“Oh, that is just so OCD; I mean she is totally obsessed with her new phone.” “I swear I had a panic attack when I heard…”
How easily people make light of things about which they know very little, inadvertently but painfully mocking what causes others prolonged suffering. Yet to the millions of Americans who live with them, anxiety and panic disorders are no joke. Obsessive compulsive disorder, panic attacks, and phobias are types of anxiety and panic disorders which range from mildly disturbing to so disabling that leaving home becomes impossible.
May is Mental Health Awareness Month.
Obsessive-compulsive disorder (OCD) traps people in endless cycles of repetitive thoughts and behaviors. The approximate four million Americans with OCD are plagued by recurring and distressing thoughts, fears, or images (obsessions) which they cannot control. The resulting anxiety becomes an urgent need to perform certain rituals or routines (compulsions) in an almost subconscious attempt to get rid of the obsessive thoughts, but just temporarily. The cycle always repeats eventually and may progress, taking seconds or hours and interfering with normal activities. People with OCD may be aware of their obsessions and compulsions, but can’t stop them.
The symptoms of OCD vary, but commonly include exaggerated fears such as being dirty or contaminated by germs, causing harm to another, making even small mistakes, social embarrassment, or thinking “sinful” thoughts. Also fairly common is a need for order, symmetry, or exactness (peas on a plate or pencils lined up just so, to the point of being unable to concentrate or otherwise act without this), or excessive doubt and the need for constant reassurance.
Common compulsions include repetitive or constant bathing, hand-washing, rearranging items, and double-checking (e.g., stoves and locks), or needing to perform certain tasks a certain number of times (e.g. always knock three but not four times, or tap each doorway twice before entering), or perhaps refusing to shake hands or touch doorknobs. The compulsion may be body-related, such as specific coughing, throat-clearing, or making certain sounds (to oneself or aloud) and eating foods in a specific order. Also common is being stuck on certain words, phrases, or disturbing images – this may last all day and interfere with sleep.
While environmental factors such as abuse or trauma can be related to or trigger anxiety and panic disorders (or at least make them worse), biological factors have also been connected, perhaps more strongly in the case of OCD. Low serotonin is one example. Serotonin – a neurotransmitter which helps ferry messages from one neuron in the brain to another – imbalances may also be genetically passed on from parent to child, even if the same condition may not appear in both persons, or at least not as obviously.
Panic disorder (including panic attacks), while it is sometimes diagnosed along with OCD in the same person, is a distinct disorder. This is more than mere anxiety, nervousness, or elevated blood pressure in a tense situation. In fact, people who suffer from panic attacks also have them without any apparent outside cause. A person in the grip of a panic attack typically feels some combination of a sudden onset of nausea, dizziness, or sweating; difficulty breathing; a thumping in the chest; and an overall frightening feeling perhaps as severe as being near death. It’s very scary, very intense, and very sudden. They generally last 20 minutes or less, but in severe cases can last hours or days.
Yes, sometimes people with PTSD, such as veterans or other victims of violence, experience panic attacks. But many who suffer from them have not had such experiences. Because they are worried about experiencing an attack in social situations, people who have them commonly avoid crowds such as weddings or parties, fearful of being in a situation with too many witnesses of an embarrassing state, or feeling vulnerable. People with panic disorders often feel very isolated and alone.
This avoidance may simply be practical or related to agoraphobia (fear of open spaces or crowds) – which is chicken or egg is not always obvious. People who are phobic may also have panic attacks.
And what of phobias? They may or may not be rooted in a conditioning event, such as a fear of dogs beginning after a bite. The subject of the phobia, or fear, may, or may not, be of things average people avoid, such as rowdy crowds, spiders, snakes, or flying. In any case phobic fears are exaggerated and can be disabling, isolating people so they are afraid to leave home, enter a building, or be in the same environment as the subject of fear.
Phobias are far more than discomfort. They can make the 8 percent of Americans who are phobic visibly shake, faint, or feel in physical danger. It’s a mistake to tell a phobic or panicking person there is no reason to be afraid; implying their fear is irrational (which they likely already know) simply makes them feel more isolated and anxious. Help them breathe in and out slowly, leave with them to a quiet and safer-feeling place, stay with them until they feel calmer.
These conditions can not simply be willed away. People with severe anxiety and panic disorders may also experience chronic depression, aware of their conditions but feeling powerless to change them.
Anxiety and panic disorders are medical; they are not a sign of weakness. They are serious and involuntary, but they can be treated and improve. Treatments generally involve medication, such as anti-depressants which boost serotonin levels, and cognitive/behavioral therapies. For more information on these and other mental disorders, see NIMH.NIH.gov. For help, referrals, and connections to local support call the National Alliance for the Mentally Ill (NAMI) helpline (800) 950-NAMI.
Sholeh Patrick is a columnist for the Hagadone News Network. Contact her at firstname.lastname@example.org.