦ اﻟ َﻬـ ﱢﻢ َو ْاﻟ ُﺤ‬
ِ ‫وﺿﻠ‬ ِ ُ ‫ـﻞ‬ ِ ‫ُﺨ‬ ِ ‫ًﺠ‬
ْ ‫ واﻟﻌ‬،‫ـﺰ ِن‬ ِ

“O Allah, I seek refuge in You from worry and grief, from incapacity and
laziness, from cowardice and miserliness, from being heavily in debt and
from being overpowered by men.” [Al-Bukhari]

Dua #3

ْ ‫ـﻚ ﺑِ ُﻜ ﱢﻞ‬
‫اﺳ ٍﻢ ُﻫ َﻮ ﻟَ َﻚ َﺳ ﱠﻤـ ْﯿ َﺖ‬ َ ُ‫ﺎؤك أَ ْﺳﺄَﻟ‬
َ ‫ﻀ‬ ٌ ‫ َﻋﺪ‬،‫ُﻚ‬
َ ‫ْل ِﻓ ﱠﻲ َﻗ‬ َ ‫ﺎض ِﻓ ﱠﻲ ُﺣ ْﻜﻤ‬
ٍ ‫ َﻣ‬،‫ﺎﺻﯿَﺘِﻲ ﺑِﯿَـ ِﺪ َك‬
َ ِ‫اﻟﻠﱡﻬـ ﱠﻢ إﻧﱢﻲ َﻋ ْﺒـ ُﺪ َك ا ْﺑ ُﻦ َﻋ ْﺒـ ِﺪ َك ا ْﺑ ُﻦ أَ َﻣﺘ‬
ِ َ‫ـﻚ ﻧ‬ ِ
‫ﯿـﻊ‬
َ ِ‫آن َرﺑ‬ ُ َ َ َ َ ْ
َ ‫ـﺐ ِﻋﻨـﺪَك أ ْن ﺗ ْﺠـ َﻌﻞ اﻟﻘ ْﺮ‬ َ ْ َ َ ْ َ َ َ ْ َ ً َ ُ َ ‫ﱠ‬ َ َ َ ُ َ ْ َ ْ َ َ ْ َ
ِ ‫اﺳﺘـﺄﺛ ْﺮت ﺑِ ِﻪ ِﻓﻲ ِﻋﻠ ِﻢ اﻟﻐ ْﯿ‬ ْ ‫ أ ْو َﻋﻠ ْﻤـﺘﻪ أ َﺣﺪا ِﻣ ْﻦ ﺧﻠ ِﻘـﻚ أ ِو‬،‫ﺑِ ِﻪ ﻧﻔ َﺴﻚ أِ ْو أﻧﺰﻟﺘـﻪ ِﻓﻲ ِﻛﺘﺎﺑِﻚ‬
‫ﺎب َﻫﻤﱢـﻲ‬ َ ْ
َ ‫وﺟﻼ َء ُﺣـﺰﻧِﻲ وذ َﻫ‬ َ َ ‫ْري‬ ْ َ
ِ ‫ﺻـﺪ‬ َ ‫ﻧﻮر‬َ ‫ َو‬،‫ﻗﻠﺒِـﻲ‬
“O Allah, I am Your slave, son of Your male, son of your female slave. My
forelock is in Your Hand. Your Judgment upon me is assured and Your
Decree concerning me is just. I ask You by every Name that You have
named Yourself with, revealed in Your Book, taught anyone of Your
creation or kept unto Yourself in the knowledge of the unseen that is with
You, to make the Qur’an the spring of my heart, and the light of my chest,
the banisher of my sadness and the reliever of my distress.” [Ibn Hibban,
972]

Dua #4

‫ﯿﻦ‬
َ ‫ُﺴﻠِ ِﻤ‬ َ ‫َرﺑﱠﻨَﺎ أَ ْﻓ ِﺮ ْغ َﻋﻠَْﯿﻨَﺎ‬
ْ ‫ﺻ ْﺒ ًﺮا َوﺗَ َﻮ ﱠﻓﻨَﺎ ﻣ‬

Our Lord, pour upon us patience and let us die as Muslims [in submission
to You].” [Qur’an, 7:126]

Dua #5

َ ‫ﺎﻧﺼ ْﺮﻧَﺎ َﻋﻠَﻰ ْاﻟ َﻘ ْﻮ ِم ْاﻟ َﻜﺎ ِﻓ ِﺮ‬

‫ﯾﻦ‬ ُ ‫ﻻﻧَﺎ َﻓ‬ َ َ‫ار َﺣ ْﻤﻨَﺎ أ‬
َ ‫ﻧﺖ َﻣ ْﻮ‬ ْ ‫اﻏ ِﻔ ْﺮ ﻟَﻨَﺎ َو‬ ْ ‫ﻻ َﻃﺎ َﻗ َﺔ ﻟَﻨَﺎ ﺑِ ِﻪ َو‬
ُ ‫اﻋ‬
ْ ‫ﻒ َﻋﻨﱠﺎ َو‬ َ ‫ﻻ ﺗُ َﺤﻤ ْﱢﻠﻨَﺎ َﻣﺎ‬
َ ‫َرﺑﱠﻨَﺎ َو‬

