How O.C.D. and Hand-Washing and Coronavirus Collide

Exposure and response prevention therapy is the most effective treatment, experts say. It systematically tests a patient’s worries that something will harm them by exposing them in a prolonged, repetitive and intensifying system to things that they fear.

When the exposure doesn’t cause significant illness or harm, the patients can begin to learn how to better cope.

But the unusual and urgent focus on sanitation to fight the spread of the virus is also creating concerns for health care professionals involved in the treatment of O.C.D., said Bradley Riemann, a psychologist and the chief clinical officer of Rogers Behavioral Health, which has mental health and addiction treatment centers around the country. (Dr. Riemann is also the clinical director of Rogers’s O.C.D. Center, in Oconomowoc, Wis.)

That’s why providing treatment for O.C.D. right now is especially complicated. “This is clearly a time when we have had to change the way we interact with one another and the way we interact with our environment — it’s a matter of public safety for all of us,” Dr. Riemann said. “But it really collides with the world of O.C.D., and in particular with patients with contamination O.C.D.”

Usually, Dr. Riemann and his staff work with patients by asking them to interact with germs, increasingly extending the amounts of time between washing their hands or otherwise sanitizing. In some situations, he said, patients are asked to touch toilet seats or bathroom floors, and then are given food to eat before washing their hands.

“As you can see, the world we live in today, that collides head on with that kind of treatment intervention,” he said. “It has been very challenging to try to achieve a balance where you are keeping your staff and patients as safe as we all can be, yet still providing effective treatment.”

Is It OCD or an Anxiety Disorder? Considerations for Differential Diagnosis and Treatment

SPECIAL REPORT: OCD AND RELATED DISORDERS

OCD manifests as recurrent and persistent obsessive thoughts, and/or repetitive compulsive behaviors. The disorder affects about 2% of the population, with incidence peaks in both pre-adolescent children, and young adults.1 Anxiety disorders are the most common emotional difficulty for children, and in the in the US, 7.1% of children (aged 3-17 years) have been diagnosed with an anxiety disorder.2 This number increases when considering lifetime prevalence, and up to one-third of the population will suffer from an anxiety disorder at some point.3 OCD and anxiety disorders present differently from child to child, and it can be challenging to distinguish between the various anxiety disorders and OCD. While anxiety disorders and OCD are often comorbid, and have overlapping symptoms, there are some key distinguishing factors that lead to diagnostic clarity.4 Differentiating between these attributes can guide treatment choices and goals for OCD as well as non-OCD anxiety disorders.

Differential diagnosis

In 2013, DSM-5 separated OCD from anxiety disorders by creating a distinct category of Obsessive Compulsive and Related Disorders. While the diagnostic criteria spell out differences between the categories, phenotypically, the presentations of OCD and anxiety disorders, such as social anxiety disorder and specific phobias, can appear very similar.

DSM defines obsessions as “recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.” This marked anxiety or distress leads to an urge to complete compulsions. Patients often come in describing that they are “obsessing,” or having persistent thoughts, yet, these descriptions do not necessarily indicate the presence of OCD and may be indicative of ruminations or fears more consistent with an anxiety disorder.

Two helpful considerations when determining whether recurrent thoughts are obsessions as defined within the framework of OCD are the source of the threat and the nature of the thoughts as well as presence or absence of compulsive behaviors.

1. The Source of Threat and Nature of the Thoughts. The source of threat can help distinguish between the various anxiety disorders. According to DSM, the presence or absence of “non-real-life concerns” or content that is “odd, irrational, or of a seemingly magical nature” can often indicate OCD. DSM-5 added the possibility that an individual may not recognize that the beliefs are possibly untrue, and in this case, there is a specifier “with absent insight/delusional beliefs.”

2. Compulsive Behaviors. There are instances in which the obsessions are about something rational; however, in these cases, there are often rituals or compulsions that are not rational responses to the thought. While DSM 5 does not require that the individual recognize that the behaviors are irrational, the criteria still clearly states “these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive.”

Case Vignette

Max is terrified of vomiting. He avoids being near sick people and runs away when he hears that someone in his class has been ill.

Sarah is also terrified of vomiting. She engages in excessive and ritualized hand washing to prevent illness, and her hands are chapped and raw as a result. She counts the number of seconds she washes to make sure she feels that she has completed her cleaning task.

In a specific phobia, there may be recurrent thoughts about a specific topic or item. It may appear that these are “obsessions.” In both of these examples, we can consider that the source of threat—illness and vomiting—is the same. This is not a non‒real-life concern and the content is not odd, irrational, or of a seemingly magical nature. With Max, rituals are not present, and instead we see significant avoidance. Only Sarah presents with compulsions, which are not connected in a fully realistic way with the prevention of illness.

We can extend this example to other anxiety disorders: in a case of social anxiety disorder, the source of threat is judgement and evaluation from others. A person may have recurrent thoughts about this but typically engages in avoidance of these situations rather than in compulsive behaviors that are disconnected with the fear. In generalized anxiety disorder, a person is likely to have recurrent and persistent thoughts about a variety of things, yet these are categorized as ruminations. If the person has compulsions, then this may warrant a separate diagnosis of OCD (Table).

Case Vignette

Jamie is having recurring thoughts about harming herself and others. She is terrified to go near knives, for fear that she will hurt someone. She is extremely distressed about these thoughts and seeks reassurance to confirm that she has not hurt anyone from her mother multiple times a day.

Danielle has suffered from OCD symptoms for years. She is now presenting with significant symptoms of depression and is having thoughts about harming herself. She is distressed about the fact that she is having suicidal ideation and hates that she is having so much trouble finding a reason to live.

Both Jamie and Danielle present with thoughts about harming themselves, and in both cases, these thoughts are distressing. The differential that we are considering is whether these thoughts are intrusive thoughts consistent with OCD, or true suicidal ideation.

Intrusive thoughts are unwanted thoughts that a person does not agree with.5 The thoughts are most often incongruent and antithetical to the person’s values and true beliefs. Jamie is having thoughts about harming others even though she absolutely does not want to, and she is even horrified by the thought. A person may have thoughts about sexual interest in children, even though he or she are not interested in children sexually. These are intrusive thoughts, and the obsession and source of threat is “does the fact that I am having a thought mean something about me?” or “does the fact that I am having a thought mean something about my desires and what I may do in the future?”

The thoughts are taken as truth and are often interpreted as holding significant meaning about the individual. With intrusive thoughts, a person often does not understand why they are having these thoughts. The thoughts are ego-dystonic, and often the opposite of the individual’s desires.

Case Vignette

Jamie is having recurring thoughts about harming herself and others. She is terrified to go near knives, for fear that she will hurt someone. She is extremely distressed about these thoughts and seeks reassurance to confirm that she has not hurt anyone from her mother multiple times a day.

Danielle has suffered from OCD symptoms for years. She is now presenting with significant symptoms of depression and is having thoughts about harming herself. She is distressed about the fact that she is having suicidal ideation and hates that she is having so much trouble finding a reason to live.

In contrast, Danielle is distressed about her thoughts of harming herself, but she is further distressed because she has some ego-syntonic desire to harm herself. Fears may also be ego-syntonic. A fear of being stabbed by an intruder is consistent with what a person wants: a desire to prevent being stabbed. In many cases, this would be categorized as a fear, and may be consistent with a phobia or anxiety disorder.

