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Riddle-Walker says the way to treat such fears is to coach each patient toward confronting the symptoms the new fear raises. “If they were washing their hands, say, three times every hour, then we work on reducing the hand-washing,” she says.

Other times, when faced with something like swine flu, obsessive compulsives get mired in a thought pattern rather than a series of avoidances or rituals. For Bre, 18, it was the worry about swine flu that was hard for her to manage.

“[I have] mental-type rituals,” she says, at a table in an Escondido coffee shop. “A thought will pass in my head when I’m driving — like, I’m going to swerve off the road. That’ll happen to anyone, but with OCD, it gets stuck in your brain and you keep thinking about it over and over again. At the same time, you know it’s irrational, but the fear grips you.”

Bre, who is soft-spoken and dressed for the hot Escondido evening in jeans and a tank top, is a recent graduate from Valley Center High School. Soon she’ll be moving on to Palomar Community College and then to Azusa Pacific University, where she hopes to study teaching and photography.

Bre was diagnosed with OCD at age 12, when she was in the seventh grade. “I was having thoughts of wanting to kill myself even though I didn’t [want to], because I’m a very happy person,” she recalls. “I thought, Why am I thinking this? I love my life. What’s going on? It scared me. I thought, Do I really want to do it? even though I knew I didn’t. I told my mom, ‘I don’t want to! I don’t know what’s wrong with me!’”

Bre, like Dina, was diagnosed by a doctor after going to her parents with her concerns and began therapy with Riddle-Walker shortly thereafter. She also began taking a selective serotonin reuptake inhibitor and the anti-anxiety drug Buspar to augment the counseling. Six years later, she has completed therapy and only sees a specialist at the University of California San Diego’s psychiatric department for routine medication adjustments. Though she is doing well, Bre acknowledges that the disorder never fully ceases to be a part of a sufferer’s life. The swine-flu outbreak, she says, was something that piqued her anxiety, if only for a brief period. “I’m more worried about infecting other people, if I’m sick,” she says. “It’s like I have an over-responsibility for other people’s feelings. I was kind of worried, being at school. [I thought,] Am I going to get it? Am I going to die? Do I need to be washing my hands more? The way people who didn’t have OCD were reacting to it and freaking out about it [made me think], Well, should I worry about this? I’m usually the one who’s worried!”

Bre and Dina both say that their worries surrounding swine flu have abated. Dina reports that speaking with Riddle-Walker on the phone between scheduled meetings calmed her anxiety greatly. “I couldn’t wait,” she says, “I had to tell her about swine flu, so I called her and she told me to just not listen to OCD when it told me to do something. She said it was like a baby that cries or makes noise; you have to ignore it for it to go away, but if you listen to it, it will stay there.”

Bre says that reminding herself that her fear is based in a disorder has helped keep her fear at bay, though there have been instances when the worries resurfaced. “My AP biology teacher played this mockumentary about smallpox from 2002 about biological weapons,” she says. “They made it seem real. Everyone was getting it and there weren’t enough vaccines and everyone was dying and they said, ‘It’s a pandemic!’ That kind of didn’t help.”

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