OCD in Pandemic: Controlling the Uncontrollable 

By Wasim Rashid Kakroo

COVID-19 pandemic has hit the whole world very hard since February 2020, however, it has specifically put India into a catastrophe after its second wave emerged across various parts of India recently. As per recent reports (recorded on 28 April 2021), 17,988,637 cases of COVID 19 infections have been recorded so far since February 2020 out of which 201,165 have died.

With the start of the COVID-19 pandemic, a significant proportion of the world’s population has been exposed to multiple burdens, in addition to immediate hazards like the risk of infection as well as social isolation and economic insecurity. Based on the diathesis-stress model, that helps us to understand the development and maintenance of many mental disorders, these stresses may have an effect on people with previous history of mental disorders due to low resilience, fewer social contacts, and reduced psychiatric care. Thus, a rise in symptom severity may be assumed and one recent research has already noted; for instance, the prevalence of anxiety and depression increased from 4% in 2019 to 20% in 2020 in the Chinese general population. Besides depression and anxiety, an increase at the beginning of the COVID-19 pandemic has also been predicted for substance use disorders, eating disorders, and Obsessive Compulsive Disorder (OCD).

OCD is characterized by the presence of obsessions (which are unwanted and unpleasant thoughts, images, or urges) and/or compulsions (repetitive behaviors or mental rituals aimed at reducing the distress provoked by obsessions). Cleanliness, contamination, and fear of contracting a disease, which are topics of concern for patients with OCD, have now become a point of discussion of news channells and social media.

People with obsessive-compulsive disorder (OCD) experience persistent or recurring thoughts (called obsessions) that are disturbing and cause anxiety.

In order to deal with these intrusive thoughts and resultant anxiety, people with OCD may use compulsions.

Compulsions are repetitive physical behaviors or mental acts that a person feels they must do in order to resolve the anxiety. E.g., a person with contamination OCD may feel his hands have got contaminated after he touches some dusty surface. This thought comes to his mind again and again and he feels if he does not wash his hands immediately, it may lead to him getting infected by some germ and hence may get ill. These thoughts are thus obsessions and these obsessions make him feel anxious. In order to get rid of these intrusive thoughts, and the associated anxiety, he may get involved in excessive ritualized hand washing- a compulsion.

Since COVID-19 pandemic has increased the sense of insecurity with relation to health, it may trigger anxiety and repetitive behaviors for people with OCD, such as frequent hand-washing and repeatedly checking the news.

OCD fears common during COVID-19 pandemic:

OCD can show its presence in numerous ways, but during the COVID-19 pandemic, a person with OCD may find that some obsessions are more common than others.

The following sections will outline these in more detail.

Contamination:

It is one of the most common obsessions among people with OCD. Even during normal circumstances contamination obsession can be difficult to deal with, but during the COVID-19 pandemic, it may become even more challenging.

The real likelihood of contracting illness may cause people with OCD to take extreme steps to keep themselves and their families safe. This could include repetitive hand-washing, frequent bathing, frequent and excessive cleaning of surfaces, or being afraid to leave the home or stopping people to leave the home to an extreme level.

Harming others:

Person with OCD may worry a lot obsessively about harming others, either by accident or on purpose.

During a pandemic, people with OCD may obsessively think that they will transmit an illness to another person and hence they may go to extremes to try to avoid doing so by taking precautionary measures beyond what COVID related guidelines are suggesting.

Hoarding:

Researchers consider hoarding (urge to collect unimportant things unnecessarily), a separate disorder that is distinct from OCD. However, many people with OCD also engage in hoarding.

Usually, people with a hoarding disorder collect things that are not useful. However, during a pandemic, they may also hoard items such as medications, alcohol-based hand sanitizers, and toilet paper in quantity far beyond their consumption.

OCD triggers during a pandemic

There are several aspects of the COVID-19 pandemic that might trigger OCD-related fears and behaviors. These triggers include:

• the constant advice from government and non government agencies to wash the hands more often
• the constant advocacy and emphasis on proper hand-washing techniques
• the need to clean the hands every time a person returns home
• the constant advice to leave the home only when it is highly required such as for food and other necessities

These triggers may contribute to the following behaviors:

• widespread panic-shopping, which can lead to hoarding
• reminding family members to wash their hands regularly and, in several cases, forcing them to take showers several times a day
• obsessively looking for information about how long the virus will remain active on different surfaces.
• establishing a routine of excessive regular washing and bathing

People with OCD can become more depressed as a result of nationwide lockdowns, making it more difficult to cope with symptoms.