Treatment strategies

In Jamie’s case, we would provide psychoeducation about intrusive thoughts and OCD, and then proceed to exposure and response prevention. We would have her face her obsession that her thoughts are meaningful by purposely thinking about harming people, while preventing any reassurance seeking and avoidance. We would also have her hold knives while thinking these thoughts. This would allow her to see that her thoughts are not dangerous, and do not reflect who she is or who she will become. She will learn that she can think the thought, and still not harm anyone. For Danielle, despite her significant history of OCD, we would address her primary concern of depression and suicidal ideation.

Case Vignette

Ben has a life-threatening allergy to nuts and is terrified of having a severe allergic reaction. Upon further assessment, Ben explains that he has stopped eating at restaurants, even when they are nut-free, and checks food labels multiple times, even on products that he has previously eaten. His mother discloses that, a few years ago, he washed his hands five times before each meal.

When it remains unclear whether a presentation is OCD or an anxiety disorder, it may be helpful to assess for other compulsive behaviors, past or present. Ben presents with fear of an allergic reaction, which could be a specific phobia. Upon further assessment, you find out that there are current checking behaviors that are irrational. Even if these were not present, the history of hand-washing compulsions is a strong indicator that Ben’s symptom presentation is likely consistent with a diagnosis of OCD (Figure).

When considering a course of treatment, it is helpful to conceptualize OCD separately from anxiety disorders, from both psychotherapeutic and medication perspectives. Anxiety disorders are treated with cognitive behavioral therapy (CBT), which includes exposure, facing fears and anxiety provoking situations. With anxiety disorders, this exercise revolves around facing the fears themselves. When treating OCD, this treatment element is part of exposure and response prevention.

Preventing a compulsion or compensatory behavior is essential. If a person completes exposures, but later engages in the compensatory behaviors, rituals, or compulsions, the individual learns that they are only okay because they completed the compensatory behavior. The impact of the exposure is diminished, and this reinforces the obsessive-compulsive cycle, rather than reducing it. For example, if a patient has OCD with contamination concerns, and he practices touching the floor throughout his session, but then goes home and scrubs his hands for 30 minutes, he only learns that he was able to tolerate the exposure because he was able to complete a compulsion. Treatment for OCD must include both the exposure AND the response prevention.

The first-line medications for both OCD and anxiety disorders are SSRIs. Additionally, for both OCD and anxiety disorders there is strong evidence for a combination of SSRIs and CBT as the most effective treatment.6,7 However, despite strong evidence of the effectiveness of SSRIs in the treatment of anxiety, the only FDA-approved medication for childhood anxiety disorders is the SNRI, duloxetine for treating generalized anxiety disorder.8 The evidence for the use of alternative medications including venlafaxine, buspirone, mirtazapine, tricyclic antidepressant, and benzodiazepine among others, is less compelling or negative.8,9

This is not the case for OCD; fluoxetine, sertraline, fluvoxamine, and clomipramine are all FDA-approved for the treatment of pediatric OCD giving clinicians numerous options before considering off-label treatments. When treating OCD with medication there are two additional major differences. OCD often requires high doses of SSRIs, doses that are not usually necessary for anxiety disorders. Moreover, OCD may take longer to respond to medications than anxiety disorders and so clinicians must prepare their patients for this and understand this before deciding to further titrate a patient’s dose of medication.

Differential diagnosis is also critical to medical decision-making as certain comorbid disorders (eg, tic disorders) may affect the choice and response to medications. For example, patients with co-occurring tic disorders and OCD may benefit more from off-label augmentation with an atypical antipsychotic than patients who do not have a tic disorder.

Conclusions

While it may be challenging to differentiate between OCD and other anxiety disorders, using a multi-informant assessment and understanding the content of a patient’s fears is a fundamental start to outlining an effective treatment plan. It is also important to consider that given the high comorbity between anxiety disorders and OCD, if a patient meets full criteria for both OCD and an anxiety disorder both diagnoses should be given.

Treatment approaches for anxiety disorders emphasize aspects of exposure treatment, and it is essential to include response prevention in the treatment of OCD. Maintaining an openness to the source of threat and presence of less typical symptoms as you assess and build rapport with a patient can aid in diagnostic clarity and provide a foundation to flexibly adapt treatment approaches.

COVID-19 creates unique mental health challenges

NOTE: I am not a mental health professional. The perspective shared below is entirely my own and is not intended to be authoritative. My goal in writing this is to reflect on one small aspect of what the world is currently experiencing.

The turmoil caused by COVID-19 confronts us with a unique set of mental health challenges.

Lately, I’ve noticed an uptick in news stories exploring how the pandemic affects people with anxiety disorders (panic disorder, phobia, obsessive-compulsive disorder [OCD], etc.); trauma-related conditions like post-traumatic stress disorder; eating disorders (anorexia, bulimia, etc.); and those who are either in recovery or struggling with an active addiction to alcohol or drugs. These subjects hit home for me, as I’m sure they do for many.

Mental health is public health, and we are in a public and mental health crisis.

It’s important to share, without fear, the impact of stress and discord on people both with and without an underlying mental health diagnosis. I think about one of my oldest friends, a lifelong addict who spent the last few years getting sober and rebuilding her career, as well as countless relationships. I wonder if she has what she needs to stay sober right now? It dawned on me that traditional twelve-step groups, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have had to abruptly disband and pivot to a virtual recovery approach—as if the general state of affairs isn’t enough to compel the average Joe to reach for something to take the edge off.

Unlike my friend, who stays sober by abstaining from drugs or alcohol, someone in recovery from anorexia or bulimia cannot simply abstain from food; he or she must confront daily the “problem” of eating, creating a challenging path to recovery, now compounded by a global pandemic that limits access to in-person therapy and outpatient care. Anorexia, the avoidance of and refusal to eat food, has the highest mortality rate of any mental illness, and can be especially dangerous during a time when we are asked to self-isolate and limit face-to-face contact. For someone with bulimia, a particularly insidious disease of bingeing and purging, the current frenzy of stockpiling and rationing food is likely to exacerbate existing binge-purge patterns.

For those with phobias, OCD or panic disorder, COVID-19 is simply adding new fuel to a pre-existing fire. Even for those without a clinical diagnosis, these are anxious times. I had my first coronavirus-related panic attack last Saturday: I half-woke up, reeling from a nightmare in which I was stranded and alone in Reagan National Airport. My chest was heavy and tight. I was hot—flushed, covered in sweat, definitely feverish. And then I was convinced, in the same way I’m sure many others have been: I have the coronavirus. I shoved a thermometer in my mouth, jumped into a cold shower, and started packing a hospital bag in my head. Three minutes later, as I was furiously brushing my teeth (who knows the next time I’ll get to use a toothbrush?), I caught my eyes in the mirror and thought: Maybe this is a panic attack.

So, what is being done to address this mental health crisis? Many mental health providers have switched to virtual or phone-based counseling platforms. The National Alliance for Mental Illness (NAMI) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have released toolkits on staying sane, healthy and sober during the COVID-19 outbreak. Wuhan opened a mental health hotline to help people under quarantine. New York, which has nearly 60,000 cases as of March 29, recently enlisted the help of 6,000 volunteers to launch a COVID-19 mental health hotline for its residents. Empower Work reported a 197 percent increase in calls from low-income workers and working single parents. Even Food Wine Magazine just posted a sobriety resource guide for hospitality and restaurant workers.

