Living with Obsessive Compulsive Disorder (OCD) during COVID-19

Obsessive Compulsive Disorder (OCD) affects 1 out of every 40 adults in the United States and 1 out of every 100 children. It is also known as “the doubting disease” and is characterized by obsessions and/or compulsions that last for over an hour a day and cause significant distress and/or impairment. OCD is one of the top 20 causes of disability across the world.  One of the most commonly known symptoms of OCD is a fear of germs/contamination; however, OCD is a very heterogeneous disorder and obsessions and compulsions can take many forms. Many people have fears they may inadvertently harm someone (for example, by leaving the stove on or the door unlocked, by hitting someone while they are driving, by preparing food for others that is not cooked well enough), or harm themselves without wanting to. People may also have unwanted sexual or aggressive or religious obsessions, fears they might lose things that are important to them, among other such fears.

The COVID-19 pandemic has the potential to lead to worsening OCD symptoms in those who suffer from it; however, it does not necessarily have to. Both individuals with OCD and their loved ones might be wondering how to persevere through this extraordinary time of uncertainty.  Following are some guidelines to help provide guidance and hope to people struggling with OCD.

1. First, know that everyone’s experience with OCD is going to be different.

For some patients with contamination OCD, their OCD will be better during this time because they are quarantined and will be able avoid many of their common triggers. In addition, loved ones around them will be acting extra cautious about cleaning in ways they had not before, which they will appreciate. For these patients, anxiety might not start to rise until society starts to open up again and they have to venture out and re-engage in society. For others, getting a grocery delivery will be enough to send them into an OCD spiral. And for others, they will not be concerned about themselves but will be more worried about contaminating and harming others. Finally, for another percentage of patients, they may have OCD symptoms that are completely unrelated to COVID-19 that increase simply because their stress level is higher because of the current situation (for example, worrying that they accidentally cheated on an exam without knowing it, obsessing about their child being abducted, or obsessing that they did something inappropriate in front of other people that they cannot recall). Patients and loved ones should be understanding of the fact that OCD is not rational, and everyone will have their own experience with it.

2. Start or continue to engage in good self-care

This should include some daily exercise, adequate sleep, healthy eating, meditating, and following a flexible but generally structured day full of meaningful activities. These behaviors will likely all provide an “emotional cushion” and some level of resiliency to help patients have the energy to fight their OCD.

3. Limit exposure to news and media

Try to limit news consumption to no more than twice a day in limited amounts each. While there may be an inclination to be constantly abreast and up to date of COVID-19 related news,  there is a difference between staying informed and compulsively checking the news every hour or every few minutes to try to get “more certainty” about the current situation.  We are all living with a certain amount of uncertainty and no amount of reading will completely erase that.

4. Follow the CDC’s advice and take appropriate precautions — but do not go beyond recommendations.

It is important to have a plan for how to handle trips outside the house, groceries, and other such activities that is based on science. Patients with OCD should follow recommendations instead of using their feelings of “cleanliness” to decide whether to “wash one more time” or not. Patients with contamination OCD often never feel completely clean, despite how much they wash, so feelings should not determine behaviors.

5. Seek out professional help if you are not already in therapy.

Many therapists are doing therapy virtually now and can help patients navigate the pandemic through online mediums. They can also meet with family members and significant others to help them determine how to respond to the OCD patient, how to be supportive, and how to avoid accommodating their symptoms in unhelpful ways. Therapists might also be able to negotiate with employers about when and how OCD patients return to work, so they can avoid a relapse and ease back into life in a manageable way.

6. Consider medication management and support.

Some patients will also benefit from speaking to their psychiatrists about medication management to help them cope with increased symptoms.

7. Stay socially engaged even if physically distant.

Continue to engage socially with friends and family whether it is via virtual methods at this time or in-person once society begins to open up. Also, consider joining an OCD online support group. The International OCD Foundation (IOCDF) website lists a number of community resources, including support groups, many of which are now virtual.

OCD patients and families would benefit from the following websites and apps as well:

International OCD Foundation (IOCDF) website (iocdf.org) provides education on OCD as well as information on finding support.

nOCD app includes video-based OCD therapy and in-between session support, based on exposure and response prevention (ERP).

Here are some other apps that focus specifically on OCD:

There are also many meditation apps which can help users deal with the stress of the situation and find some calm. Some options include Calm, Headspace, and Stop, Breathe & Think. You can find other mental health apps on the One Mind PsyberGuide App Guide.