Understanding obsessive-compulsive disorders & panic attacks.

Shawnta was walking around the mall with a couple of her friends one Saturday when it happened. Suddenly her heart started pounding, she felt she was smothering, and thought she was having a heart attack and was going to die. After about 10 minutes of terror, she started to calm down. She was afraid to leave the house for some time afterward.

While walking to school every morning, Tom makes sure that he doesn't step on any cracks on the sidewalk. If he does, even at the entrance of the building, he rushes back home and starts all over again. Sometimes he is an hour late.

Shawnta and Tom are suffering from two different psychological problems - Shawnta from panic attacks, and Tom from obsessivecompulsive disorder - yet in a way, these conditions are similar. Both are what experts call anxiety disorders. Shawnta experiences totally overwhelming anxiety that leaves her shaken and fearful that it will corne again. For Tom, his daily walking ritual is a way of avoiding anxiety. Only by doing it right and avoiding all the cracks can he ward off the feeling that something terrible may happen.

I'm Gonna Die"

"When I remembered that I left my semester project in the trunk of the car that my father was driving to Texas, I panicked." You've probably had that feeling, that sickening sense of dread combined with nervousness. Your stomach feels queasy, your mind starts racing, you feel as if you have to do something right away or you are frozen with worry. It's awful.

But true panic attacks are a thousand times worse. Like Shawnta, you may feel as though you are going to die - you may feel chest pains, choking, sweating, dizziness, shaking, a racing heart - and you can't do anything about it. There is an awful sense of disaster - that you will be hurt or will die, that you are going crazy, that the world is going to blow up.

Most people shrug off the first attack, but then a few days later another one occurs, sometimes less intense, and maybe a week later another. Same place, different place, there is no clear pattern, no warning. Now the person begins to dread future attacks and feels anxious all the time. Even though he or she may not have another one for weeks, months, or even years, there is the awful sense of uncertainty. Some people begin to limit what they do - Stop driving, stay out of elevators - because they think that is what triggered their attacks.

Actually, experts aren't sure what really causes panic attacks. Research shows there may be a biological link - those prone to panic attacks seem to have different brain chemistry from other people. This disorder also may be genetic. Some experts believe the problem stems from the way people like Shawnta interpret or misinterpret what is happening to them. Where most people realize that they are just feeling nervous and will be fine, those susceptible to attacks automatically think the worst, and these thoughts fuel the panic, setting off a vicious cycle. Panic attacks usually affect people between the ages of 16 and 40. They affect 1 percent to 2 percent of the population, and two to three times more women than men.

OCD-Trying to Keep

the Anxiety Away

As the name implies, obsessive-compulsive disorders can either be problems with obsessions, compulsions, or most often, both. As with panic, you've most likely experienced a taste of obsessions - thoughts that keep running through your head about that guy or girl you met last weekend, for example-but these usually make sense, and don't bother you too much. True obsessive thoughts seem irrational even to the person experiencing them - ideas or images (possibly violent thoughts) that are disturbing and that can't be turned off, no matter what the person does.

Compulsions are rituals that the person knows don't make sense but feels compelled to follow to feel less anxious. A man may have to count all the tiles on the floor in the bathroom before he feels comfortable enough to leave; a woman may have to say the name of her sisters and brothers before she can type the next word on the computer. Usually the compulsions are linked to the obsessions - the person who is afraid of hurting someone may develop the ritual of always going back over a route he or she has driven in order to make sure no one was hit, or spend hours and hours every day cleaning the house in order to try to kill germs that may cause illness. Obviously these rituals severely disrupt a person's life. But because the person realizes they are irrational and is embarrassed about them, the person usually tries to hide his or her problem from others as much as possible.

OCD affects roughly 2.4 million Americans - both men and women. The average age for onset is around 20, although it may occur in childhood. Like panic attacks, OCD can run in families, and its cause is uncertain. Some experts think that it is at least partially a brain chemistry problem.

Practice and Pills

There are two primary treatments for these disorders: behavior therapy and medication. For panic disorders, therapists teach the patients to not overreact to their feelings. A therapist may ask Shawnta to breathe into a paper bag, which will make her heart pound and make her short of breath. Then Shawnta will be taught to "talk herself down," telling herself that she is not having a heart attack, and that she will be all right. For compulsions, the goal is to face the fears and break the ritual. A therapist may go along the route to school with Tom and help him try to step on the cracks.

Medications, which help by actually affecting brain chemistry, can be used either alone (as with obsessions in which behavior therapy doesn't work) or together with behavior therapy. For panic, certain antidepressants and antianxiety drugs are used, and these often can eliminate or relieve this condition. Certain antidepressants also are used for OCD; they can greatly relieve the symptoms and make behavior therapy easier.

Looking Ahead

People such as Shawnta and Tom certainly aren't crazy, but their lives can be seriously handicapped by their anxiety and fears. While there is still much to learn about these disorders, there is a great deal that can be done to help. if you feel you have any of these symptoms, talk to someone about it, a counselor or doctor, for example. There is no need to be scared any more.