When An OCD Ritual Becomes A Public Health Guideline
Coronavirus; A Perfect Storm For OCD
OCD sufferers live in a constant threat state, fearing that a failure to perform rituals “just right” will lead to disaster. In many respects these rituals are a twisted form of Pascals Wager in relation to the disaster that one fears; better to be safe than sorry. OCD can take many forms, with one of its most common manifestations being Contamination OCD. This entails a fear of becoming sick from germs, in particular a fear of terminal illnesses such as HIV and Cancer. Furthermore, it is not uncommon for it to latch onto the cultural fears of the day as has been witnessed in previous health scares such as the Swine Flu and SARS outbreaks. Sufferers can lose hours excessively washing their hands and disinfecting belongings to minimise the perceived risk of these illnesses.
It should come as no surprise then that the Coronavirus pandemic is currently creating a host of challenges for those with OCD, not least of which is that frequent hand-washing is being encouraged by WHO and government agencies. On top of this, sufferers may have intrusive thoughts over passing on the virus to others, and health anxiety regarding their own vulnerability. In short, the current situation is awakening old obsessions in those who have been through treatment for OCD and undermining those in treatment currently. All of these factors explain why there has been a sharp rise in people seeking help from OCD charities.
I myself used to dissolve into pure panic if I had any contact with street pavements or the bottom of shoes, with plasters representing the ultimate danger. In the current climate, these fears currently have plenty of new fuel; videos showing the diffusion of the virus in a sneeze are positive horror films for those with such obsessions. With health campaigns recommending frequent hand washing and social distancing in response to the Covid-19 outbreak, many OCD sufferers may feel themselves vindicated. Suddenly, their Exposure Response Therapy (ERP) is at risk of falling on deaf ears.
Sufferers perform compulsion’s to provide temporary relief from anxiety, however, each time they are performed it reinforces the obsessive behaviour. To overcome this, one must face their triggers, be it pavement or an unwashed surface, and not perform the associated ritual, thereby challenging their beliefs and catastrophic thinking patterns. Right now, that could seem a tall task and be deemed contrary to public health guidelines; the lines are blurred between obsession and necessary caution.
As a sufferer of OCD, I can attest to the fact that the disorder will thrive in the face of all reason, so it is especially hard to resist when your behaviour is being endorsed by legitimate sources. In addition, whereas before the pandemic contamination OCD may have been easy to spot, now it can be misidentified as a natural response to the current virus and the need to sanitise regularly. Unfortunately, OCD will twist the official guidelines and make sufferers question whether they have washed sufficiently; those with contamination OCD will never feel like they have disinfected themselves “just right”, and so will repeat the process, rubbing their hands raw in an attempt to achieve mental calm.
Furthermore, this is not the only way that Covid-19 will adversely affect those with mental health issues such as Generalised Anxiety Disorder and OCD; another very understandable fear (and one I find myself having) is an exhausting moral battle internally about whether one has infected others out of carelessness. As a result, OCD sufferers may spend hours ruminating, tracing their movements, or trying to pinpoint actions that could have put a vulnerable person at risk. Suffice to say, it is mentally and physically draining and can severely reduce quality of life. Though non-sufferers may relate to this mental checking about spreading the virus to an extent, in those with anxiety disorders these questions become all-consuming and the resultant guilt crippling.
Despite these challenges, Exposure Response Therapy need not be put on hold during the current crisis whilst you follow the WHO guidelines. Instead, you just need to redefine what constitutes excessive in the Covid age. Luckily, it has been done for us. In short, your new benchmark should be the official guidelines, and anything more than that should be resisted. Furthermore, if you have any lesions on your hands or are developing dry, scaly skin, you are almost certainly overdoing it. Challenge your OCD when it questions whether hand-washing was sufficient, and measure the frequency and intensity of your hand-washing against others who do not have OCD, that way, you can continue to uphold the necessary precautions to prevent Covid 19 whilst fighting back against the disorder. If necessary, get a friend or relative to monitor your hand-washing and call out any obsessive behaviour.
Lastly, social distancing should be practiced, masks worn in public and hands washed within reason. If you follow these guidelines, then you need not ruminate over whether you have inadvertently harmed anyone. Moreover, continue to challenge harm OCD thoughts when they arise and remember: You are not what you think, and you are certainly not what you fear. Having OCD during the pandemic can feel like fighting a war on two fronts, but by using Cognitive Behavioral Therapy techniques and continuing to practice a slightly modified Exposure Response Therapy, you can get through this.