What is the way forward?

Usually people with anxiety are often under pressure to obey rules to the letter. As a consequence, an individual with OCD can struggle to distinguish between taking reasonable COVID-19 precautions and unreasonable or perfectionistic behavior.

As a clinical psychologist, I recommend that people with OCD create a safety plan based on official public health recommendations. People with OCD will know that they are taking good measures if they stick to the plan.

They should think about their cleaning and hygiene habits more consciously rather than obsessively. There is no need to disinfect anything if a person did not go outside or if no one entered their house. It’s a good idea to disinfect often used surfaces once a day.

People with contamination OCD should consider washing their hands with soap just for 20 seconds  (or sanitizer) and only:

• after going outside
• before eating
• after going to the washroom
• after coughing, sneezing, or blowing their nose
• before touching their mouth, face or nose

If a person with OCD finds it troublesome to determine whether or not their safety plan is appropriate, they may find it beneficial to ask someone else as a reference.

Coping with OCD during a pandemic

The following sections outline some other ways to cope with the OCD during a pandemic.

Limit news and social media:

During the COVID-19 pandemic, several news outlets are providing free live streaming and regularly publishing news alerts to ensure that everybody has access to information.

People with OCD may feel an urge to check the news excessively due to the amount of frequent updates in the news and on social media.

People who find that they are checking the news more than normal should set a limit for themselves. Setting a cap, such as just reading the news once a day, will help to reduce anxiety.

Such people should limit the number of news sources they use to find facts. They should limit themselves to a few reliable sources of information rather than consuming it from every possible outlet. 

Practice self-compassion

Many individuals, including those who did not have a preexisting mental health problem, have been terrified and stressed by the COVID-19 pandemic.

People with OCD should remind themselves that it is natural to feel stressed and that it is not their fault if their OCD symptoms worsen as it can help them feel better.

Self-care will assist people in focusing on what they can handle rather than the pandemic.

People who suffer from OCD or other anxiety disorders should keep socializing with their family and friends. Socializing can be difficult due to physical distance, but video chat apps can help avoid feelings of isolation.

Some other healthy coping behaviors they can use include:

1. Do regular physical exercise at home.
2. Do regular relaxation/meditation exercises
3. Take a balanced diet.
4. Maintain daily routine during waking hours.
5. Include indoor recreational activities to daily practice
6. Read inspirational books (including religious books and biographies of people who have endured tough times)), watch inspirational movies, talk over phone or video chat with people who have positive outlook about life even in these difficult times.

Seek online support and teletherapy:

To limit the spread of SARS-CoV-2, which is the virus that causes COVID-19, people may can choose teletherapy online or over the phone with a clinical psychologist/psychiatrist to deal with OCD and related co-morbidities.

Researchers have found that online modes of psychotherapy including (Cognitive Behavioral Therapy, CBT), (Acceptance and Commitment Therapy, ACT), Dialectical Behavior Therapy, DBT) etc. can be effective for people with OCD, and it allows more people to access help.

Researchers have reported that online/over phone psychotherapy can be a viable therapeutic choice for OCD, enabling people to learn various skills and techniques to deal with their OCD from the comfort of their own homes.

Conclusion:

Covid-19 pandemic has put a lot of challenges on humanity and almost all the areas of being human have got affected, most importantly mental health. While we are trying to deal with challenges in terms of infrastructure and medical facilities to those who are suffering because of Covid-19 infection, we should not ignore the mental health needs of people who have developed symptoms of various mental illnesses in post Covid-19 era or who were already battling with mental health issues such as OCD before the Covid-19 pandemics.

Views expressed in the article are the author’s own responsibility. These are for educational purposes only and are not a substitute for medical advice. 

The author is a Clinical Psychologist at IMHANS and can be reached at [email protected]

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