Anxiety Disorders at College

Anxiety is a normal human emotion. We commonly feel anxious before we give a speech, or start a new job, or send our children off to college. But anxiety disorders are serious medical illnesses that according to the National Institute of Mental Health affect approximately 19 million American adults and 9.1 percent of college students.¹¹ Sasha is one of them:

Sasha first showed symptoms of the anxiety disorder called obsessive compulsive disorder (OCD) at age four. Describing herself as "a checker, arranger, mental re­ peater, and washer," she began seeing a psychiatrist at age twelve, and then she became one of the many students who enter college with a diagnosed mental health dis­ order. But like so many others, she didn't tell anyone about it. "This is not something I advertise," says Sasha. "On those health forms that students fill out, I didn't mention anything about OCD or even tell my roommate."

In fact, Sasha's mental health was not something her family ever openly talked about. "I think my parents partially blamed themselves for this problem and always wondered where they had gone wrong, so it was something to keep quite about. No one outside our immediate family (and that includes even my grandmother) was ever told about my OCD, and that was the feeling I brought to college with me." This fear of being "found out" can make the transition to college life even harder for someone like Sasha.

"I wasn't happy at all my freshman year. I'm the kind of person who has a few really good friends, but it takes me a long time to get to know new people. Even in normal circumstances, I tend to think people are ignoring me when they're really not. In college, this feeling got so much worse. I was really lonely."

Intensifying her feelings of being out of place, the bathroom situation in Sasha's freshman dorm caused her great stress. "The bathroom was down the hall across from my room," she recalls. "I particularly disliked having to share the shower; it grossed me out that people might hang their dirty clothes where I was hanging my clean towel. So I Lysoled a lot. I also didn't like touching so many doorknobs after washing my hands, so I'd open doors with paper towels and frequently cleaned the door handle in my room. Plus, it was annoying to have to run back and forth across the hall every time I wanted to wash my hands, which could be more than thirty times a day."

After a while, Sasha noticed something else. "I felt so sad and lethargic most of the time. I had felt like this before, but this was so much more intense. My sleep was fragmented; I didn't want to go anywhere, and I could cry for several hours at a time. I'd also had such negative thoughts like 'Nobody likes me. I'm not smart. I've lost everything that was good. I want to get away from this school and my whole life.' Because I'm pretty savvy about mental health, I knew I was getting depressed." But Sasha couldn't put her finger on the reason she felt so miserable.

Although unhappy and lonely, Sasha held herself together through the first semester, worked hard, and earned good grades. But in the following spring semester, things began to unravel, and Sasha felt that she had nowhere to turn. The university was about a four-hour drive from Sasha's home, so she wasn't able to see her psychiatrist, and she didn't take the psychiatrist's advice to find a new therapist near the school. There were days when Sasha could barely drag herself to class.

Sasha's parents knew nothing about their daughter's pain until Sasha came home in March for spring break. Feeling desperate, she scheduled a visit with her psychiatrist (whom she hadn't seen since the summer before) and left with the diagnosis of depression and a prescription. "I had never taken any medication for OCD. I was always totally against it because I felt it made me weak to turn for help to something outside myself. So when I told my parents I was on Prozac, they knew something was very wrong."

Sasha feels that the Prozac didn't help the root of the problem. "It made me numb so that I wasn't crying for hours anymore, but it didn't solve anything. I still knew everything was wrong, but now I didn't have the capacity to get riled up about it. The life problems were still there: I was still really anxious about doing well in college; I didn't have a supportive social circle; I was still obsessive compulsive, and I was lonely. My problems weren't things you could take away with a pill. So I ­ didn't do much better when I returned to school after spring break."

Although medication is often extremely helpful for OCD and can have a dramatic effect on the symptoms, it does not work for everyone. Shortly after Sasha found that the medication was not the magic bullet she was hoping for, she developed a fear of writing, and her grades began to plummet. She just couldn't get started, and so all her papers were handed in very late, if at all. "I could get stuck for a whole day on one word"I'd go crazy trying to choose just the right word. It was horrible: my perfectionism was in overdrive, and that was turning me into a pathological procrastinator."

Sasha feels her trait of perfectionism, common in obsessive compulsives, is both her strength and her weakness. "I'd be curious to know how many other students at this very competitive university have OCD," she laughs, "because I don't think you can get here without being compulsively perfect about your school work. But then being pathologically perfect starts to work against you."

In the fall of her sophomore year, Sasha found a new therapist near her college and developed a strong group of friends. Although the OCD and depression were always there, the symptoms lessened, life was much better, and she gave up the Prozac. But in her senior year, the problems again intensified. "This was a make-­ or-break year for me. My major in folklore and mythology required a senior thesis, and writing was still my nemesis. So I thought for sure I'd never graduate on time. But with the help of my therapist and a behavioral therapist I started to see, somehow I began to put things in perspective. I realized that my thesis maybe wasn't going to be the best thesis ever written in the whole wide world, but it could still be damn good. I accepted that I wasn't going to wake up one day and be cured of OCD, and that I was never going to be perfect even if I tried harder. This wasn't easy to accept, but I did, and it worked for me."

Sasha recently graduated and is now living with two roommates and working in a major city. She looks back on her own college years with worries about the students she left behind who are still struggling with anxiety disorders. "Suicide," she says, "is not seen as the worst-case scenario in anxiety disorders as it is in depression. So in a sort of public health triage, depression gets treated first. But these disorders do severely affect the quality of life in social, academic, and occupational areas, so I hope that students begin to speak up about their illnesses and get the help they need and deserve."

Unlike the relatively mild, brief anxiety accompanying everyday events, anxiety disorders like Sasha's are chronic and relentless, and they can become progressively worse if not recognized and treated. Although some disorders have a genetic base, the stress of college seems to be a trigger in susceptible people, and that's why it is not uncommon for a person to experience his or her first anxiety disorder attack during the stressful college years.