Obsessive-compulsive disorder and panic attacks can each limit your ability to live the life you want. Sometimes they’re meaningfully related, and sometimes they’re not. Read on to learn more.
What Is Obsessive-Compulsive Disorder (OCD)?
OCD is a mental health condition that involves two primary symptoms: obsessions and/or compulsions.
Obsessions are intrusive, unwanted, repetitive thoughts or urges that cause emotional distress. Intrusive thoughts can be about many different things, like contamination, fear of harming others, or discomfort with things not being “just right.”
Compulsions are physical or mental actions that feel difficult to stop and, sometimes, necessary to repeat. They serve to decrease the distress that comes from obsessions. Examples of compulsions include checking locks, excessive handwashing or cleaning, and reassurance seeking.
Obsessions typically lead to compulsions, which become entrenched habits. People with OCD typically rely on compulsions to cope with some difficult feelings. Unfortunately, the reliance on compulsions paves the way for more obsessions. The process becomes a vicious cycle.
SEE ALSO: The OCD Cycle: How OCD Keeps You Trapped and Miserable
What are Panic Attacks and Panic Disorder?
Panic attacks are when you feel a sudden, intense fear that lasts for at least several minutes, escalating until it reaches a peak (usually within 20 minutes). They can occur with or without an obvious trigger and often feel out of your control.
Panic disorder is a condition that involves recurrent panic attacks or repeated efforts to avoid panic attacks. Many people experience panic attacks without having panic disorder.
Symptoms of Panic Attacks
A panic attack can be extremely distressing, especially when it happens in public. You might have experienced a panic attack if you have experienced several of the following symptoms together:
- Increased heart rate
- Shortness of breath
- Feeling like you are choking
- Chest pain
- Sweating
- Numbness or tingling in your arms or legs
- Chills or hot flashes
- Trembling or shaking
- Nausea
- Feeling dizzy or lightheaded
- Feeling like things aren’t real or like you are detached from yourself
- Fearing losing control or dying
The Relationship Between OCD and Panic Attacks
How OCD can trigger panic attacks
Sometimes OCD symptoms become intense enough that they trigger panic attacks. Let’s consider an example to see how this can happen.
Joe has obsessive thoughts is that he will stab his roommate with a knife. (Joe has a type of OCD known as “harm OCD.”) He is at home with his roommate making dinner, and all of a sudden Joe has the thought “I could stab him right now, and there’s nothing to stop me.” Joe had visual images of stabbing his roommate, and felt extremely scared. His distress continued to build as the thoughts and images continued. He noticed his heart beating faster and his breath becoming shallow. He began to feel dizzy and lightheaded, and felt the need to escape the kitchen as fast as possible.
In Joe’s case, OCD symptoms led to a panic attack.
Having unrelated panic disorder and OCD
In other cases, people can have OCD and panic disorder, but the two are not meaningfully related. Consider the following example:
Annie spends over an hour each day washing her hands (an OCD symptom) due to her fears about spreading germs. The hand washing makes her skin raw and irritated. Recently, Annie has had panic attacks while riding the subway – but not because of her OCD. The panic attacks started a few months ago while she was riding the subway. Annie felt extremely scared that she might get stuck on the train without a way to escape. She felt her heart beat faster and she became very hot and started to sweat. “What if I need to get off the subway, but we get stuck between stations?” she thought.
Over the next few minutes, Annie began to shake and felt like she was floating above herself, rather than in her body – she was having a panic attack. Ever since that day, she has experienced more frequent panic attacks while commuting to work or traveling to visit friends.
Annie has panic disorder and OCD, but they are likely not related.
The role of anxiety in both conditions
Anxiety can play a role in OCD as well as panic disorder. Anxiety is a persistent worry, fear, or uneasiness, about something that might happen in the future. OCD can cause worry that feels out of your control. You might engage in compulsions to reduce these thoughts.
Panic attacks cause extreme fear that can feel “out of nowhere.” The fear is accompanied by many physical anxiety symptoms. You might try to escape the environment or situation you’re in, hoping that they will subside. Unfortunately, repeatedly escaping a situation due to panic symptoms can lead to anxiety around the possibility of future panic attacks.
