Obsessive Compulsive Disorder in a pandemic | MHT

Lockdown restrictions are beginning to ease but the threat of coronavirus lingers. Abi Crossland-Otter is a counsellor and writer who lives with Obessive Compulsive Disorder. Here she describes why renewed exposure to “the normal that was once just about doable” for the many who share her diagnosis is challenging but achievable. 

For some people living with Obsessive Compulsive Disorder, the rise of the COVID-19 pandemic may not have provoked as much distress as you might assume. Personally, I have always felt the presence of germs, to a point where I can almost visualise their transference. As a consequence, I have always felt the need to carry out the meticulous hygiene measures that many people have now introduced into their lives. Whilst contamination fear is just one facet of OCD, in the context of COVID-19, this is where its power will be most prevalent.

  • Explore everything you need to know about OCD in Mental Health Today’s new OCD information hub

So, whilst my behaviours or ‘compulsions’ have not changed with the arrival of this pandemic, my thoughts or ‘obsessions’ have. My fears have become real, which makes challenging the impulses harder. Luckily, I have learnt how to control my OCD to a limit that does not interfere with my daily functioning. But for those who have not yet reached this point, or for those who are coming face-to-face with OCD for the first time, the consequences of COVID-19 can feel utterly debilitating.

Concerns (obsessions) may include:

• Contamination fears
• Fears of putting others at risk
• Health anxiety about being particularly vulnerable

Whilst it is likely that people without OCD may be having these same worries, the difference is how they are responded to. People with OCD may feel compelled to perform behaviours (compulsions) to ease these worries, and even then the sense of anxiety may be prolonged indeterminably.

Compulsions may include:

• Excessively washing hands
• Consistently checking up on and seeking reassurance from loved ones
• Frequently disinfecting things you come into contact with
• Hoarding or collecting things
• Repeating prayer-like sentiments
• Avoiding particular places or people
• Compulsively watching the news and seeking information

There are three categories of individuals to consider during a pandemic:

1. Those currently recovering or dealing with an OCD that may be exasperated by additional worries and unhelpful compulsions that are now being encouraged by public health guidelines.

2. Those who have previously suffered with OCD, but feel they have since got it under control, but now feel the presence of intrusive thoughts returning and find ignoring these thoughts more difficult than ever.

3. Those who may be having these disturbing and difficult thoughts for the first time and not knowing how best to respond.

In all three cases, there is the possibility that through self-isolation, individuals will have become desensitised to things that they were previously able to manage. Now, as the lockdown restrictions begin to ease but the threat of COVID-19 still lingers, exposing ourselves to what was once normal, or for some just about doable, may seem a real challenge.

At its root, OCD is a disorder of control. Whilst self-isolating at home in our own shielded cocoons, we are able to exert a degree of control over our environment. We can keep it clean, adapt it to suit our needs, and limit our triggers. In the public sphere however, this may not be possible.

With this in mind, creating a safe haven at home where OCD urges may be kept at bay or responded to with compulsions may actually have the reverse desired effect in making the inevitable transition into the outside world more challenging. With people who cannot work at home now being asked to go to work, it is likely that a lot of people are experiencing this struggle and coming to terms with what may at first feel like some scary and uncomfortable changes.

  • See also: What is OCD?
  • See also: Video insight: What is Obsessive Compulsive Disorder?
  • See also: What are the signs and symptoms of OCD?
  • See also: Treatment and support
  • See also: I need urgent help

Another difficulty for individuals with, or developing OCD is the tendency to self-diagnose and obsess over physical sensations in the body that may be normal, or not actually there at all. This can lead to panic over believing they have COVID-19.

Though such fear may attach itself to individuals as they begin to increase their contact with others over the coming months, the exhausting and paralysing effects can be eased with understanding and action.

Challenge your behaviours

As Ashley Fulwood, CEO of OCD-UK says, “instead of implementing excessive strategies to prevent contracting coronavirus, start implementing practical short and long-term strategies to challenge your OCD”. For example, instead of excessively washing your hands, set a goal where you do it for 20-seconds and not a second longer. Whilst trying to quell troubling thoughts and impulses by performing a compulsion may feel like the correct thing to do to seek comfort, responding in this way is likely to only provide brief relief, instead reinforcing and fuelling the unwanted thoughts. Instead, it may be helpful to try to challenge your behaviours by differentiating between helpful and unhelpful worries. Ask yourself, is this behaviour helping to reduce the potential spread of the virus, or am I just doing it to ease my anxious thoughts?

Psychiatry professor Dr Steven Taylor emphasises the importance of “clear communication from leaders” in reducing uncertainty and anxiety. Whilst this seemed to be lacking at first, we now have access to a number of detailed guides that outline how to return to work safely, travel safely and more (GOV.UK).

Above all, for people with OCD or those who feel at risk of developing it, it is crucial to take the journey back to normality slowly. Whilst you may feel a pressure to get back to work or spend more time out of the house, it is important to make your mental health a priority by gradually reintroducing things. For many, the changes to come will need to be handled delicately. Whilst humans are remarkably resilient beings, and we will come back from this, for some it may be more of a gentle stroll and testing of the waters than the simple act of ‘bouncing back’.