When COVID-19 health measures and obsessive-compulsive disorder collide during pandemic

While we all need to continue practising public-health recommendations as the COVID-19 pandemic continues, those very actions—hand washing, avoiding touching things in public, sanitizing and cleaning surfaces—may appear similar to those performed by people with obsessive-compulsive disorder (OCD).

There are, however, significant differences between the two activities.

In a phone interview, psychologist Maureen Whittal, who cofounded Vancouver-based Anxiety Canada in 1999 and is an expert in cognitive behavioural therapy, explained the difference between someone being vigilant and someone with OCD.

According to Anxiety Canada, people with OCD may experience obsessive thoughts about self-doubt or harming others that create anxiety or distress, or they may have compulsions to engage in deliberate actions—including repeated checking of things like switches and plugs, arranging objects in specific orders, or unnecessary hoarding—to prevent something terrible from happening.

Where hygienic behaviour crosses the line depends on the reason or intent behind the behaviour, Whittal explained, particularly when people rely heavily upon “internal cues of anxiety to guide behaviour” instead of because of being advised to do so. In other words, people with OCD tend to base their actions upon emotion or what feels right instead of facts and objective logic.

For instance, Whittal said, they may be saying to themselves: “if I feel anxious, something must be dangerous, so I’ve got to do something to keep myself safe.” They may even repeat the hand washing, say, if they didn’t feel it was thorough enough.

So the actions of people with OCD are attempts to prevent a feared consequence. But underlying the fear, Whittal explained, is a specific negative belief about themselves, such as “I’m not good enough” or “I’m an awful person” if they make a mistake. If the “bad thing” doesn’t happen, she said, they may feel that their actions were successful and their behaviour may become reinforced.

Interestingly, Whittal said, most of those with OCD are aware that what they’re doing doesn’t make sense, but they will often have an ongoing feeling of doubt and “a mixing up of knowing and certainty”. A person with OCD who is asked, for example, if they locked their door after leaving home would have to be 100-percent certain to answer “yes”.

OCD occurs in about one to two percent of the population, and Whittal said she has seen heightened severity of the disorder during the pandemic due to increased stress.

She said she began speaking about COVID-19 to people with OCD in February, and many of them became more anxious in March due to future uncertainty. The lockdown, she said, was actually easier for them because the rules were clear, but when restrictions were loosened and public-health officials began saying “use your judgment”, Whittal said, “that’s a tough place for someone with OCD”.

Whittal tells people with OCD that public-health messages aren’t meant for people who are already responsible like themselves but are “meant for people who need that reminder”.

“It’s not uncommon for folks with OCD to have incredible amounts of responsibility and feeling like, ‘It’s my job to protect other people,’ and, of course, that’s what public health has been telling us,” she said.

She also advises people with OCD to reduce searches for COVID-19 information and to limit such data to those from primary or reputable sources—such as the B.C. Centre for Disease Control or Health Canada—while avoiding blogs or unestablished sources. Those seeking more information about OCD can visit the Anxiety Canada website, which has a specific section on anxiety during the pandemic.