Our Lord, and burden us not with that which we have no ability to bear.
And pardon us, and forgive us, and have mercy upon us. You are our
protector, so give us victory over the disbelieving people.” [Qur’an, 2:286]

Dua #6

‫ـﺢ ﻟﻲ َﺷ ْﺄﻧـﻲ ُﻛﻠﱠـﻪ َﻻ إِﻟَ َﻪ إِﱠﻻ أ ْﻧـﺖ‬ ْ َ‫ َوأ‬،‫ـﺮ َﻓ َﺔ َﻋـ ْﯿﻦ‬

ْ ِ‫ﺻﻠ‬ ْ ‫ـﻚ أَ ْرﺟﻮ َﻓﻼ ﺗَ ِﻜﻠـﻨﻲ إِﻟﻰ ﻧَ ْﻔـﺴﻲ َﻃ‬
َ َ‫اﻟﻠﱡﻬـ ﱠﻢ َر ْﺣ َﻤﺘ‬

O Allah, I hope for Your mercy. Do not leave me to myself even for the
blinking of an eye. Correct all of my affairs for me. There is none worthy of
worship but You. [Ibn Hibban, 864]

Dua #7

ً‫ـﺮ ُك ﺑ ِﻪ َﺷ ْﯿـﺌﺎ‬ ُْ ُ ُ
ِ ِ ‫اﷲ اﷲ َر ﱢب ﻻ أﺷ‬

O, Allah! Allah is my Lord, I do not associate anything with Him.

[Abu Dawud, Ibn Hibban, 970]

Dua #8

‫ش‬ َ ْ‫ َﻻ إﻟَـ َﻪ إ ﱠﻻ ﱠ‬،‫ـﺮش اﻟ َﻌ ِﻈﯿـﻢ‬ ُ‫َ َ ﱠ ﱠ‬ ْ ْ ُ‫َ َ ﱠ ﱠ‬

ِ ‫ور ﱡب اﻟ َﻌ ْﺮ‬
َ ‫ض‬ِ ‫ور ﱡب اﻷ ْر‬
ّ ‫اﻟﺴ َﻤـﻮﱢات‬
‫اﷲ َر ﱡب ﱠ‬ ِ ِ ِ ِ ْ ‫ ﻻ إِﻟ َﻪ إِﻻ اﷲ َر ﱡب اﻟ َﻌ‬،‫ﻻ إﻟ َﻪ إِﻻ اﷲ اﻟ َﻌﻈـﯿ ُﻢ اﻟ َﺤﻠِـﯿ ْﻢ‬
‫اﻟ َﻜـﺮﯾﻢ‬

There is no god but Allah, the Great, the Tolerant; there is no god but Allah,
the Lord of the Magni cent Throne. There is no god but Allah, the Lord of
the heaven and the earth, and the Lord of the Edifying Throne.” [Al-
Bukhari]

Dua #9

‫ﻮذ ﺑِ َﻚ ِﻣ ْﻦ َﺷ ﱢﺮ َﻣﺎ َﻋ ِﻤ ْﻠ ُﺖ َو ِﻣ ْﻦ َﺷ ﱢﺮ َﻣﺎ ﻟَ ْﻢ أَ ْﻋ َﻤ ْﻞ‬

ُ ‫اﻟﻠﱠ ُﻬ ﱠﻢ إﻧﱢﻲ أَ ُﻋ‬
ِ

O Allah, I seek refuge with You from the evil of what I have done and from
the evil of what I have not done yet. [Sunan an-Nasa’i, 5526]

