By: Syeda Ammara Bukhari
OCD (Obsessive complexion disorder) is a mental illness. It is composed of two parts: obsession and compulsions. Some people experience obsession and compulsion and some experience both which causes distress among them.
Obsessions are unwanted thoughts which causes anxiety. These thoughts can be uncomfortable. Basically obsessions are not thoughts on which a person will focus on, nor they are the person’s character. Whereas Compulsions are the action which reduce anxiety caused by obsession. These actions can be washing, cleaning or arranging things in perfect order.
COVID-19 pandemic has caused distress among whole world. After COVID-19 was declared a pandemic by WHO, it resulted in extraordinary precautionary measurements i.e quarantine, self-isolation and social distancing. These measures were imposed globally to reduce the risk of infection. But these measures caused many serious psychological problems in people around the world. The main reasons for these problems were loneliness, reduced social interaction, seperation from the loved ones and loss of freedom.
The psychopathological consequences of the pandemic and quarantine were anticipated to be of particular relevance, especially in patients with psychiatric disorders such as Obsessive Compulsive Disorder (OCD). Studies conducted in italian patients show they were more frequently found to experience suicidal ideation and attempt, increased Internet checking, sleep disturbances, avoidance behaviors, and work difficulties. A significantly increased need of therapy adjustment and family accommodation was also observed. Further research is warranted to clarify the potential risk and related consequences of the current COVID-19 pandemic on OCD patients.
The pandemic has increased anxiety and stress in the general population, but when it comes to people with mental illnesses such as obsessive compulsive disorder, this stress can considerably worsen their symptoms. Due to the characteristics of the pandemic and the recommended disinfection measures, those with contamination OCD may be more likely to obsess about cleanliness and sanitization, both of themselves and the place where they live. Another of the most common types of OCD is an obsession with potential harm, which means that those affected have an excessive fear that something very negative will happen to their loved ones, and they will be responsible. These two types of OCD could be particularly affected during the COVID-19 pandemic. When a person with OCD is receiving psychological treatment for their condition, it should ideally include what is known as ‘exposure with response prevention’, in other words, facing the situations that produce fear and ceasing the compulsions or rituals. This can be complicated during this period, but there are some guidelines that can be useful, for example separating the cleaning behaviours recommended to protect against the virus, which are healthy, from the excessive behaviours that are part of OCD. It is very likely that certain obsessions with contamination or cleaning behaviours have increased during this period.
As a general guide, you should wash your hands with soap and water for around 20 seconds if you have left the house, or if you have been in contact with people from outside. If you have not left the house, you should limit the number of times you wash your hands. If you are unsure, you can do it only at certain times, such as before and after eating, or after sneezing or blowing your nose. It is also important to follow the advice to wash your hands for 20 seconds, but not for any longer. If this is difficult, you can ask someone close to you to tell you when 20 seconds is up.
One of the other hygiene measures recommended during this period is disinfecting certain surfaces in the home. In the case of people with contamination OCD, they should try to only clean the surfaces that are regularly in contact with the hands. If the surfaces are not in contact with the hands, or if you haven’t left the house and nobody has entered, this should be avoided. This disinfection should not take more than a few minutes a day.
The significance of negative thoughts about the coronavirus during this period should be highlighted. You shouldn’t force yourself to not think about the coronavirus, as this can have the opposite effect and make you think of it more often.
It is preferable to accept that you will have these thoughts, let them come, and then allow them to disappear after a while. Nor should you avoid receiving information related to COVID-19, because this is very difficult and will probably make you even more attentive. It is, however, recommended that you dedicate a maximum of 10 minutes a day to the topic.
Finally, if the person with OCD feels that their general anxiety and stress levels have increased due to lockdown, they can do physical exercise, or try relaxation and
breathing techniques. The key is to do this regularly, at least once a day. Furthermore, it may also be very useful to request help from family members or friends who have similar problems, even if you have to communicate via telephone or internet.
Although the frequency of mental disorders is expected to increase during pandemics,1 the peculiarities of the COVID-19 pandemic can directly impact the clinical course of obsessive compulsive-disorder (OCD), a condition that affects approximately 3% of the general population.OCD is characterized by the presence of obsessions (which are unwanted and unpleasant thoughts, images, or urges) and/or compulsions (repetitive behaviors or mental rituals aimed at reducing the distress provoked by obsessions). Cleanliness, contamination, and fear of contracting a disease, which are topics of concern for patients with OCD, have now become a central theme of news and social media. Thus, we would like to elaborate on some possible implications of the COVID-19 pandemic for both diagnosis and clinical decision making about OCD.
According to the current biopsychosocial model of psychiatric disorders, sociocultural, biological, and psychological factors interact synergistically to determine the onset of different disorders. These factors include the patient’s beliefs and behaviors, which may be influenced by historical and environmental
changes.Diagnostic classification systems, including the DSM-5 and ICD-11, include the core symptoms of disorders, as well as the level of distress experienced by patients and the impact of symptoms on functioning. Frequent handwashing, which was previously considered excessive and one of the most common symptoms of OCD, have now been normalized. Currently, considering time-consuming cleaning rituals as a single symptom seems insufficient to diagnose OCD. In such cases, clinical reasoning should counterbalance the degree of protection these rituals produce with their level of interference in functioning. Such reasoning is required to confirm an OCD diagnosis or consider treatment changes for those already on medication or in cognitive-behavioral therapy.
Patients may experience a worsening of OCD symptoms in different dimensions, including, but not limited to, contamination/cleaning, aggression, and hoarding dimensions. Patients who had never presented such symptoms may experience their onset in the context of this major environmental change. Higher levels of avoidant behavior are also expected.
Exposure and ritual prevention, a key behavioral technique in OCD treatment should be carefully tailored during this period. Recommending unrestricted exposure to feared stimuli may prove imprudent. Psychological strategies for treating OCD should consider the well-being and safety of patients. Pharmacological strategies should be guided by the best evidence-based recommendations.
Protection recommendations (e.g. hand washing) can reinforce the irrational beliefs of patients with OCD and poor insight. Therefore, engagement in exposure and ritual prevention activities may be lower, which could impact the long-term prognosis for OCD.
Although the above considerations should be considered speculative, they are based on clinical experience and previous scientific research. Predictions regarding the outcome of OCD in response to stressful situations should be confirmed by longitudinal studies.
Social relations are disrupted. Individuals are staying at home. Wearing masks is becoming more and more common in some countries where people were not used to it, and individuals no longer see each other’s facial expressions. The COVID-19 pandemic is having a psychological impact on individuals (Asmundson and Taylor, 2020; Li et al., 2020). For adolescents with psychiatric disorders, lockdown may result in a sudden break or shift in care
Quarantine has negative and potentially prolonged effects on the psychological health of individuals, including post-traumatic stress symptoms, confusion, and anger and OCD aggravation. Optimistic approach ,stress management and hygienic environment can help reduce symptoms.