Obsessive-Compulsive behaviour increases as a result of COVID-19

The symptoms of obsessive-compulsive disorder (OCD) are not to be confused with perfectionism, with the need for things to be orderly, or with a strong drive for neatness and order. OCD is a psychological disorder which causes the individual to have repetitive thoughts (called “obsessions”), and/or results in the individual wanting to perform certain routines repeatedly (called “compulsions”). These repetitive thoughts and actions causes the individual great distress, and/or limit a person’s daily functioning. A person who experiences these symptoms of OCD is normally unable to control the obsessive thoughts and compulsive behaviours. Most adults with OCD realise and acknowledge that the obsessions and compulsions are illogical and don’t make any sense, but are fairly powerless to control it.

Obsessive–compulsive disorder affects about 2% of people, and is associated with nervous tics, certain forms of depressions and/or anxiety, and sleep disturbances. The cause for OCD is not clearly defined, but it is generally accepted that genetics and stress-inducing events can lead to the onset of OCD. OCD usually starts in the teen or young adult years, and although it is a lifelong condition for many people, it is rare for OCD to start after the age of 35.

The symptoms of OCD seem to be grouped together in 4 clusters or dimensions:

1. Concerning symmetry – Related to counting, ordering, and repeating compulsions, for example Intense stress when objects aren't orderly or arranged in a specific way, or chronically doubting that the doors have been locked or whether the tap has been turned off.
2. Concerning “forbidden thoughts” – Related to intrusive and distressing thoughts of a violent, religious, or sexual nature. Examples can be a preoccupation with the thought or image of a loved one dying, or the possibility that God, the devil, or maybe disease—will harm either the person or the people that the person cares about.
3. Concerning cleanliness and hygiene – Related to obsessions about contamination and compulsions about cleaning. Examples include fear of being contaminated by touching objects others have touched, and/or the obsession about germs leading to incessant hand-washing.
4. Concerning “hoarding” – Related to obsessions and compulsions about hoarding and storing items and the inability to get rid of unnecessary items. For example, an individual who engages in compulsive hoarding might be inclined to keep all empty food tin cans, while accepting that such behaviour is irrational on a more intellectual level.

OCD varies in intensity, but can severely impair an individual’s life. Problems resulting from obsessive-compulsive disorder may include:

1. Excessive time spent engaging in ritualistic behaviours, for example rearranging objects
2. Health problems, such as dermatitis due to frequent handwashing
3. Struggling to attend work, school or social events
4. Conflict in relationships
5. Depressed and/or anxious mood

Excessive skin-picking, hair-pulling and nail-biting are all examples of compulsive behaviour. However, compulsions are different from tics (e.g. tapping, slapping rubbing, or blinking),and stereotypical movements (such as head banging and body rocking). More than half of people diagnosed with OCD have had suicidal tendencies, and about 15% have attempted suicide. Furthermore, Individuals diagnosed with OCD are affected with sleep disturbances at a much higher rate than the general population.  OCD further frequently occurs together with general anxiety disorder, bipolar disorder and major depression.

Symptoms of OCD should always be evaluated in context. In certain situations, people repeat certain behaviours, but they do not necessarily perform these behaviours in a compulsive manner. For example, bedtime routines, “normal” hygiene routines, family activities, and religious practices are usually not compulsions, and therefore certain behaviours can be seen as compulsions or just as habit, depending on the circumstances in which these behaviours take place.

Covid-19 has had the effect of generally increasing anxiety, stress, panic and worry. However, the symptoms of people struggling with OCD can worsen considerably due to how they experience the pandemic. Individuals who obsessed with cleanliness and hygiene before the onset of COVID-19 will especially be affected. They are likely to obsess more about the risk of contamination and would be inclined to increase their frequency of compulsive cleaning or scrubbing.

Especially during COVID-19, people experiencing OCD should attempt to separate their compulsive behaviours from what is appropriate under the circumstances. For example, individuals should not wash their hands for longer than 25 seconds. Handwashing should only occur If you have left your house, sneezed, blowed your nose, came in contact with others or when your hands are objectively dirty. Only surfaces which are in regular contact with people’s hands should be cleaned, otherwise these areas should be avoided. Cleaning or disinfecting surfaces at home should not take more than a few minutes a day.

Treatment involves appropriate medication combined with psychotherapy, and in many cases has assisted individuals to be symptom-free, or at least to be able to manage the symptoms more effectively.