The COVID-19 outbreak is upending every aspect of our lives. We are shuttering businesses and livelihoods. We are losing loved ones.

Essential workers risk their lives to pick up our garbage and stock our shelves; a huge swath of our fellow citizens have been laid off; others navigate what working from home looks like, in many cases along with homeschooling, in an increasingly apocalyptic atmosphere. And, as with most disasters, poverty, systemic inequalities, and stigma compound trauma. We must practice patience, understanding, and grace as part of our collective obligation to reduce mental health stigma. Don’t be afraid to talk about things that are uncomfortable. Don’t think your problem isn’t deserving of airtime. Mental health is public health, and we are all in this together.

+++

The National Suicide Prevention Lifeline offers free and confidential support for people in distress, prevention and crisis resources for you or your loved ones. Call 1-800-273-TALK (8255).

For those with anxiety disorders, pandemic presents special challenge

At first, Jonathon Seidl wasn’t worried about the coronavirus despite his anxiety disorder. But that changed.

The 33-year-old digital media strategist from Dallas, who takes medication, said his concern was less about getting sick than about the battering the economy could sustain. Would he be able to feed his family? Would there be a run on food stores? He could not shake his worries.

So he paced. His heart raced. He wanted to go to bed early “because sleep was the only respite.” But his sleep was rarely restful. “I would wake up during the night,” he said.

The pandemic is worrisome enough for most people. For those with anxiety disorders, it presents a special challenge, especially if they are not receiving treatment.

That’s the case for about two-thirds of people with anxiety disorders, says Dr. Bruce Schwartz, president of the American Psychiatric Association. “Those are the ones I’m worried about,” he said.

Schwartz, who maintains a practice in New York, said those who are in treatment “do pretty well” in the face of the pandemic.

Still, some psychologists say the have noticed an uptick in symptoms with the spread of the virus. And for some anxiety conditions, the recommendations from health officials can appear to feed the problem. People who fear interacting with others now hear advice to avoid crowds. People with obsessive-compulsive disorder who fear germs so much they wash their hands excessively now hear public health authorities encouraging frequent hand-washing.

Standard treatments can deal with coronavirus fears in people who already had anxiety troubles, helping them to avoid emotional extremes, psychologists say. The goal is accepting an appropriate level of anxiety and living with some uncertainty.

“You don’t have to like that any of this is happening to accept that this is our reality right now,” said Vaile Wright, director of clinical research and quality at the American Psychological Association. People can focus on what’s under their control, she said, like how to work from home or manage the kids with schools closed.

Mary Alvord, a psychologist in Rockville, Maryland, said she sees increased anxiety in people whose fear of picking up germs drives them to rituals to ease that fear. Public health messages about cleaning surfaces and washing hands can make some patients think “we were right all along,” Alvord said.

So “we have to really deal with reality checks,” she said. People with an anxiety disorder tend to focus on “what-if” ideas and worst-case scenarios more than what is going on in the present, she said. “That’s what we’re trying to get under control.”

It’s tricky to get people with obsessive-compulsive behavior to focus on taking reasonable precautions without fueling their condition, said Neda Gould, associate director of an anxiety clinic at the Johns Hopkins Bayview Medical Center in Baltimore. A mental health provider can help them set goals and limits, she said, while techniques for relaxation and meditation can help “turn off that heightened anxiety or stress response … or at least to turn it down.”

Somebody with obsessive-compulsive disorder might be encouraged to touch some surface they fear is contaminated, and then not wash their hands for 20 minutes, and even then for only the recommended 20 seconds rather than five minutes with scalding-hot water, Wright said.

For people apprehensive about dealing with others, the public health advice about avoiding groups also makes therapy challenging, Gould said. The key thing is to stay connected to other people, and that can be done by social media, email, video conferencing or phone calls, she said.

Alvord, in fact, said she avoids the term “social distancing” and instead talks about “physical distancing and social connectedness.” That allows for connecting online, she said.

It can be hard for anxiety-prone people to reach out when they feel overwhelmed, Wright said, so other people should put in the effort to contact them, just to ask how they’re doing. “There’s nothing wrong in talking about the virus in a productive way,” encouraging people to take care of themselves physically and emotionally without inducing panic and destructive riffs of “what-if,” she said.

And it’s OK to contact friends and family “and talk not at all about the virus right now,” she said. “We need that too. We need a balance.”

Schwartz recommends that people staying home limit the amount of time spent listening to the news, which includes not leaving it on in the background. And he suggests staying busy with projects like cleaning closets and drawers and cooking with one’s family, as well as getting outdoors for walks.

Alvord, who directs 18 therapists in two offices, said her practice, like many others, has moved its patients to online contact. She noted that thousands of psychologists signed up for her recent webinar on practicing psychology remotely in the pandemic age.

In her case, the shift was promoted both by people anxious about showing up in person and the practice’s own precautions for a caseload that could land 50 people in a waiting room on a Saturday morning.

Research shows internet therapy can be as effective as doing in in person, Alvord said. But “it’s different than having somebody in the office,” she said. “I only see you from the waist up … I don’t see you walking. I don’t see all the full range of gestures.”

Gould said she recently moved all her sessions to telephone or videoconferencing, including group sessions. The goal is to help people like Seidl, who says he has found some solace in thinking about life after the outbreak.

“It’s one of the things that gives me hope,” he said, describing a point where his mind slows down and his heart stops racing. “There is so much relief, and there is so much rest.”

The Coronavirus Pandemic May Be Causing an Anxiety Pandemic

As the physical coronavirus pandemic continues to spread, an emotional pandemic is following fast in its wake. When the whole world is going to pieces, it’s awfully hard for the human mind—a fragile thing in the best of times—to cope, and more and more, doctors are reporting the spread of despair, worry and depression among their patients, especially those already suffering from some form of anxiety disorder.

Even before COVID-19 hit its shores, the U.S. was a clinically anxious place. According to the National Institute of Mental Health, just over 19% of all American adults will experience at least one anxiety disorder over any 12-month period. The fifth edition of the Diagnostic and Statistical Manual, the mental-health professionals’ bible, lists a dozen different anxiety and related conditions. Not all are likely to be especially affected by the COVID-19 pandemic, but a number are, especially obsessive-compulsive disorder (OCD), generalized anxiety disorder, social anxiety disorder, agoraphobia, acute stress disorder and separation anxiety disorder. Given that many around the world are being told by public health and political officials not to come within six feet of one another, this last one hits especially hard.

It’s too early in the coronavirus plague to know the exact extent to which anxiety disorders are on the rise, mostly because the clinical cases are lost in the much louder noise of the global panic. But anecdotally, at least, doctors are reporting both new anxieties among existing patients, and relapses among former ones. “We are seeing our clients who are prone to anxiety or depression or OCD experiencing more symptoms,” says psychologist Stefanie Sugar, a Manhattan-based practitioner.

“I’m seeing a lot of disappointment among patients,” says Chicago-based psychologist Patrick McGrath, head of clinical services for NOCD, a telemedicine site that provides online treatment with licensed practitioners for people suffering from OCD. “Someone with social anxiety disorder will say, ‘I was in the middle of treatment, I was just getting out and meeting people and this is setting me back.’”

