Imagine trying to tell yourself not to think about the coronavirus. Impossible, right?
But everyday virus-prevention measures such as handwashing, disinfecting and physical distancing also happen to overlap tremendously with the type of circular thinking and repetitive behaviors known all too well by those with obsessive-compulsive disorder, or OCD.
Tangled with anxiety, OCD is now recognized as a separate diagnosis in the DSM-5 manual of mental disorders. But both conditions unquestionably share impulse control problems as a trait. And Covid-19 presents a perfect storm of sorts to anxious and obsessive people, whom mental health professionals describe as “sticky” due to their trouble letting go of thoughts, fears and impulses.
Walking a fine line between doing what’s necessary to avoid the virus and doing too much too often is an especially fraught tightrope for those with OCD.
Overlapping fears trigger
All of us need to focus each day on taking proper steps to avoid catching the coronavirus and unwittingly spreading it to others if we’re asymptomatic. And these measures simply take time, whether it’s restocking masks or disinfectant supplies, diligently washing our hands in 20-second spurts or strategizing about how to stay 6 feet apart from others in various settings safely.
While these actions add up, however, they probably still don’t take the one hour or more each day that crosses into the realm of OCD. Obsessions, compulsions and disruptive thoughts trigger marked distress for those with the disorder, consuming an hour or more of a sufferer’s day or significantly interfering with their ability to work, go to school, socialize and otherwise live their daily lives normally.
Several aspects of the Covid-19 pandemic might trigger OCD-related fears and behaviors. What do they include?
• Contamination: Keeping hands, body and surfaces clean can be a daily obsession for someone with OCD during normal times. So public health advice to wash hands more often and using proper techniques can trigger excessive handwashing and household disinfecting far beyond what’s necessary. Sufferers may also pressure family and friends to wash their own hands frequently.
• Hoarding: Buying months’ worth of toilet paper, canned goods and other pandemic supplies? In Covid times, it doesn’t take a diagnosis of OCD to trigger the urge to stockpile. A scarcity mindset has infected many of us. But someone with OCD may panic-shop, which can lead to hoarding.
• Harming Others: Either by accident or on purpose, some with OCD worry excessively about hurting others. But Covid-19 may turn up the volume on such fears, triggering sufferers to go to extremes to avoid spreading the virus. They may decide to forgo any trip out of their home, even to shop for food or other necessities.
Tips for coping and compassion
Nobody likes feeling anxious. For those with OCD, anxiety levels can be crippling. But a sometimes-overlooked aspect about anxiety is that there’s a “sweet spot” that actually works in our favor. Too little anxiety can be as harmful as too much — but the right amount can be healthy and useful, propelling us forward to take care of ourselves and our priorities.
The same is true for OCD, of course, as well as the fear of germs and contamination. If you have OCD or know someone who does, watch for ways that the Covid-19 crisis may be changing OCD symptoms, obsessions and behaviors. Those in treatment for OCD should talk to their mental health providers about these ripple effects.
There are also ways you can better cope at balancing public health advice and symptoms. These include:
• Limit news or information: No, you don’t have to turn off the news completely or avoid all public messaging. It might lower anxiety, however, to allow only 10 or 15 minutes a day to update yourself on the latest about the health crisis.
• Disinfect on a schedule: Clean surfaces in your home only once a day for several minutes and no more. If no one has visited, you don’t need to wipe down the doorknobs again.
• Handwash for only 20 seconds: Sure, follow public health guidelines regarding handwashing. But overdoing it can actually introduce infection by breaking down the moisture barrier of your skin.
• “Practice resisting (some) impulses”: While it’s good to be thoughtful and careful, it’s also equally important to know when it’s too much. Take handwashing as an example or any checking behavior. At some point it can be too much (especially if no threat of contamination is present). In these instances, and more generally for anyone with any repetitive or checking behavior, I ask that person to try to resist the “impulse” at least one in fives times, maybe one in three times, especially when there is no clear risk or danger. The goal is not to be completely under the control of our fears and irresistible impulses. Otherwise, it can quickly become a slippery slope, and behaviors can go unchecked.
If anything positive can result from the coronavirus pandemic, it’s that it offers those without OCD a valuable window into anxiety. On a daily basis, every one of us is getting a chance to experience what it’s like to live with anxiety and behaviors that may veer toward obsession.
Next time you’re wondering if you’ve washed your hands enough or worry you’ve somehow spread the virus to another person, it’s a small glimpse into OCD — and an opportunity for greater understanding.
Alex Dimitriu, M.D., is double board-certified in psychiatry and sleep medicine and founder of Menlo Park Psychiatry & Sleep Medicine. For more, visit siliconpsych.com.
– Alex Dimitriu, M