In the past, I have written extensively about obsessive-compulsive disorder, its many manifestations and the psychological underpinnings of the illness. OCD is often misrepresented in popular culture, simplified to a disorder of cleanliness or orderliness, while neglecting the anxiety and depression that often occurs simultaneously. OCD can also latch onto subjects that have nothing to do with “being neat”— ask anyone who suffers from intrusive thoughts about harming other people or becoming a pedophile (yes, these themes are real).
The COVID-19 pandemic illustrates just how variable the disorder is across the board of sufferers: Some have been afflicted severely, tormented because their greatest fear has finally come to fruition. Others, not so much—because the classic manifestation of OCD as a disorder of germaphobes often fails to accurately represent the many worries which plague a sufferer daily.
“For some, it may exacerbate their symptoms, especially if their symptoms or obsessions are in line with contamination or getting sick or fear of being responsible for harm coming to others through potentially passing the virus on to someone else,” said Nathaniel Van Kirk, Ph.D., who serves as coordinator of Clinical Assessment for McLean Hospital’s OCD Institute. “I’ve talked to many people with OCD who have said they don’t feel overly concerned with COVID-19. It’s not one of the things they worry about, and it pales in comparison to some of the other worries that they may have.”
Indeed, Van Kirk raises an interesting point about how OCD during the age of the coronavirus pandemic can cause seemingly unrelated fears to “adapt” to the current stressors- such as with those who struggle with perfectionism or harming others as their main themes. The International OCD Foundation touched on some of these manifestations and how to best approach them in an article from earlier this year.
“Be mindful that your OCD may take advantage of COVID-19 fears by telling you that you might have infected someone or that you are going to infect someone in the future, whether accidentally or on purpose,” the article said. “Remind yourself that no one can protect themselves ‘perfectly’ from COVID-19, and no one expects you to. Times like these call for using your common sense instead of going to perfectionistic extremes.”
““Remind yourself that no one can protect themselves ‘perfectly’ from COVID-19, and no one expects you to. Times like these call for using your common sense instead of going to perfectionistic extremes.”Extracted from the article by the International OCD Foundation
A woman by the name of Carli, who spoke with Scientific American in June about her OCD, said she is having difficulty distinguishing what is a normal stress reaction to COVID-19 and what is her OCD, making the situation all the more debilitating.
“The compulsions in my head have definitely gotten worse, but in terms of wearing a mask and cleaning my groceries and going into stores, it’s really hard to gauge what is a normal reaction and what is my OCD,” Carli said. “I try to ask people, ‘Are you doing this? Are you doing that?’”
However, Carli has found solace in the convenience and safety of telehealth, which allows her to speak to her therapist via video conference without the added stress of venturing out to a medical office for help where the risk of contamination is increased significantly. Telehealth also allows medical professionals to gain a better understanding of how OCD presents itself in a sufferer’s day-to-day life.
“I never want to go back to actually being in a therapist’s office,” Carli said. “Therapy is something that’s really uncomfortable for a lot of people, including me. And to be able to be on my own turf makes me feel a little more powerful.”
Reid Wilson, Ph.D., is a clinical psychologist who directs the Anxiety Disorders Treatment Center in Chapel Hill and Durham, North Carolina. He has written extensively for Psychology Today, and seeks to help those with OCD distinguish between a “signal” and “noise” when coping with the pandemic and trying to find a healthy balance.
“Signals are worries that are deserving of our attention and prompt us to take meaningful action,” Wilson said. “For instance, in the midst of the COVID-19 pandemic, if we go for a run and return home, our worries might motivate us to go straight to the bathroom and wash our hands for 20 seconds with soap and water, just as the World Health Organization suggests.”
“Signals are worries that are deserving of our attention and prompt us to take meaningful action. For instance, in the midst of the COVID-19 pandemic, if we go for a run and return home, our worries might motivate us to go straight to the bathroom and wash our hands for 20 seconds with soap and water, just as the World Health Organization suggests.”Reid Wilson, PH.D in Clinical Psychology
Noise, on the other hand, represents the accumulation of anxiety a sufferer might still feel after completing a basic health guideline, and this “push” to continue to perform certain actions is almost never rooted in facts or logic, Wilson said.
“Now, let’s say I wash my hands thoroughly, just as instructed, and then my worries prompt me to wash them again five minutes later. If I’ve been at home, and I haven’t come into contact with anything that might be contaminated, then we can reasonably label this worry as ‘noise,’” Wilson said. “Noise refers to those repetitious, unproductive thoughts that create further doubt and distress. Noisy worries are not useful or worth listening to. Noise is static.”
If there is no tangible or reasonable way to solve an issue at hand, it likely falls into the category of “noise,” and with help from therapists and other mental health professionals, those suffering from OCD can navigate ways to cope and filter out the excess worry (although it is easier said than done!)
“When you hear worries that you believe are signals (‘Oh no, I think I touched the grocery cart without sanitizing it first.’), you should take actions that help you resolve that problem (‘I’ll ask an employee if there’s a customer bathroom or some hand sanitizer I can use,’” Wilson said. “On the other hand, if that worry pops up and sounds like noise (‘What if the hand sanitizer is contaminated, too?!’), then that means you can’t solve it. No solution exists. You can dismiss this pesky worry, treat it as noise, and return to your task.”
The Department of Psychiatry at the University of Michigan devised guidelines earlier this year for those suffering with OCD to help them keep their symptoms in check while practicing good hygiene and safe measures. The guidelines include a safety plan, social media limitations and encouragement towards physical activity.
The safety plan should be created in collaboration with your therapist or support group, and should include the general WHO directions for maintaining your health during the pandemic. These guidelines include washing your hands for 20 seconds with soap and water before/after eating, after going in a public space and after blowing your nose and sneezing. They also include disinfecting frequently touched surfaces only up to twice a day and maintaining six feet of social distance when out and about. Past that, the safety plan should remain unchanged as to avoid tweaking and room for compulsions.
“If you struggle with contamination fears, this safety plan may help relieve some anxiety over how extensive your routine for protecting against COVID-19 truly needs to be,” the article said. “If you would like to do more than this or you find yourself repeatedly adding more to this list, pick a person who can help you decide what are rational safety measures for you to follow.”
“If you would like to do more than this or you find yourself repeatedly adding more to this list, pick a person who can help you decide what are rational safety measures for you to follow.”Extracted from the article by the Department of Psychiatry at the University of Michigan
Social media limitations are intended to allow for enough time for the sufferer to garner any new information about the coronavirus pandemic while not overloading on news which could possibly worsen the anxiety the patient is feeling—once again emphasizing the need for balance.
“Spend 5-10 minutes a day gathering new information on COVID-19. That should be enough information to stay up to date on protective measures and social isolation guidelines,” the article said. “Setting a time limit will help prevent your OCD from taking over and getting hooked on learning all there is to know about COVID-19. Decreasing exposure to stressful content will also help reduce fears that could worsen OCD behaviors.”