As its name suggests generalized anxiety disorder (GAD) involves a pathological response to everyday challenges like worries over money, work deadlines, and parenting. For people with GAD, those common woes produce disabling pain, and coronavirus is surely having an impact.

“The worry becomes, ‘How do I pay my bills? What if I lose my job? What if I lose my car?’” McGrath says. “Anxiety disorders are based on two words: ‘What if,’ followed by the worst scenario your brain can devise.”

Related Stories

People living with post-traumatic-stress disorder (PTSD) are also feeling the impact of the coronavirus pandemic. PTSD patients live with a sort of chronic angst, and anxiety about one more mortal threat like COVID-19 can be more than they can bear. What’s more, social distancing denies PTSD patients one of their most effective therapeutic strategies: company. Detachment from family, friends, other relationships and previously pleasurable activities are all hallmarks of PTSD, according to the Mayo Clinic.

“Patients with PTSD can be isolated and often arrange for people to come by and check on them,” says McGrath. “Now no one is knocking on the door.”

People with OCD might be the most susceptible to the impact of a viral outbreak. The disorder by definition entails anxiety about germs, disease and social interactions. It’s that much harder to manage when the world tells you that, guess what, now is the time to feel that fear for real.

“The coronavirus situation is an awful recipe for some people,” says Sugar. “A core component of OCD is intolerance of uncertainty. It’s hard to know what news sources to trust, which numbers to trust.”

McGrath’s NOCD site is a leading indicator of the effect this is having. “We are currently treating 200 patients in individual sessions,” he says, “But the site includes a message board and 300 people have signed up a day in just the past few weeks.”

Others telemedicine psychotherapy services like BetterHelp and Talkspace are experiencing similar trends. “Talkspace has definitely seen an uptick in people seeking therapy—for both new and returning patients,” wrote a company spokesperson in an email to TIME. “Since mid-February Talkspace’s user volume is up around 65%.”

The usual strategies for managing anxiety disorders in general and OCD in particular don’t really work in the midst of the pandemic when hand washing and avoiding crowds are two central pillars of controlling the spread of the virus. But one more tool that can be aggressively used even now involves patients writing down their feared scenario, and regularly re-reading what they’ve written. In the case of corona it can seem exceedingly counterintuitive for the GAD patient to write the words, “Yes, I’m about to lose my job and my home” or for the OCD sufferer to write “I indeed contracted the virus from the cashier who gave me change and I’ve fatally infected my grandmother too.” But reading the words several times a day can strip them of their power.

“They’re brutal scripts to write,” says Sugar, “and they’re tremendously effective.”

As the pandemic rages, words like “tremendously effective” are tremendously welcome, no matter what part of the crisis they address. The human mind is not the principal target of the virus, but it can be very much a collateral casualty. Like all of the other such casualties of the crisis—the struggling businesses and the reeling economy and the shuttered schools—it can recover too.

The Coronavirus Brief. Everything you need to know about the global spread of COVID-19

Write to Jeffrey Kluger at jeffrey.kluger@time.com.

They already had an anxiety disorder. Now comes a pandemic.

NEW YORK — At first, Jonathon Seidl wasn’t worried about the coronavirus despite his anxiety disorder. But that changed.

The 33-year-old digital media strategist from Dallas, who takes medication, said his concern was less about getting sick than about the battering the economy could sustain. Would he be able to feed his family? Would there be a run on food stores? He could not shake his worries.

So he paced. His heart raced. He wanted to go to bed early “because sleep was the only respite.” But his sleep was rarely restful. “I would wake up during the night,” he said.

The pandemic is worrisome enough for most people. For those with anxiety disorders, it presents a special challenge, especially if they are not receiving treatment.

That’s the case for about two-thirds of people with anxiety disorders, says Dr. Bruce Schwartz, president of the American Psychiatric Association. “Those are the ones I’m worried about,” he said.

Schwartz, who maintains a practice in New York, said those who are in treatment “do pretty well” in the face of the pandemic.

Still, some psychologists say the have noticed an uptick in symptoms with the spread of the virus. And for some anxiety conditions, the recommendations from health officials can appear to feed the problem. People who fear interacting with others now hear advice to avoid crowds. People with obsessive-compulsive disorder who fear germs so much they wash their hands excessively now hear public health authorities encouraging frequent hand-washing.

Standard treatments can deal with coronavirus fears in people who already had anxiety troubles, helping them to avoid emotional extremes, psychologists say. The goal is accepting an appropriate level of anxiety and living with some uncertainty.

“You don’t have to like that any of this is happening to accept that this is our reality right now,” said Vaile Wright, director of clinical research and quality at the American Psychological Association. People can focus on what’s under their control, she said, like how to work from home or manage the kids with schools closed.

Mary Alvord, a psychologist in Rockville, Maryland, said she sees increased anxiety in people whose fear of picking up germs drives them to rituals to ease that fear. Public health messages about cleaning surfaces and washing hands can make some patients think “we were right all along,” Alvord said.

So “we have to really deal with reality checks,” she said. People with an anxiety disorder tend to focus on “what-if” ideas and worst-case scenarios more than what is going on in the present, she said. “That’s what we’re trying to get under control.”

It’s tricky to get people with obsessive-compulsive behaviour to focus on taking reasonable precautions without fueling their condition, said Neda Gould, associate director of an anxiety clinic at the Johns Hopkins Bayview Medical Center in Baltimore. A mental health provider can help them set goals and limits, she said, while techniques for relaxation and meditation can help “turn off that heightened anxiety or stress response … or at least to turn it down.”

Somebody with obsessive-compulsive disorder might be encouraged to touch some surface they fear is contaminated, and then not wash their hands for 20 minutes, and even then for only the recommended 20 seconds rather than five minutes with scalding-hot water, Wright said.

For people apprehensive about dealing with others, the public health advice about avoiding groups also makes therapy challenging, Gould said. The key thing is to stay connected to other people, and that can be done by social media, email, video conferencing or phone calls, she said.

Alvord, in fact, said she avoids the term “social distancing” and instead talks about “physical distancing and social connectedness.” That allows for connecting online, she said.

It can be hard for anxiety-prone people to reach out when they feel overwhelmed, Wright said, so other people should put in the effort to contact them, just to ask how they’re doing. “There’s nothing wrong in talking about the virus in a productive way,” encouraging people to take care of themselves physically and emotionally without inducing panic and destructive riffs of “what-if,” she said.

And it’s OK to contact friends and family “and talk not at all about the virus right now,” she said. “We need that too. We need a balance.”

Schwartz recommends that people staying home limit the amount of time spent listening to the news, which includes not leaving it on in the background. And he suggests staying busy with projects like cleaning closets and drawers and cooking with one’s family, as well as getting outdoors for walks.

Alvord, who directs 18 therapists in two offices, said her practice, like many others, has moved its patients to online contact. She noted that thousands of psychologists signed up for her recent webinar on practicing psychology remotely in the pandemic age.

In her case, the shift was promoted both by people anxious about showing up in person and the practice’s own precautions for a caseload that could land 50 people in a waiting room on a Saturday morning.

Research shows internet therapy can be as effective as doing in in person, Alvord said. But “it’s different than having somebody in the office,” she said. “I only see you from the waist up … I don’t see you walking. I don’t see all the full range of gestures.”

