COVID-19 has caused many changes to everyday life that can lead to feelings of stress, which experts are finding has led to some individuals developing symptoms typical of obsessive-compulsive disorder (OCD) — a psychiatric illness characterized by intrusive, anxiety-inducing thoughts (obsessions) that lead to repetitive behaviours (compulsions) done in an effort to ease the anxiety. For those who already have OCD, however, response to the pandemic has varied significantly.
Dr. Peggy Richter, psychiatrist and head of Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre, talks about the pandemic’s impact on OCD and what we can do to help those who may be struggling.
How has the pandemic impacted people with OCD?
For people who already have OCD, the pandemic has had very mixed effects. There are some people who, of course, are made much more anxious by it. But there are also many who say the pandemic has made things easier.
For example, during COVID, recommended public health measures have included limiting contact with items, cleaning surfaces, using sanitizer and having more frequent hand washes. For people who would call themselves “germaphobes” or who have contamination as the focus of their OCD, these actions actually reduce their anxiety. Before COVID, these individuals might have found themselves feeling anxious going into supermarkets. Now, they know that in some stores, carts have been wiped off before every use, and if they’re concerned, they can take their own wipes with them, clean their cart, and nobody notices.
Contrarily, for individuals whose OCD focuses on illness anxiety, the pandemic has been very difficult because they are ordinarily preoccupied with potentially developing a medical illness or problem. This means they are highly vigilant around any risks in their environment and are very concerned that sensations that don’t necessarily mean COVID could be COVID. I am seeing individuals in that population struggle.
Another group that may be having a hard time are those who need orderliness and things precisely in position. If you’re in a home that’s gone from people coming in and out at the start of the day to now everybody spending more time in the home, working or doing school remotely, there is a lot more chaos, which can be very difficult.
OCD is an illness that affects individuals in different ways.
Has the pandemic caused more people to develop OCD?
Though I haven’t seen the data to back it up, anecdotally, mental health colleagues in the community feel they are seeing a lot more OCD. My colleagues in child and adolescent mental health, especially, have expressed they are seeing more cases of new-onset OCD compared to past years.
OCD does very much seem to occur on a spectrum of severity, so the pandemic may also be leading to obsessions or compulsions for many that are milder than required to make a formal diagnosis, while nonetheless causing some degree of distress.
How will easing restrictions impact people with OCD or those who are experiencing symptoms?
In the case of anxiety disorders, avoidance can make symptoms worse. With the pandemic, that avoidance has been mandated, which may have felt better in the short-term, but will make re-entering the wider world that much harder.
In fact, one of our best first-line treatments for all anxiety disorders is a form of treatment called cognitive behavioural therapy (CBT), in which people are encouraged to systematically confront their fears by triggering them.
With OCD, many people have been avoiding a lot of the situations that normally would trigger them. For example, for someone whose OCD would ordinarily compel them to check the doors, lights and appliances when they leave the house, lockdown and working from home may have made things easier. However, going out to work and socialize will now trigger them like before, and may feel even harder as they have not had to challenge this fear for a while.
Returning to these triggers that have been avoided, it’s going to be hard.
When should someone seek help?
The simple answer, for any psychiatric or psychological problem, is for someone to seek help when it causes distress or when it begins to interfere with their ability to function. If it’s getting in the way of their relationships, causing problems in their work environment or in their functioning at home, that’s a clear indicator that maybe it’s worth talking to a professional.
The core features of OCD are the presence of obsessions or intrusive, recurrent anxiety-provoking thoughts and urges, as well as compulsions, which are repetitive acts the person does in response to obsessions. When these symptoms cause significant distress, impaired functioning or waste an hour or more of the day, it is considered severe enough to make the diagnosis. With that said and as mentioned before, OCD does very much seem to occur on a spectrum of severity. So, if someone is unsure if they meet the criteria for an OCD diagnosis but are still having a hard time, they shouldn’t hesitate to get help.
How can I help my loved one who’s struggling with OCD or OCD-like symptoms?
If someone you know is struggling, be supportive and non-judgemental. Just being there for someone and letting them know that you care is incredibly helpful for most people.
You can also encourage them to seek professional help. Seeing their family doctor is often a very good place to start, as they can help them find effective treatments for OCD, including drug therapy and CBT. In general, most people will greatly improve with treatment.
Also, one thing that’s happened because of the pandemic is a mushrooming of resources online, so it is much easier than in the past to find great online educational material, to find online therapy and to find support groups.
Further, help your loved ones have hope. This is a tough time, but they are not alone, help is available, and things can get better.
This interview has been edited for length and clarity.