Dua #10

،‫آﺧ َﺮﺗِﻲ اﻟﱠﺘِﻲ ِﻓﯿﻬﺎ َﻣ َﻌﺎ ِدي‬

ِ ‫ﺻﻠِ ْﺢ ﻟِﻲ‬ ْ َ‫ َوأ‬،‫ﺎﺷﻲ‬ ِ ‫ﺎي اﻟﱠﺘِﻲ ِﻓﯿﻬﺎ َﻣ َﻌ‬ َ َ‫ﺻﻠِ ْﺢ ﻟِﻲ ُد ْﻧﯿ‬ ْ َ‫ وأ‬،‫ﺼ َﻤ ُﺔ أَ ْﻣ ِﺮي‬ ْ َ‫اﻟﻠﱠ ُﻬ ﱠﻢ أ‬
ْ ‫ﺻﻠِ ْﺢ ﻟِﻲ ِدﯾﻨِﻲ اﻟﱠ ِﺬي ُﻫ َﻮ ِﻋ‬
.‫اﺣ ًﺔ ﻟِﻲ ِﻣ ْﻦ ُﻛ ﱢﻞ َﺷﺮﱢ‬ ْ ‫ َو‬،‫واﺟ َﻌ ِﻞ ْاﻟ َﺤﯿَﺎ َة ِزﯾَﺎ َد ًة ﻟِﻲ ِﻓﻲ ُﻛ ﱢﻞ َﺧ ْﯿ ِﺮ‬
َ ‫اﺟ َﻌ ِﻞ ْاﻟ َﻤ ْﻮ َت َر‬ ْ

“O Allah! Set right for me my religion, which is the safeguard of my affairs.

And set right for me the affairs of the world wherein is my living. Decree
the Hereafter to be good for me. And make this life, for me, (a source) of
abundance for every good and make my death (a source) of comfort to
me and protection against every evil.”[Muslim, 2820]

Dua #11

‫ َو َﺷ َﻤﺎﺗَ ِﺔ ْاﻷ ْﻋﺪَا ِء‬،‫ﻀﺎ ِء‬

َ ‫ َو ُﺳﻮ ِء ْاﻟ َﻘ‬،‫اﻟﺸ َﻘﺎ ِء‬ ُ َ‫اﻟﻠﻬ ﱠﻢ إﻧﱢﻲ أ‬
ْ ‫ َود‬،‫ﻋﻮذ ﺑِ َﻚ ِﻣﻦ َﺟ ْﻬ ِﺪ ْاﻟﺒَ َﻼ ِء‬
‫َر ِك ﱠ‬

Oh the Allah, I seek refuge in You from the distress of trial, from the lowest
level of misery, from the perversity of fate, and from the malicious
rejoicing of enemies. [Bukhari and Muslim]
Dua #12

‫ﯿﻦ‬
َ ‫اﺣ ِﻤ‬ ‫ﻧﺖ أَ ْر َﺣ ُﻢ ﱠ‬
ِ ‫اﻟﺮ‬ َ َ‫اﻟﻀ ﱡﺮ َوأ‬
‫َﻣ ﱠﺴﻨِ َﻲ ﱡ‬

Indeed, adversity has touched me, and you are the Most Merciful of the
merciful.” [Qur’an, 21:83]

Narrated by Abu Huraira (May Allah be pleased with him): Allah’s

Messenger (‫ )ﷺ‬said, “If Allah wants to do good to somebody, He af icts
him with trials.”

Great reward is associated with trials and calamities. With every problem
and dif culty, there comes an opportunity for great reward if borne with
patience.

Doubts in one’s Faith

The questioner has mentioned this problem and is afraid of its

consequences. I say to him, rejoice, for its consequences cannot be
anything but good. By means of this waswas, the Shaytan tries to gain
control over the believers and shake the sound belief in their hearts, and
make them suffer psychological and intellectual anxiety that will affect
the purity of their faith and their life, if they are believers.

This is not the rst or the last time that the believers have been exposed
to this. It will continue so long as there is any believer in this world. The
Sahabah/Companions of the Prophet (may Allah be pleased with them)
also faced this problem. It was narrated that Abu Hurayrah (may Allah be
pleased with him) said: “Some of the Companions of the Messenger of
Allah (peace and blessings of Allah be upon him) came to the Prophet
(peace and blessings of Allah be upon him) and said to him, ‘We nd in
ourselves thoughts that are too terrible to speak of.’ He said, ‘Are you really
suffering from that?’ They said, ‘Yes.’ He said, ‘That is a clear sign of faith.’”
(Muslim).
It was narrated in al-Saheehayn, also from Abu Hurayrah (may Allah be
pleased with him), that the Prophet (peace and blessings of Allah be upon
him) said, “The Shaytan comes to one of you and says, ‘Who created such
and such? Who created such and such?’ Until he says, ‘Who created your
Lord?!’ If that happens to any of you, let him seek refuge with Allah and
put a stop to these thoughts.”

It was narrated from Ibn ‘Abbas (may Allah be pleased with them both)
that a man came to the Prophet (peace and blessings of Allah be upon
him) and said, “I think thoughts to myself, which I would rather be burnt
to a cinder than speak of them.” The Prophet (peace and blessings of Allah
be upon him) said, “Praise be to Allah, Who has reduced all his [the
Shaytan’s] plots to mere whispers.” (Abu Dawood).