Gould said she recently moved all her sessions to telephone or videoconferencing, including group sessions. The goal is to help people like Seidl, who says he has found some solace in thinking about life after the outbreak.

“It’s one of the things that gives me hope,” he said, describing a point where his mind slows down and his heart stops racing. “There is so much relief, and there is so much rest.”

___

Marshall Ritzel in New York contributed to this report.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Malcolm Ritter, The Associated Press

Coronavirus

OCD, the Coronavirus Freakout, and Me

You get home from work and walk through the door. Your house is the Zone of Least Contamination, and the outside world is the Zone of Full Contamination. All day long you’ve been forced to interact with keyboards, doorknobs, subway poles, and handshakes. You’ve stood in the same air as strangers, cringing in agony as sloughed off skin cells and droplets of spittle fly off their bodies and into your shared space. If you live in a densely populated city, you’ve been forced to press your body up close to theirs and breathe in shared, stale air.

This is a normal day if you have Obsessive Compulsive Disorder like I do, a disease that’s still widely misunderstood and parodied in culture. Now imagine those painful, intrusive thoughts—every cell in your body feeling swollen with contagion, the crushing fear that if you don’t spend three hours decontaminating yourself and your house you’ll actually die—compounded by the coronavirus pandemic, which seems like the ultimate validation of all your obsessive tendencies.

What exactly happens to the obsessive-compulsive mind in the midst of a global pandemic, when a fear of germs and contamination suddenly seems perfectly rational? As of March 20, more than 244,000 cases of novel coronavirus have been reported worldwide, and at least 10,000 people have died. In Italy, which has the largest outbreak outside of China, the entire country is on lockdown, all shops and venues have closed, and prison revolts are breaking out across the region, as incarcerated people recognize the unique threat they face living in close quarters, with deeply uneven access to quality medical care. In the U.S., markets are in freefall, a national emergency has been declared, and even Broadway theaters have gone dark. UNESCO estimates that around 776 million students across the globe are currently out of school because of the virus. Even for someone without OCD, this kind of a public health crisis is impossible (and inadvisable!) to ignore—life as we know it has fundamentally changed.

What exactly happens to the obsessive-compulsive mind in the midst of a global pandemic?

But for folks with abnormally high levels of serotonin reuptake and a hyperactive amygdala, our threat-detection meter is malfunctioning constantly. Upsetting thoughts are paired with cognitive alarm bells, dousing your body in fear, anxiety, and adrenaline. Your system gets used to this feedback loop and starts to equate your thoughts and fears with actual danger. Next thing you know, the thought, What if that doorknob had coronavirus on it? becomes I just got coronavirus and now I’m going to die. And with the 24-hour news cycle blaring desperate pleas to “wash your hands, wash your hands, WASH YOUR HANDS!!” the idea of getting a handle on that harmful feedback loop becomes even more impossible.

Unsurprisingly, the coronavirus panic has hit people with OCD especially hard. “The disorder is going to become exacerbated in every sense,” Dr. Robert Lancer, a psychologist and co-founder of the New York Center for OCD and Related Anxiety Disorders, told ELLE.com. “Folks with OCD are very vulnerable to the power of suggestion, so hearing that hand sanitizer is selling out and seeing people wearing masks in public is going to trigger their need to compulsively purify.”

Teenaged Boy Washing His Hands

Nadia*, a 16 year old in Alberta suffering from OCD, described how intense her fear has gotten amid the outbreak. “I freak out every time I touch my face, constantly ask for reassurance. I don’t leave my house on the weekends anymore and I was crying every morning before school. I forgot my lotion at home one day and washed my hands to the point that they felt like sandpaper.”

It’s difficult for Nadia to escape her triggers, especially on social media. “Twitter news has played a huge part in my panic and got me scared about it in the first place. When anyone talks about it my mind starts going crazy.”

Smith, a 26 year old who lives in New York, said they’ve been “shocked” by how much the pandemic has affected them. “I’m on medication for my OCD and I had it relatively under control before this started, but now it has constructed real barriers to my ability to function in the city. The stress is making it hard to focus on work; I’m more isolated and more reluctant to participate in anything at all.”

Lancer described this slow retreat into total isolation as inevitable. “The more they avoid, the more the threshold is raised on what could be contaminated,” he explained. “The need to avoid is more and more…but avoidance is, in and of itself, a compulsion. The more they give in to that compulsion, the more extreme it will get.” Now that so many Americans are on self-imposed quarantine, or at home due to school and work closures, this avoidance feels justified.

Although scientists say that decontamination and avoidance practices are our best bets for flattening the curve of infection, the rhetoric of intensified hand washing, surface sanitization, and social isolation runs directly counter to OCD therapeutic recommendations. Cognitive Behavioral Therapy, one of the most common and effective treatments available in treating OCD, requires patients to break the ritual behaviors associated with their contamination obsessions. This usually involves a complete moratorium on all non-essential behavior associated with the compulsive rituals.

So for someone like Nadia, who is trying to break her ritualized hand-washing, a public health crisis acts as license to immerse herself fully in the behavior that holds her mind captive. She’s now up to 60-plus hand washes in a seven hour period.

“I feel like it makes people with contamination OCD compulsions seem more valid, which results in us feeling a lot more inclined to agree with the intrusive thoughts rather than fighting them,” she said.

“I’m more isolated and more reluctant to participate in anything at all.”

John, a 47 year old man living in the UK, agreed that the constant (but warranted) surge of messaging urging him to decontaminate has been detrimental to his mental health.

“The irrationality of the condition feels more rational now,” he said. “The compulsions feel more justified. Any psychological progress I’ve made has been wiped out.”

As an OCD sufferer myself, my heart goes out to our anxious little community as we try to navigate an unprecedented global disaster. It’s scary enough to be living through this time with a normal relationship to dirt and germs, and I’m sure there are even folks out there who do not suffer from OCD who have still descended into full paranoid germaphobia.

The actual illness isn’t even the only concern that could affect our mental health. The economic realities we’re all facing—as layoffs begin and industry after industry is hobbled or shuts down—leaves freelancers, independent contractors, gig workers, small businesses, and day laborers vulnerable to a partial or complete loss of income, with no expectation of if or when their job could come back. It’s enough to drive anyone insane with worry.

But to those of us whose amygdalas were screaming out in terror even before this all started, my advice is this: Listen to the incoming guidelines and restrictions and follow standard hygienic protocol. But please, for the love of God, stay off of social media, news outlets, and message boards. I know the compulsion to check in on the minute-by-minute feed is gnawing on the back of your brain stem at all times, but the best thing you can do for yourself is only read the completely relevant updates.

“There’s so much misinformation out there,” Lancer also said. “Don’t seek that information out compulsively; if you have OCD, you already aren’t thinking about it rationally, and all that doubt and uncertainty over what to believe is going to override your ability to have a safe and reasonable response.”

Instead, check in with your therapist about establishing a baseline acceptable standard for virus-limiting decontamination practices, and otherwise continue your work to limit compulsive behavior. And if you can’t afford therapy (well hey, wouldn’t now be a great time for Medicare for All?), here are some great resources to check out. Community support is the greatest balm to the soul in times of extreme alienation; and if we know OCD, we know its primary goal is to alienate us inside our own minds. Solidarity to my squeaky clean community.

