OCD impacts 1.6 of all adults and 1-3 percent of all children. During stress, OCD seems to act up.The choice of obsessions is different and unique for each person. For some, germs and contamination become of a focus of anxiety. Therefore, the pandemic is a likely trigger for some OCD sufferers. This webpage will discuss some of what we currently know about Covid-19 related OCD.
Interestingly, many therapists have found that their anxious and OCD clients haven't reacted dramatically to COVID-19. Although some have had an upswing in anxiety, some haven't. There is also no evidence that rates of OCD have increased during past pandemics. Among my clients who have had an uptick in OCD symptoms, they aren't all Covid-19 related. There is tremendous variation.
OCD related COVID 19 has the same features as run of the mill OCD. It is unique in that the clinicians who are treating it, and the rest of the world, are also experiencing some of the same symptoms of anxiety and dealing with uncertainty. It is more difficulty to differentiate Covid 19 related OCD from other strains of OCD because some of the symptoms are normal reactions to the pandemic.
OCD may manifest itself in the form of fear of illness or fear of contamination. OCD sufferers who have this flavor of OCD engage in cleaning compulsions and hand washing. It is time consuming and distressing and causes significant impairment. The WHO hand washing guidelines immediately made me worry for my OCD clients.
How do we know if behaviors are normal reactions to the pandemic or OCD behaviors? The answer is, it can be challenging to do this. I've attempted to highlight some of the key differences below.
Intolerance of uncertainty (IOU) is a feature of OCD very much present in COVID- 19 related OCD. But the pandemic is replete with uncertainty and unknowns that make it difficult for the average person to cope.
Questions intelligent people have been grappling with all center around these kinds of uncertainty. Should we wear masks? How can we become infected? How can we transmit it? Can we get it from food? How long does it live on surfaces?Are we taking the right approach? Too excessive or not careful enough? For most of us, this uncertainty is uncomfortable , but it is unbearable for someone with germ or illness flavored OCD.
The unknowable questions do not torture the average person in the same way it does and OCD sufferer.
Ritualized guidelines trigger OCD
Government guidelines around hand washing and social distancing are stringent and ritualized. They almost have an OCD feel about them. How can someone who suffers from OCD determine what is acceptable and what is OCD? This is a challenge.
Inflated responsibility another OCD trigger.
People with OCD may suffer from the EXAGGERATED belief that one can bring about adverse outcomes for others and is responsible for preventing those adverse outcomes.
Yet this is another issue that average citizens are grappling with during the pandemic. We realize suddenly that we have a tremendous sense of responsibility to our neighbors and we are all interconnected. This is what has ignited the debate over masks, social distancing and lock downs that have closed business and schools.
It's clear to see here how OCD issues are overlapping with the real issues Covid 19 are bringing up.
There may be some distinctions between COVID-19 related OCD and normal thoughts and behaviors.
Distorted sense of agency
People with OCD may assume that if they have an intrusive thought or fear about someone getting COVID 19, then they are responsible for preventing that person from getting it. This is dubbed "distorted concepts of agency". This is not present in people who don't have OCD.
Thought event fusion and magical thinking
People with OCD may believe they have the power to cause Covid-19 by just thinking about it or that they have the actual ability to predict whether someone gets it.
People who don't have a mental illness or OCD do not usually suffer from this kind of thinking.
Fears of transfer
Fear of transfer refers to the idea that if I have an intrusive thought it can actually transfer properties onto another object or person. People without OCD do not have this kind of fear.
Perception of risk are over estimations.
People with OCD are likely to overestimate the perceptions of risk in most situations. This is a tricky one because most of us without OCD struggle with knowing what the actual risk is of catching COVID-19 is. Lets just say we LIKELY don't struggle with this thought error to the same extent. This is still a gray area .
People with OCD are likely to engage in dramatically increased safety-seeking and avoidance behavior. You may have noticed during the pandemic that people have a range of behaviors of safety. Generally we just have to accept this about people ( to a certain extent). Some are more or less comfortable with levels of risk. For example, some may go to the grocery store and some may order their groceries. People who have COVID-19 related OCD will be extreme in their perception of risk behavior. They may squirt down every surface with disinfectant multiple times far beyond what the guidelines suggest is safe.
People with OCD want absolute certainty that they have taken the proper precautions.
This will often led to repetitive compulsions and checking behaviors. They will also adopt different criteria for when to stop washing their hands or using sanitizer than what is prescribed. For example it has to feel right rather than the 20 second rule.
People with OCD make severe attempts to remove contamination.
They may use special products to clean and engage in repeated checking.
They may mentally check and retrace and review who they were in contact with and repeatedly ask for reassurances that you or they were safe or don't have COVID-19.
Agoraphobia may be the only way to achieve certainty so they may refuse to leave their house, get their mail or open their door for any reason.
Lock down will include severe disruption of routine financial and interpersonal stress and limited access to protective factors. This may lead to depression which can in turn lead to an increase in OCD symptoms.
Families of those with OCD might report increased anxiety tension and conflict due to accommodating and stress.
People with COVID-19 related OCD will likely follow internal guidelines set by OCD such as ( feeling just right) whereas those without OCD will wash their hands in response to government guidelines.
People with COVID-19 related OCD will wash hands in response to and obsession or a trigger or a preoccupation with a trigger rather than an actual time they need to.
People with COVID-19 related OCD will follow guidelines that are set by their OCD in a ritualized or rigid way they will be uncomfortable or upset when they cannot do it. I've included the WHO GUIDELINES beneath this paragraph to help assist in determining what might some behaviors set by OCD.
People with COVID-19 related may have time limited methods for their rituals and information seeking that are excessive.The checking is dictated by their ocd.
They may also frequently engage in reassurance seeking.
People with COVID-19 related OCD may be repeatedly consult with medical professionals and this assurance wont last, they will also likely consult with multiple medical professional
People with COVID-19 related OCD may become reclusive to the point that it impairs their job ( if it is safe for them to work) Some jobs are not safe.
Treatment of COVID-19 related OCD
The article I read suggested that when the therapist and client are planning treatment, they carefully consider the risk factors. The knowledge we have about the virus is continually changing, as is our ability to deliver treatment safely, but addressing thought patterns above can often creatively be addressed.
Treatment will bring it's own challenges
COVID-19 related OCD references
Home. (n.d.). Retrieved August 12, 2020, from https://www.who.int/
Jassi, A., Shahriyarmolki, K., Taylor, T., Peile, L., Challacombe, F., Clark, B., & Veale, D. (2020). OCD and COVID-19: A new frontier. The Cognitive Behaviour Therapist, 13. doi:10.1017/s1754470x20000318
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Medical information obtained from this website is not intended as a substitute for professional care. If you have or suspect you have a problem, you should consult a healthcare provider.