COVID AND OCD

Have I been right all along!?

“I’m following the guidelines!” exclaims a person who has recently started to spend many hours of the day at the sink, and much of the remaining time disinfecting other surfaces.   Their chapped hands look like they have aged a decade since the pandemic has begun. In the last few years they had made some progress and had stopped taking a UV wand with them to disinfect anything they encountered beyond their doorstep.  They had finally managed to feel some sense of hard-won mastery over their debilitating symptoms.

They have had an understandable resurgence of symptoms since the pandemic, and they are not alone.  COVID and OCD, especially OCD that is manifested by contamination fears, is tough.  The current situation is terrifying. There are pervasive messages from credible resources reinforcing behaviours that were once recognized as maladaptive and something to be worked on.    Anyone listening to the news is being asked to adopt more vigorous hand washing, maintain a social distance and there’s even a protocol for sanitizing our groceries. www.youtube.com/watch?v=sjDuwc9KBps&feature=youtu.be

There is some reinforcement that not only should you be engaging in these behaviours that you have tried hard to temper, but also that everyone else should too!  You might be tempted to monitor or control other people’s behaviours, which can potentially cause interpersonal problems during this already stressful time. It is also plausible that this pandemic could induce OCD symptoms in people who have not suffered from this disorder before.

What defines a compulsive behaviour rather than
an adaptive one during the pandemic? How to determine the boundaries between being
careful, conscientious and prepared vs. compulsive and dysfunctional?   

Sometimes, that line feels blurry when we are encouraged to sterilize everything, open doors with elbows, and stay 6 feet away from others.  And frankly, considering that we are trying to flatten the curve, vigilance IS important.  I am absolutely NOT arguing that we should not be vigilant. In fact, we must.

Extreme fears or beliefs related to OCD are easier to detect; e.g., that air particles within a kilometer of a hospital will infect you; or  you start to think that the only way to decontaminate yourself is to burn you belonging in a bonfire in the backyard. 

In the absence of some of these more severe manifestations, however, it might now be hard to distinguish OCD from adaptive instincts to protect yourself and your family.  Some features suggestive of maladaptive fears and behaviours include:

• Intrusive and recurring thoughts and urges that seriously compromise your ability to function, take up much of your day, and feel almost impossible to ignore.
• You engage in repeated compulsions to manage your anxiety, beyond what is recommended by medical professionals; furthermore, these behaviours cause significant distress or impairment. For example, you might be using harsh cleaning solutions on your body or scrubbing yourself raw.  (Incidentally, there is evidence to support that excessive handwashing can remove good bacteria, lead to breakdown of the skin, and actually make people more prone to infection.)

 How to cope?  

This is not an exhaustive list and for more debilitating OCD, therapy combined with medication [often Luvox or Zoloft] is standard treatment. But some basic suggestions include:

• Offer yourself some self-compassion.  These are scary times and it is no wonder that your symptoms are back or magnified.   Finding the right balance between being conscientious and responding appropriately and suffering and engaging is compulsions is tougher to find than usual.
• Consider being transparent with loved ones so that they can offer you some compassion and cultivate a deeper understand of your struggles.
• Limit the amount of news.  While it is important to be aware of what is going on, and things are changing quite rapidly, there is a law of diminishing returns when you are spending the day white-knuckling the sanitized remote.  In fact, doing so can exacerbate your symptoms.
• Consider updating yourself in the morning and in the evening.  (You can ask a loved one to give you a lunch time briefing if there is something imperative to know.)
• OCD is a type of anxiety disorder, so consider engaging in behaviours that biologically downregulate your anxiety; e.g., meditation, exercise.
• Try to develop some structure and normalcy and routine during quarantine.
• Acknowledge your intrusive thoughts but consider that you do not have to attend to the content, nor must you engage in the ritual behaviour.
• Be aware of actual recommendations by experts and try your best to follow but not greatly exceed these guidelines. The Centre for Disease Control has a set of helpful tips. https://www.cdc.gov/coronavirus/2019-ncov/prepare/cleaning-disinfection.html
• Do not be ashamed to ask for professional help.  Often cognitive behavioural therapies + medication are most effective in treating this condition.  Psychologists, psychotherapists, and social workers are up and running and have moved practice to telehealth so help is there.