How COVID-19 Is Deepening Anxiety Disorders

BUENOS AIRES — The situation is extreme. It’s an economic, social and a healthcare crisis that exempts nobody and will leave its mark on all. It is a global emergency. And even in the coolest of heads, anxiety is creeping in as people struggle to navigate these uncertain times.

So far, those with the emotional tools to manage their feelings are riding the wave of events without succumbing to undue fear or disproportionate concern. But for those who struggleD with anxiety even before the epidemic, people who had trouble leaving their homes even in the best of times, or hypochondriacs who struggle against a constant obsession with disease, the coronavirus has become a double threat. It may or may not attack their physical health, but is most definitely harming their emotional state.

“The generalized stress this pandemic is generating has resulted in a 20% relapse rate,” says Gabriela Martínez Castro, head of the Argentine Center for Specialized Studies in Anxiety Disorders (CEETA).

Like other mental health professionals in Argentina, Castro says there’s been an uptick in recent weeks in patients seeking help. Many people being treated for anxiety disorders and phobias and who were gradually recovering are now relapsing, she explains. And what’s triggering them, the specialist adds, are the restrictions being put in place.

“Many patients have become much worse, to the point of provoking symptoms again, in spite of the progress we were making,” she says.

Gustavo Bustamante, president of the Phobia Club Foundation, says that among patients who already had a phobic framework or specific disorders like Generalized Anxiety Disorder (GAD) or Obsessive Compulsive Disorder (OCD), panic attacks or agoraphobia, anxiety levels have risen considerably.

“These are people who were already stressed about money and the pandemic’s consequences,” he says. “Even before the government began issuing guidelines, most of my patients had abandoned their daily routines and were in self-confinement. Some had to move up their appointments or seek closer attention, as the level of anxiety and worry the illness is generating is making them feel vulnerable.”

Virtual platforms have become essential in providing emotional support. “We are implementing a strategy to give them support through online services,” Bustamante says. Among other things, his foundation is offering more after-hours or night night consultations.

The Argentine anxiety disorder center has also adopted remote consultations for those who need them most. Patients are being encouraged to continue their therapies, says Martínez Castro. “Not only are they not stopping but we have people who are consulting more than once a week,” she adds.

OCD patients with cleaning-related rituals are convinced their longstanding fears were not baseless after all.

Specialists say that for patients with GAD and OCD and forms of hypochondria, behavior patterns are now even more intense. Rossana Speranza of the Argentine Association of Anxiety Disorders (AATA), says patients “overestimate the level of danger.” People overly concerned about health show a “heightened observation of the general state of the body, and you have to work to make sure they won’t go to night pharmacies,” she adds. “With OCD, patients with cleaning-related rituals boost this kind of behavior, convinced that their longstanding fears were not baseless after all.”

Susana Dagos, a 63-year-old podologist and agoraphobic, is familiar with a lot of this conduct. She had managed, since 2012, to control her fear leaving her home. She’d been attending workshops and even managed to travel abroad. She was “well enough,” she says. But with the pandemic, she’s struggling once again.

“There is fear, which is what makes the phobia reappear,” she says. “I decided not to travel on public transport. I took the precaution two weeks ago. I don’t want to be with people all packed together… I’m much more afraid.”

Liliana Traber, coordinator of the Trauma and Anxiety clinic at INECO, a public research body, points out that there are different kinds of fears and phobias, and that to treat them it’s important to distinguish one from the other. “Fearing the illness or its contagion is not the same as being really worried about the future, about what will happen with the economy, for example, or your family,” she says.

What many patients have in a common is a fear of death — of their own death and the death of others. And the panic over the pandemic, says Martínez Castro, “can arouse and trigger latent disorders, as it can work as an unleashing factor.”

Bustamante of the Phobia Club says the coronavirus outbreak will also impact people who hadn’t previously sought mental health advice. He says there is precedent for this in Argentina, where there 2001 financial crisis prompted a 300% increase in therapy visits. For many, he says, the trauma of the crash soon became a “constant worry” about falling into poverty that “became chronic, and changed the way daily lives developed.”

The pandemic will have a similar effect, Bustamante says. “It will alter many habits in society generally,” he adds. “And many people who previously had no history of mental illnesses or disorders, or thought they were less at risk, will from also be living in a heightened state of alarm.”


See more from Coronavirus here

Fighting fear

Even in times of social distancing, isolation, and quarantine, a lot of us are keeping our spirits up by singing, dancing, cooking, and making up hilarious Corona memes. However, there is a small, yet significant section of people that is not laughing. The spread of the pandemic has meant something very different to them.

“These are troubling times for people who live with contamination obsessions,” says Dr C J John, chief psychiatrist of Medical Trust Hospital. Since the Corona outbreak, he has seen a couple of people who were in a state of panic. The viral outbreak could trigger irrational fears in those who have mild to severe contamination obsessions and washing compulsions. “It may exacerbate the condition in a few patients,” says Dr John.

Those who are predisposed to obsessive compulsive disorder (OCD) or have illness anxiety are at a higher risk of being affected by the fear caused by the spread of the virus. OCD is defined as a mental disorder in which a person has recurring, unwanted thoughts, ideas or sensations (obsessions) that make him or her feel driven to do something repetitively (compulsions). The repetitive behaviour, such as hand washing, checking on things, or cleaning, can significantly interfere with the person’s daily activities and social interactions, according to the DSM 5 (Diagnostic Statistical Manual of Mental Disorders) of the American Psychiatric Association.

While awareness and information are vital, there is a literal “infodemic” (an information pandemic) that is adversely affecting people with anxiety disorders, says Dr John. “A lot of the information passed around on social media may be authentic, however, this information overload could prove distressing to patients who keep tracking news compulsively, worsening their condition.”

Mental health experts suggest that those with pre-existing emotional disorders such as health anxiety and depression, those being treated for OCD or anxiety, and those who are experiencing distress, seek medical help. If you have a family member who has OCD, help them by regulating the flow of information at home, and by avoiding real-time tracking of the news.

However, the situation, says Dr John, is also an opportunity to trace signs of obsessive disorders in a loved one. “Even to remove contamination by a deadly virus such as Corona, you need to wash your hands only for 20 seconds.” If you or someone close to you is doing this more than necessary, do check in with a psychologist.

Coronavirus is a ‘personal nightmare’ for people with OCD and anxiety disorders

Sarah Mergens showed signs of obsessive-compulsive disorder long before she was diagnosed with it as an adult. It initially took the shape of harmless quirks, like organizing dinosaur toys by shape and color. More debilitating symptoms crept in as she got older, such as being afraid of public doorknobs or worrying that she’d use a bad egg when baking and cause someone she loves to become ill.

As an adult, Mergens, 27, held her OCD symptoms at bay through exposure and response prevention therapy, supportive friends and family and internal pep talks. Then COVID-19, the disease caused by the coronavirus, began to spread and threatened to set her back on the progress she’s made in convincing herself that her fear of circulating an illness is overblown. The virus, she said, is her “personal nightmare.”

“I can’t think of another event that’s hit me like this has,” said Mergens, a psychotherapist who lives in the Minneapolis area. “Suddenly everything that I told myself again and again until I believed it was true is in direct contradiction to what my boss, the government and the community were telling me.”