Treatments for OCD and Panic
Cognitive-behavioral therapy (CBT)
CBT is an evidence-based therapy for OCD and for panic disorder. CBT focuses on understanding the relationship between thoughts, emotions, and behaviors. By changing one of these (e.g., behavior), you can change often another (e.g., your thoughts), or vice versa. CBT therapists use different skills and techniques to help reduce the intensity or presence of your symptoms.
CBT can help with panic attacks in a few different ways. How it accomplishes this will depend on *why* you’re having panic attacks. If excessive worry leads to panic attacks for you, your CBT therapist may help you improve your ability to think differently about the topics that you worry about. If, instead, you have panic disorder, your therapy may include panic control treatment (PCT). This therapy uses multiple effective strategies to reduce your vulnerability to panic attacks.
If you have OCD, you’ll likely receive a special type of CBT therapy tailored for obsessions and compulsions. This therapy is called exposure and response prevention (ERP).
Exposure and response prevention (ERP)
ERP is a type of CBT therapy in which your therapists helps you practice gradually facing challenging thoughts or sensations without doing anything that would immediately decrease that distress — like compulsions or avoidance. This helps you learn to tolerate the feelings that come with your obsessions. This process helps reduce your distress over time.
This often involves intentionally thinking of obsessive fears without engaging in a compulsion. ERP helps you tolerate those uncomfortable thoughts, feelings and physical sensations. They start to feel much less threatening and alarming with time and repetition.
Medication options
Medications can be prescribed to help you manage OCD symptoms as well as panic. For OCD, medications like selective serotonin reuptake inhibitors (SSRIs) are often prescribed. You and your medical provider would work together to figure out the best medication for your symptom goals.
Panic symptoms can also benefit from medications. In addition to SSRIs for longer-term anxiety management, some anti-anxiety medications, like benzodiazepines, may be prescribed. Other types of medications, like beta blockers, are sometimes used for panic as they help decrease the physical symptoms of anxiety.
Coping Techniques for Panic Attacks
Although the best strategy for addressing panic attacks is to seek out treatment that will leave you less vulnerable to these attacks, there are some short-term strategies that can be helpful if you’re having a panic attack right now.
Grounding exercises
Panic attacks can make you feel detached from the here and now. Grounding exercises help you get in touch with your senses, “grounding” you into the present moment. Here are some ways to practice grounding:
A popular grounding exercise is the 5-4-3-2-1 technique. Here’s how to do it:
- Notice 5 things you see, like the color of the wall, a piece of fruit, or a pen.
- Notice 4 things you can touch, like the texture of your chair or the temperature of your drinking glass.
- Notice 3 things you can hear, like the hum of an air conditioner or traffic from the street.
- Notice two things you can smell, like the smell of your food, or what you smell when you open a window or door.
- Notice 1 thing you can taste, like the taste in your mouth from a recent meal.
A shorter version of grounding is the 3-3-3 technique:
- Notice three things that you can see.
- Notice three things you can hear.
- Move three parts of your body.
This can help bring you back into the present moment and out of your panic thoughts and feelings. Repeat these skills more than once for increased effect.
Breathing techniques
Your breath can help you prevent or slow down panic symptoms. By focusing on slowing your breathing, you can counteract the quick, rapid breathing that often happens during panic.
Diaphragmatic breathing is a specific type of breathing that comes from your diaphragm, or belly, rather than from your chest. Diaphragmatic breathing helps us breath deeper and trigger the “relaxation response.” Here’s a video that teaches you how to do diaphragmatic breathing.
When to Seek Professional Help
Both OCD and panic attacks, together or by themselves, can be difficult to live with. The anxiety and fear associated with both conditions can make it hard to go to work, interact with others, and do the things that bring you joy.
If you are feeling like your OCD, panic attacks, or both, are too much to manage alone, you would probably benefit from speaking to a professional. There are treatments that can help you feel less controlled by your anxiety.
You don’t have to be alone in your experience of OCD and panic. Reach out to us at Manhattan Center for Cognitive Behavioral Therapy to get connected to an anxiety treatment specialist.
