How the Coronavirus Pandemic Can Exacerbate Symptoms of Obsessive-Compulsive Disorder
The heightened anxiety, fixation on hygiene, and the virus itself can all play a role in worsening OCD symptoms.
By now, you (hopefully!) can recite ways to prevent the spread of coronavirus in your sleep: wash your hands regularly with soap and water for at least 20 seconds, don't touch your face, and sanitize commonly used surfaces often, among others. With the constant warnings about COVID-19 and repeated reminders to focus on hygiene, it's possible even the most laidback person might become obsessive about cleanliness.
On top of that, there's an underlying layer of stress that's hard to shake, not to mention handle. Some people are burying themselves in work, some are baking on a regular basis, and others are leaning into at-home workouts—all in an effort to distract themselves from the daily reminders of COVID-19 while bringing a little joy and comfort into their lives.
But for those with obsessive-compulsive disorder (OCD), these diversion tactics might only do so much, especially since the stress and anxiety from the global pandemic might be making their symptoms worse—and nearly impossible to brush off, says Gail Saltz, M.D., an associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine and host of "Personology" podcast from iHeartRadio.
Some background: OCD is a common, chronic mental health disorder where a person has uncontrollable repeated obsessions and/or behaviors known as compulsions that they feel the urge to repeat over and over, according to the National Institute of Mental Health (NIMH).
There are different forms of OCD that can cause various symptoms, such as obsessions—repeated thoughts, urges, or mental images that cause anxiety—and/or compulsions—repetitive behaviors in response to an obsessive thought. Common OCD obsessions can include fear of germs or contamination, fear of losing something, needing to have things symmetrical or in perfect order; while common OCD compulsions may involve excessively cleaning or washing a body part, repeatedly checking on things, repeatedly counting items, arranging items in a certain way, according to NIMH.
But under a stressful situation, such as the current coronavirus pandemic, these symptoms can be more intense than usual and happen more often, says Frank A Ghinassi, Ph.D., president and CEO of Rutgers Health University Behavioral Health Care. "Anxiety can exacerbate obsessive-compulsive disorder, and anxiety is high for everyone right now." (Related: 5 Ways to Manage Your Anxiety During the Coronavirus Outbreak)
Anxiety is closely tied to OCD—obsessions cause anxiety and compulsions can help relieve anxiety, at least temporarily, explains Ghinassi. When you add more anxiety to the mix, people with OCD can struggle even more to manage their obsessions and compulsions, even if they were under control before, he says.
"People with OCD of all forms are often susceptible to increases in their anxiety based on life events," says Simon Rego, Psy.D. chief of the psychology department at Montefiore Health System. "Increasing anxiety can [also] cause an increase in the intensity of obsessions, regardless of form. On top of this, over time people with OCD often learn to engage in rituals in order to cope with anxiety in general, even if caused by an unrelated life event."
It's important to note that, like all health conditions, there is a wide range of severity with OCD. "It's on a spectrum," meaning some people have more severe obsessions, compulsions, or overall cases than others, says Ghinassi. Similarly, some people have OCD tendencies rather than OCD as a diagnosed condition. "The current view on disorders such as OCD is that, to some degree, we all have these tendencies in us," says Rego.
Someone with OCD tendencies may have an obsessive way of thinking and may prefer that things are done a certain way, but those thoughts are not something that they feel they can't stop, says Dr. Saltz. So, if you have OCD tendencies, you may get annoyed that your partner loaded the dishwasher differently than your go-to method, but you can move on with your day. For some people with clinical OCD—which typically involves uncontrollable, intrusive thoughts—that can be something that's hard to move past.
TL;DR—anxiety can, and more often than not, does make OCD worse, no matter if it's a diagnosed condition or just a tendency.
How can COVID-19 make OCD symptoms worse?
Of course, every person is different and not every person with OCD will react to the current situation the same way. But the type of OCD and how well a person's responded to treatment in the past can influence how they're impacted by the ongoing pandemic, according to experts.
People who have obsessive thoughts and compulsions about how their clothes are ordered in their closet or who have a fear of losing things are "unlikely to be directly impacted by a viral pandemic," because their fixations aren't related to health and hygiene, explains Ghinassi. But they may be indirectly impacted by the pandemic by way of all of the anxiety it creates, says Dr. Saltz.
So, now, a person who has an intense fear of losing or misplacing things may spend hours checking and rechecking to make sure their car keys are in the right spot before they can relax, whereas before the coronavirus outbreak, they may have had those compulsions under control, or at least done them less often.
In addition to the increased anxiety surrounding the pandemic, the virus itself can also exacerbate OCD symptoms, especially for those with hygiene or health-related OCD. "Getting sick often makes OCD worse temporarily," says Dr. Saltz. Contracting even just a common cold could send an OCD patient with a fear of germs or contamination into a spiral, causing them to constantly clean or do compulsions even more than usual, she explains. (BTW, here's what to if you think you have the coronavirus.)