Her thoughts became an endless stream of “what ifs.” What would happen if she was quarantined? Will she contract the virus? Could someone she cares about die after getting the virus from her? When she washes her hands hourly or disinfects her entire office each day, she tells herself: “This is from the outside. This is not a Sarah thing. This is not OCD. This is necessary.” But it doesn’t stop her racing thoughts, and she worries that her extra vigilance will be hard to shake.

“I’m afraid that I’m going to want to continue those when the crisis is over,” Mergens said of her constant hand-washing and sanitizing, “and as a result, really take steps back in my progress.”

Unlike anything they’ve seen before

Over 2 million Americans are estimated to be affected by OCD, according to the Anxiety and Depression Association of America. Nearly 7 million people in the U.S. are affected by generalized anxiety disorder and about 6 million by panic disorder. While the concern about the COVID-19 pandemic has upended the lives of Americans from all walks of life, interviews with people with mental health issues — including anxiety, bipolar disorder, OCD and panic disorder — as well as counselors who are treating them, reflect a particular chaos the virus has caused.

Many people with these disorders are going through a wave of similar emotions and thoughts. They fear getting someone else sick, even if they aren’t showing symptoms. Those who already keep hand sanitizer and disinfectant with them at all times suddenly can’t find those products at stores thanks to panic shoppers. Some behold the irony that their daily routine of hyper-cleanliness is suddenly everyone else’s reality, while others feel thrown off by the government’s telling them that to prevent coronavirus spread, they need to do all the excessive cleaning and isolating that they’ve previously tried not to do to control their mental health disorders.

Full coverage of the coronavirus outbreak

As more events, schools and services have been canceled, the nonprofit Crisis Text Line saw an increase in people reaching out for help because of the coronavirus, the intervention hotline said Monday. As of March 13, COVID-19 was mentioned in 15 percent of all conversations on the Crisis Text Line. On Reddit, forums for people with OCD are full of users sharing memes related to COVID-19 and their community, describing how social distancing is giving them more time to worry and asking for support with the fear that has taken hold of them.

Mental health counselors say the wave of anxiety sweeping their patients in clinics is unlike anything they’ve seen before.

“This one is so broad, and you know everyone is being exposed to this particular fear — I think it’s unraveling lots of folks,” said Reid Wilson, director of the Anxiety Disorders Treatment Center of Durham and Chapel Hill, North Carolina.

One of Wilson’s OCD clients nearly canceled an appointment because they were concerned they had touched their nose too much and could give the coronavirus to Wilson, he said. Another, with generalized anxiety disorder, couldn’t stop worrying about whether their daughter traveling from another country was at risk.

“Uncertainty is the basis of all anxiety disorders, so in some ways, COVID-19 has set a fire to the foundation of anxiety,” said Christina Maxwell, a counselor at the Anxiety Treatment Center of Greater Chicago.

Maxwell said every patient she’s seen in the past few weeks has had anxiety related to COVID-19. She’s also received calls from people who have never struggled with anxiety before but are now having difficulty coping with work or school changes, loss of income or being in close proximity to an estranged spouse for a long period of time.

“The concerns are numerous and severe,” Maxwell said.

‘Your normal has become everyone else’s normal’

For Tam Sanders, 28, a Cincinnati resident, it’s not the virus that makes her afraid; “it’s other people’s hysteria and panic that makes me most anxious.”

“Suddenly everyone is like you. Suddenly everyone feels they need disinfecting wipes and hand sanitizer as much as you feel you do, every single day of your life,” Sanders said. “Your normal has become everyone else’s normal.”

A 24-year-old transgender man with social anxiety and panic disorder living in Hollywood, Florida, who has spent the past couple weeks trying to replenish their hand sanitizer, had a similar sentiment.

“I think most people without anxiety issues don’t understand that for us with anxiety disorders, this fear everyone’s feeling is our everyday life,” said the man, who asked that their name not be published to protect their privacy. “If there’s anything to take away from this terrible virus, it’s that people finally understand how some of us feel every single day.”

Molly Grace Larson, 20, a student at the University of Wisconsin-Eau Claire who has been treated for panic disorder and OCD, said seeing panic buyers clear the shelves exacerbated her stress and made it more difficult for her to compartmentalize. She’s become more neurotic about washing her hands lately, she said.

“It makes me feel like I’m not doing enough,” Larson said. “Maybe I should be buying hand sanitizer in bulk. But I don’t know — nobody really knows how best to respond to this kind of crisis.”

Download the NBC News app for full coverage of the coronavirus outbreak

Faryl Zaklin, 48, who lives in San Diego, said she started canceling appointments and workouts in early March to mentally prepare herself for social distancing before businesses began closing, even though that meant depriving herself of tools she uses to manage her OCD. She worries that the fallout from COVID-19 could upend her progress, turning her back into a chronic hand-washer who often uses disposable gloves and struggles to leave the house.

“What’s more scary to me is having an OCD relapse — that’s worse than my fear of getting this virus,” Zaklin said.

The most effective behavioral forms of treatment of obsessive-compulsive disorder include exposure, response prevention and cognitive therapy, which require people to go through what they’re most afraid of to realize that their fears are unfounded. So if people feel they must wash their hands every time they touch a door handle, this treatment would help lead them to see that nothing bad will happen if they don’t. However, that isn’t necessarily true right now.

“When everyone else comes on TV and starts saying ‘wash your hands as often as you can,'” Wilson said, “that’s opening that door for people with the disorders to give up their routines.”

Wilson said he’s offering similar advice to clients as he always has, encouraging them to set up rules they can follow, such as how often they’ll allow themselves to clean their homes or when they’ll wash their hands without impeding daily life.

“These worries pop up in your head, and you can’t control that,” Wilson said, “but you can control what you do next.”

What is it like to have an anxiety disorder in the time of coronavirus? My worst nightmare come to life

 

When I was 12, and my only worries should have been whether or not I made the netball A team, I became convinced I was going to die of Aids.

I saw germs everywhere: on the seats of the Tube and the tables at school and in the air that I breathed. So I washed my hands. I washed my hands so hard, so regularly, that they began to crack open and bleed, my fingers like those of a bare-knuckle boxer, not a girl who had just started secondary school.

The Christmas holidays arrived and I temporarily breathed a sigh of relief: now I did not have to leave the house. But into the vacuum left by one worry, a new one quickly appeared: what if I already had this infectious illness, and was going to give it to my family?

I locked myself in my room, hid my toothbrush under my pillow, began chanting phrases I hoped would keep them alive. Every day, I imagined the death that would come from the physical illness I was so sure I had. I did not know that the actual illness I had was mental, and quite common: Obsessive Compulsive Disorder (OCD).

OCD is, according to the World Health Organisation (ironically), one of the most debilitating illnesses to live with. I am lucky enough that through endless treatment I now, over 25 years on, can right-size my OCD without it disrupting my life too much.

But I have been thinking of all the people out there who might be experiencing it now – perhaps for the first time, perhaps not – in light of the march of Covid-19. OCD tends to attach itself to modern panics – when I was 12, the Aids crisis was reaching its tragic peak – and it is almost inevitable that currently, some people are as tempted to self-isolate because of symptoms of mental illness as they are because of symptoms of physical illness.

I cannot recall, in my life, a more anxious or extraordinary time, bar perhaps the terrorist attacks of the nineties and early noughties. But then the cause of the fear had the face of an enemy – of the IRA or al-Qaeda – and now its face is that of anyone that this novel coronavirus has the ability to infect – which is, as we are realising, everyone. Loved ones, friends, colleagues – we are all vectors for disease.

