by Allison Reardon, Public History Graduate Student at the Indiana Medical History Museum

The COVID-19 pandemic has contributed to feelings of isolation and uncertainty for many people, so it is evident that it could have a significant impact on mental well-being. According to the World Health Organization, the pandemic has negatively impacted mental health worldwide, with cases of anxiety and depression increasing by 25% in just one year [1]. While it is extremely important to acknowledge the impact on general mental health, this post will focus on the pandemic’s effect on one specific mental illness: obsessive-compulsive disorder (OCD). The unique characteristics of this disorder can make life in the face of a global pandemic more challenging, in terms of both symptom presentation and treatment.

Although not all people diagnosed with OCD suffer from obsessions and compulsions related to germs and contamination, this form is the most common, or, at least, “the most frequently reported” [2]. Many of these contamination-related compulsions, such as hand washing and avoiding places that may be contaminated, share similarities with the behaviors encouraged during the pandemic [3]. These similarities have allowed for the perpetuation of misconceptions about OCD in a new context. Near the beginning of the pandemic, for example, OCD-UK responded to a March 2020 article from the Wall Street Journal entitled “We All Need OCD Now.” As evident from their response, the article provides an example of someone recognizing the similarities between COVID-19 precautions and some OCD compulsions without understanding or acknowledging the anxiety and thought patterns that contribute to the disorder [4]. [Photo: Santa Clara County public health graphic showing ways to reduce the risk of COVID-19, including hand washing and social distancing. These precautions, on the surface, share similarities with some OCD compulsions.]

Contamination-related OCD is not an advantage during a pandemic. In fact, the specific conditions of a disease outbreak can exacerbate the anxiety around this form of the disorder. One specific article describes a case of one woman in Europe who experienced intensifying OCD symptoms from the start of the pandemic - before any cases were reported outside of China [2]. Another article describes a similar case in which a woman experienced debilitating symptoms at the very beginning of the pandemic. This article, published in late 2021, additionally mentions that “[a]necdotally, some authors have reported increased numbers of patients with obsessive-compulsive disorder (OCD) or personality difficulties seeking psychiatric help in recent months” [3].

These reports show that life in a pandemic can exacerbate certain OCD symptoms, but what actually leads to this escalation? It can be explained through two main parts: assessment of obsessive thoughts and access to treatment.

Starting with assessment of obsessive thoughts, the previously-mentioned overlap between contamination-related OCD and COVID-19 precautions has certainly posed unique issues. One woman showed that although she “exhibited good insight into the nature of her OCD symptoms,” she had “difficulty in cognitively re-appraising her intrusive thoughts in light of the public discourse surrounding COVID-19” [2]. When public health authorities encourage thorough cleaning and other precautions that align with certain compulsions, it can be challenging to separate these behaviors from obsessive thoughts about contamination and to break the compulsions. In other words, it can be difficult for those struggling with contamination-related OCD to effectively distinguish between adaptive behaviors that prevent the spread of disease and maladaptive behaviors that simply reinforce anxiety and obsessive thoughts [3].

The exacerbation of OCD symptoms is also more likely during a pandemic due to treatment issues. Similar to patients, clinicians can have difficulties distinguishing between adaptive and maladaptive behaviors [2]. They can also struggle to find practical strategies for treatment. One of the most effective treatments for OCD is exposure and response prevention, which involves exposure to anxiety-inducing situations. The actual dangers associated with exposure in certain situations due to the pandemic makes this treatment more challenging to attempt [3].

It can be more difficult for patients to receive any treatment at all due to the effects of the pandemic, such as social distancing guidelines. One article suggests that telemedicine is a possible solution for some of these issues [2]. It is important to note, however, that these new challenges pile onto existing disparities in mental health care that create obstacles to treatment. One report from 2017 explains that “[m]ental disorders are among the top most costly health conditions for adults 18 to 64 in the U.S.,” and there are also racial and ethnic disparities that can contribute to poor mental health care [5]. Recognizing these disparities is the first step in working toward mental health equity, which is an essential consideration when discussing treatment solutions. [Photo: Sign in the window of a coffee shop explaining that they are closing due to COVID-19. Many places, including those dedicated to mental health treatment, were forced to find new solutions for operation due to the pandemic.]

Several aspects of the COVID-19 pandemic, such as the encouraged precautions of hand washing and social distancing, can contribute to the worsening of some OCD symptoms. These intensified symptoms are not unique to this pandemic, though; previous outbreaks of diseases like MERS and influenza have had similar impacts. Although these effects have been observed before, one study from 2020 reports that little attention went to care for people struggling with contamination-related OCD during the COVID-19 pandemic [2]. The evidence suggests that more specific attention should be paid to those suffering from these symptoms.

Clinicians are not the only ones who should be aware of the issue, though. As evident from OCD-UK’s response to the Wall Street Journal article, misunderstandings still exist around OCD, and these incorrect views can contribute to the stigma that prevents people from seeking help. The goal of this blog post series is to bring awareness to the real diagnosis of obsessive-compulsive disorder and play a part in the reduction of this stigma. Although it is especially relevant now during the COVID-19 pandemic, it is important to continue this awareness and learning to support those affected by the disorder.

References

[1] “COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide.” World Health Organization. March 2, 2022. https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide.

[2] French, I., and J. Lyne. “Acute exacerbation of OCD symptoms precipitated by media reports of COVID-19.” Irish Journal of Psychological Medicine 37, no. 4 (2020): 291-294, https://doi.org/10.1017/ipm.2020.61.

[3] Costa, Ana, Sabrina Jesus, Luís Simões, Mónica Almeida, and João Alcafache. “A Case of Obsessive-Compulsive Disorder Triggered by the Pandemic.” Psych 3, no. 4 (2021): 890-896. https://doi.org/10.3390/psych3040055.

[4] Fulwood, Ashley, and Zoe Wilson. “Response to Wall Street Journal article.” OCD-UK, April 2, 2020, https://www.ocduk.org/response-to-wall-street-journal/.

[5] American Psychiatric Association. “Mental Health Disparities: Diverse Populations,” 2017. https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-Diverse-Populations.pdf.

Image Credits

Image 1: Santa Clara County Public Health. “3 W’s to Reduce Risk of COVID-19.” Wikimedia Commons. August 2020, https://commons.wikimedia.org/wiki/File:%223_Ws_to_Reduce_RIsk_of_COVID-19%22,_Santa_Clara_County_Public_Health.jpg.

Image 2: Webster, Tony. “COVID-19 - Coffee Shop Forced to Close.” Wikimedia Commons. March 17, 2020, https://commons.wikimedia.org/wiki/File:COVID-19_-_Coffee_Shop_Forced_to_Close_(49670878693).jpg. (To view the license for this image, visit https://creativecommons.org/licenses/by/2.0/deed.en)