Shaykh al-Islam Ibn Taymiyah (may Allah have mercy on him) said in Kitab
al-Eeman: “The believer may suffer from the whispers of the Shaytan
insinuating thoughts of kufr (disbelief), which may make him feel
distressed. The Sahabah (may Allah be pleased with them) said, ‘O
Messenger of Allah, some of us think thoughts which we would rather fall
from heaven to earth than speak of them.’ He said, ‘That is a clear sign of
faith.’ According to one report, ‘… thoughts which are too terrible to speak
of.’ He said, ‘Praise be to Allah, Who has reduced all his [the Shaytan’s]
plots to mere whispers,’ meaning that the fact that these whispers come,
but they are so greatly disliked, and they are pushed away from the heart,
is a clear sign of faith. This is like the mujahid (warrior) to whom the enemy
comes, but he resists him until he overwhelms him, and this is a mighty
jihad (battle)… Hence the seekers of knowledge and devoted worshippers
experience waswas and doubts which others do not face, because they
(the others) are not following the way prescribed by Allah, rather they are
following their own whims and desires and neglecting to remember their
Lord. This is what the Shaytan wants, in contrast to those who are striving
to draw closer to their Lord by seeking knowledge and worshipping Him.
He is their enemy and seeks to prevent them from drawing closer to
Allah.” (p.147 of the Indian edition)
I say to this questioner, if you are faced with this waswas from the
Shaytan, then ght it and resist it. Know that it can never harm you when
you ful ll the duty of ghting and resisting it, and you refuse to be
controlled by it. The Prophet (peace and blessings of Allah be upon him)
said, “Allah will forgive my ummah (followers) for any insinuating whispers
that may cross their minds, so long as they do not act upon it or speak of
it.” (Agreed upon).

If it is said to you: Do you believe the insinuating whispers you

experience? Do you think that they are true? Do you really think that
Allah is like what this waswas says? You would say, “It is not right for us to
speak of this. Glory be to You (O Allah)! This is a great lie” [24:16 ]. You would
denounce that in your heart and with your tongue, and be the one who
objects to it the most, for it is only whispers and thoughts that cross your
mind. It is a trap set by the Shaytan, who ows through the son of Adam
(peace be upon him) like blood ows, to make you doomed and to
confuse you about your religion.

Hence you will nd that the Shaytan does not cast doubts or suspicions
into your heart about trivial matters. For example, you may hear of the
existence of great cities lled with people and buildings in the east and
the west, but it would never cross your mind someday to doubt that they
exist or to criticize them and say that they are in ruins and un t for
habitation, or that they are uninhabited, and so on. The Shaytan has
nothing to gain by making people doubt about these cities. But he does
have a lot to gain by corrupting the believer’s faith, so he strives with his
cavalry and his infantry to extinguish the light of knowledge and
guidance in his heart and to make him fall into the darkness of doubt and
confusion. The Prophet (peace and blessings of Allah be upon him) has
told us of the appropriate remedy for such problems, which is to seek
refuge with Allah and put a stop to it. If a person puts a stop to it and
continues to worship Allah, seeking and hoping for (the reward) which is
with Allah, it will stop by Allah’s leave. So turn away from all the thoughts
of this kind that cross your mind. You are worshipping Allah, calling upon
Him and glorifying Him, and if you were to hear anyone ascribing to Allah
the things that are whispered to you (waswas), you would probably kill
him if you could. So the things that are whispered to you are neither real
nor true, they are merely imagination and whispers which have no basis.
Handling Religious Scrupulosity:

Puri cation and removal of impurity is done by washing the private part; it
is not essential to wash the area around it, so do not pay any attention to
the water that drops elsewhere, as stated above. Be con dent that you
are tahir, praise be to Allah, and that your prayer offered with this
puri cation is valid and accepted, if Allah wills, for Allah is Most Merciful
and Kind, and He shows mercy to His sinful slaves, so how about those
who are obedient and love Him?

With regard to deciding to stop wudu or prayer, that does not matter
either, rather you should ignore these thoughts and carry on with your
wudu or prayer, because there is no reason to interrupt an act of worship,
rather this is waswas and it does not affect your act of worship, praise be
to Allah. No matter what thoughts of interrupting your act of worship or
repeating it come to you, do not pay any attention to that, and carry on
with it, and ask Allah to accept it, because you have done as much as you
could, and you have done what was required of you, and Allah does not
burden any person beyond his scope.

Remember this advice, and carry on, and ignore the waswas, for it is a trick
of the shaytan, but his tricks are weak as our Lord has told us. Be
con dent that if you ignore the waswas it will disappear, by the power of
Allah.

We ask Allah to help you to obey Him and to make you happy by
worshipping Him, and to take away the problem that you are facing.

And Allah knows best.

References:

https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

https://islamqa.info/en/answers/12315/suffering-from-waswas-insinuating-
whispers-of-the-shaytan-about-the-essence-of-allah

https://islamqa.info/en/answers/100268/remedy-for-insinuating-whispers-
that-has-to-do-with-puri cation-and-prayer