So, in the case of a contagious and widespread pathogen like coronavirus, "at an extreme, people with this form of OCD might wash [their body parts] hundreds of times, with harsh chemicals or scalding water," says Larry Needleman, Ph.D., a psychiatrist at The Ohio State University Wexner Medical Center. "With COVID-19, most people with contamination/illness OCD, are having an upsurge in symptoms—having more distress, washing even more, and compulsively watching the news about the virus." (And even on a good day, the news can seriously make you anxious.)
Meanwhile, some people with contamination OCD are feeling validated, given that most people—regardless of mental health status—are very vocal right now about their fears around hygiene and COVID-19, says Ghinassi. But this "reinforces and justifies the fears, many of which may not have been realistic in the past." And that can also exacerbate obsessions and compulsions, as people with OCD may now feel like everyone else is behaving in a similar way, therefore their actions are rational, he explains.
The uncertainty of COVID-19 and changing recommendations on what people should do to protect themselves can be especially problematic for people with OCD, says Thea Gallagher, Psy.D., clinic director at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania's Perlman School of Medicine. "People with obsessive-compulsive disorder tend to look for the rules, but then go above and beyond what is recommended," says Gallagher. "I've been encouraging people to stick with protocol and not try to go beyond that." Gallagher says she has patients who are Googling information "excessively" and trying to create certainty in a time that's anything but—and that can lead to more symptoms because of the anxiety which, again, can make OCD symptoms worse, she explains.
Can a global pandemic make you suddenly develop OCD?
If you have OCD tendencies, it's possible for your tendencies to develop into a more severe case due to stress from the pandemic, says Dr. Saltz. Whether it develops into a clinical case of OCD or stays within the realm of OCD tendencies ultimately depends on the person and their individual situation. "Many people have OCD symptoms that are lower-level and don't impair them a lot but, in this time, they may get much worse and think this is a new OCD diagnosis when it is not," she explains. Needleman agrees: "People who develop OCD are thought to have had a predisposition for developing the disorder. The onset of the disorder is often associated with high stress and can be thematically related to stressful events." (Also making matters and mental health potentially worse? Social distancing, which is necessary but tough on your mind.)
Obsessions and compulsions are essentially coping mechanisms that people with OCD tendencies may do them more often or more intensely at this time as a way to try to grapple with what's happening, says Dr. Saltz. That can create a negative cycle, where people resort to the obsessions and compulsions for comfort more and more until they become regular occurrences, she explains.
But attempting to self-diagnose OCD is tricky. To get a sense of whether your behavior could be symptoms of OCD, Needleman recommends comparing what you're doing to what friends and family are doing. If it's more extreme and above and beyond recommendations from public health organizations like the Centers for Disease Control and Prevention or World Health Organization, you might be veering into disorder territory, he says. "If you have intruding thoughts you find sticking there a lot of the time and interfering with your ability to think about other things; if you are doing a repeated behavior, even though you don't really want to but can't stop…this is OCD," adds Dr. Saltz. (Related: Amanda Seyfried Opens Up About Her Struggle with OCD)
Just don't judge yourself too harshly on how you're approaching hygiene these days. It's easy to feel preoccupied with cleanliness right now even for people who don't have OCD tendencies. The difference between that and OCD is how often you're doing this and how much it disrupts your life, says Gallagher.
What can people with OCD and OCD tendencies do to get help right now?
It's important for people with OCD to know that professional help is still available, even though it may be more difficult than usual to see a mental health professional in their office. Many mental health professionals are now offering telehealth services, and restrictions on telemental health services have been loosened due to the crisis, says Rego. "Many clinicians have moved to 'seeing' their patients via online video platforms in order to keep up treatment momentum and offer support." (Related: What Is Telemedicine, Exactly?)
If you have OCD and you notice your symptoms are getting worse, it's important to reach out to your mental health professional. Don't wait on this—Ghinassi recommends that you do it immediately. From there, your doctor will determine if you need to modify your existing treatment plan (both for your cognitive behavioral therapy and medication, if you take any), he says.
If you feel like you're not getting anywhere with your normal doctor, Gallagher recommends looking for a new provider who is trained in exposure and response prevention treatment for OCD, a form of therapy that encourages you to face your fears and let obsessive thoughts happen without feeling like you need to neutralize the fears with compulsions. This is true whether you're in the middle of a pandemic or otherwise. (Need some inspo? The CEO of The Dogist credits exposure therapy for saving her life.)
And you're concerned you may be developing a severe form of OCD, Needleman recommends finding a doctor through the International OCD Foundation and taking things from there.
The information in this story is accurate as of press time. As updates about coronavirus COVID-19 continue to evolve, it’s possible that some information and recommendations in this story have changed since initial publication. We encourage you to check in regularly with resources such as the CDC, the WHO, and your local public health department for the most up-to-date data and recommendations.