Dina is 11, slight in her turquoise hoodie, and dark-haired. She’s finishing up the fifth grade at a private North County middle school where, she says, “there’s a lot going on.” Though she’s too young to join the studio audience, as she and her mother lament, she loves the Ellen Degeneres show. A few weeks ago, she completed the STAT 10, a reading, writing, math, vocabulary, and language exam given at some San Diego schools, which took almost a week in total to do.

But what’s been occupying Dina’s mind is swine flu. Is this a legitimate fear that I have, she often wonders, or is it just my obsessive-compulsive disorder?

“I’ve had it ever since I was four,” she says, matter-of-factly, sitting in a metal chair by the fountain in the UTC mall. Her mother sits across from her, wearing sunglasses to shield her eyes from the bright sun overhead. “My parents didn’t know I had it so I just called it ‘my game.’”

Two years ago, when Dina saw a television program about the disorder, she identified with the guests being profiled. Her “game,” which involved complicated blinking rituals designed to ward off bad luck, finally made sense to her. Her parents took her to a doctor for a diagnosis. Turned out, she was right.

In addition to movement-based compulsions — blinking, dragging her feet around obstacles in her path — Dina has a lot of anxiety surrounding the possibility of illness.

“I have a lot of fears about throwing up and getting sick and needing to go to the hospital,” she says.

Dina first heard about swine flu on the news, which, she says, is always on in the morning in her home near Encinitas. At first, the outbreak didn’t generate much worry for her.

“I just thought they were just exaggerating, but I was on the way to school and my dad said, ‘Dina, don’t share food with anybody, and wash your hands,’” she says. “Then my friends came to school and I said, ‘There’s a flu going around!’ And they said, ‘Yeah, swine flu, 80 people got killed from it!’ And then I got really scared.”

Swine flu is not the first illness to have exacerbated Dina’s OCD. A water-contamination scare that hit Del Mar in November of last year frightened her. “I had to go somewhere with my mom. I was thirsty and she said to go drink some water,” Dina, who heard about the contamination from the news, recalls. “I said, ‘No, Mom, there’s contaminated water in Del Mar.’ And she said, ‘Dina, I’m going to drink it to show you.’ And so she drank it, and it got me really scared that she was going to die.”

Lori Riddle-Walker, Dina’s therapist, explains that this sort of thing is fairly common for those with obsessive-compulsive disorder, especially children. “That’s who it usually hits the worst,” she says, as she sits in her converted attic office in Escondido. “Back when we had that spinach [E. coli scare], I had some kids freaking out. They’ll stop eating spinach, then they don’t want to eat lettuce, and then anything that’s green, [then they] don’t want to go to restaurants... Usually it seems to affect the kids worse.”

Riddle-Walker, a marriage and family therapist, specializes in obsessive-compulsive disorder. She says, in the case of widely publicized illness scares, the most common symptom in children is the repetitive asking of questions. “Swine flu comes along and a child is asking every five minutes, ‘Am I going to get sick? Am I going to throw up? Do you think I’m going to get the swine flu? What are the symptoms of the swine flu? Do I need to wash my hands again?’” she explains.

For Dina, it is the continued media coverage of the swine flu that helps feed her fear. “The headlines always say ‘swine flu,’ and it scares me a lot,” she says, her orange-painted fingernails twisting her zipper pull. “[They] say ‘outbreaks in schools,’ and that makes me scared that it will be in [mine].”

When Dina began to feel as though she had a few of the listed symptoms, “I told my mom, ‘Mom, we have to go to the doctor!’” Dina recalls. “She [said,] ‘Dina, you’re just worrying about this because of OCD.’”

This reassurance served to calm Dina. Riddle-Walker uses a form of counseling designed to help sufferers safely confront their fears and has been doing this with Dina, who recalls one of Riddle-Walker’s techniques in which patients sketch out the center of their worries or phobias. “One time we drew a picture of barf,” Dina says. “And then, when I would drag my feet or have to step over certain things, we would go outside where there were lots of leaves and things where I could walk without worrying about it.”

After each activity, Riddle-Walker checks in with Dina and asks her, on a scale of one to ten, what her anxiety level is.

“Then we’d play a game or something and then she’d ask me again,” she continues. “Once [my anxiety level] was to one or three or two, then we’d go back outside and start over again. That was what she started with.”

“Usually,” Riddle-Walker comments, “the compulsions will be extra or excessive hand-washing, [and] avoiding places. Somebody told me they were avoiding restaurants in the first part of the scare. Sometimes, it will get really extreme and a person might start avoiding things that don’t really make any sense, like, say, because [the scare] started in Mexico, they might start avoiding the word ‘Mexico.’”

Dana Terrell, a licensed clinical social worker who specializes in a treatment method called eye movement desensitization and reprocessing, a therapy that is generally used to treat post-traumatic stress disorder, has also had patients react irrationally to what they perceive to be a threat. Though her patients know their fear is unfounded, it may feel very real to them and send them into a wave of anxiety. She offers the example of a man she treated who was cripplingly afraid of contracting AIDS. At a restaurant, this man became terrified he had contracted the disease by having a gay man wait on him. “Even though his rational mind knew there was no known case of any type of spread through that means — hand contact or having a hand on a plate or something like that — he was just obsessed it could happen,” Terrell says.

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.”