I wanted to write my column this week about the effect that coronavirus will have on people’s mental health, because in recent weeks I have favoured making light of the situation, and today I think it’s important to acknowledge the gravity of what is facing us, and how everyone is feeling. Humour can be an effective way for people to manage fear, but it often hides… well, fear. This is the greatest public health crisis of our generation, as the Prime Minister said on Thursday. But we should not forget the toll this will take on mental as well as physical health. 

My best friend is a nurse who has been unfailingly pragmatic about the coronavirus – until this week, when the briefings started to change and the ICUs started to be marked for Covid-19. She told me she was scared, and that she felt bad for feeling scared, as if experiencing emotions was a negative thing for a healthcare professional to do.

I don’t want to be accused of stoking fear,  but I do think it’s really important to say that it is ok to feel fear, that it is ok to be scared, that if you feel panicked you are not somehow letting down your country and your people. The British stiff-upper-lip mentality of keeping calm and carrying has officially been dispensed with, following advice from the country’s Chief Medical Officer to stay indoors if you experience even mild symptoms of disease. You do not need to keep buggering on. You can stop. You can be.

But I do think it is really important that, if you are forced to self-isolate, you continue to connect, through phonecalls, Skype and WhatsApp. Anxiety thrives in the quarantine of a person’s head and, most of all, during times of uncertainty. Schedule regular calls with friends and family. Talk about the way you are feeling. But try not to make the way you are feeling the only thing you talk about – maybe start a book club, or agree to binge-watch something on Netflix.

Remember that, however scared and anxious you are feeling, you are not alone in this. This is a very ordinary human reaction to an extraordinary global event – and, like everything that has gone before it in history, it too shall pass.

 

 

 

The coronavirus pandemic takes heavy toll on people dealing with OCD

Chicago – Chicago-area clinical psychologist Karen Cassiday estimates that three-quarters of her patients in recent therapy sessions described heightened anxiety stemming from the coronavirus epidemic. Other clients have been texting her questions ignited by fears related to the new disease.

Should I come to my appointment or just call in, to avoid being out in public and limit possible exposure?

I bought 10 pounds of rice in case of a quarantine, but I heard others are buying 50 pounds of rice. Should I buy more rice?

While health experts say the risk of contracting the new coronavirus locally remains relatively low, the swirl of news over outbreaks — and the ensuing public reaction — has taken a particularly heavy toll on the mental health of some who have obsessive-compulsive disorder and other anxiety illnesses.

“It’s tripping the wire for many different people,” said Cassiday, owner of the Anxiety Treatment Center of Greater Chicago and former president of the Anxiety and Depression Association of America.

She said patients triggered the most by the recent epidemic tend to fall into three categories: Those with illness anxiety disorder, what was formerly known as hypochondriasis; those with contamination OCD, a subtype of the disorder marked by a fear of germs or sickness; and those with generalized anxiety disorder, an overall pervasive and excessive worry over numerous things.

Cassiday says she’s found the level of panic over the coronavirus to be much higher compared with other recent health scares such as the SARS outbreak of 2003, the 2009 surge in H1N1 cases or the 2014 Ebola crisis in West Africa. She says the reaction has been more akin to fear at the height of the HIV epidemic in the 1980s, which she attributes to the unknown nature of both viruses when they first emerged.

Medical providers and infectious disease experts are still grappling with so many questions about coronavirus: What is the source of the epidemic? Will a vaccine be discovered? Will the outbreak worsen or quell, and when?

“The thing that makes the coronavirus difficult for people with anxiety is the level of uncertainty,” she said. “We know that when there’s uncertainty, then people with anxiety disorders try and narrow down the field of uncertainly to assume the worst-case scenario.”

Social media provides a glimpse at how some are coping with anxiety symptoms in the wake of the coronavirus outbreak, which originated in Wuhan, China and has sickened tens of thousands across the globe. While far fewer coronavirus cases have been reported in the U.S. compared with other countries overseas — and seven have been confirmed in Illinois — the Centers for Disease Control and Prevention has warned American communities to prepare for the disease’s likely eventual spread.

“I wash my hands so much that my hands are dry and even start bleeding sometimes,” said one woman on Twitter. “The coronavirus outbreak definitely isn’t helping. OCD is an anxiety disorder, and I think some people fail to realize that mentally, we’re likely to be affected most out of everyone else.”

“My mum has general anxiety disorder and is terrified of the coronavirus,” read another tweet. “She 100% believes this is the end of mankind. (It’s) heartbreaking to see her like this.”

“As someone recovering from OCD after a few years now, I feel as though OCD is trying to spike like there is no tomorrow,” said another woman on Facebook, “and I’ve been struggling to figure out what is OCD and what is just a normal response.”

Anxiety disorders affect some 40 million adults in the United States, according to the Anxiety and Depression Association of America. The International OCD Foundation estimates that about 2 million to 3 million adults nationwide have some form of OCD, a particular anxiety disorder characterized by a cycle of distressing obsessions and compulsions. One OCD subtype centers on contamination fears, which often spur compulsive hand-washing, disinfecting, avoiding contact with perceived contaminants, and other unhealthy coping mechanisms.

Stephen Smith, 26, of Northbrook described his struggle with OCD and severe, intrusive thoughts, which developed when he was in college years ago.

“It feels like you’re literally in prison in your own mind,” Smith said.

He then sought treatment and found relief through exposure and response prevention therapy – repeatedly facing the source of the fear without engaging in compulsions, rituals, avoidance or other unhealthy coping mechanisms. The experience inspired him to launch a mobile treatment platform called NOCD, which connects the user to an OCD-trained therapist and offers treatment via live video appointments.

“If you have OCD, you’re not alone,” said Smith, who doesn’t have contamination fears and hasn’t experienced heightened distress due to coronavirus. “There’s millions of people out there who suffer but also get better once they get access to effective treatment.”

Psychologist Patrick McGrath, head of clinical services for NOCD, cautions the public against trivializing OCD in the kinds of jokes or offhand comments that tend to become more frequent during health epidemics.

“OCD is not a joke,” said McGrath, a member of the Scientific and Clinical Advisory Board of the International OCD Foundation. “It’s not something that’s funny. For people who do have OCD, when they hear people say things like ‘I have a little OCD’ it shows that they don’t understand what the person with OCD is really suffering with.”

Cassiday advises those who are distressed by anxiety symptoms to follow CDC and local health department guidelines, but not to check those sources to excess or take more precautions than recommended. Those with anxiety disorders might feel the urge to go further — more protections, more hand-washing, more avoidance, more assurance-seeking — but these behaviors create a cycle of fear and ultimately exacerbate anxiety, she said.

If social media or news sources become overwhelming, taking a brief break is all right; seek therapy if worries over the health epidemic impair daily routines or the ability to go out in public, Cassiday said.

“Don’t just white-knuckle your way through this outbreak,” she said.

Another coping strategy, she added, is to focus on the positive: Locally, medical providers say the risk of contracting coronavirus is low, the nation has a robust health system, and the United States had more advance notice of the virus than many other countries.

“If someone can view this as practice managing the inevitable uncertainty of life, this can be a really productive situation,” she said. “The only way to live with peace inside your heart is to accept this uncertainty and to live well in the present moment.”