COVID and OCD, More than a Year Later

The coronavirus pandemic continues to mark the present day with uncertainty, instability, and significant concern. And with obsessive-compulsive disorder, its effects have even more complications. Read on to find out how in the context of OCD, COVID-19 has reverberated throughout the world of mental health, more than one year in.

Still Reeling from a Global Crisis

COVID-19 has posed a serious threat to the world population at large. The highly contagious disease attacks the respiratory system and has already infected over 180 million individuals and killed over four million. It has repeatedly halted the global economy, ushering in a widespread recession. Entire countries have been thrown into lockdown, with scores of individuals confined to their homes and isolated from society. As healthcare providers struggle to offer crucial treatment and mental health services, with no definitive end in sight. At-risk populations, such as older adults and individuals with preexisting respiratory conditions, remain under threat as the long-term effectiveness of COVID vaccines remains to be seen. On top of that, pre-existing psychiatric conditions have been found to be the strongest independent factor linked to experiencing worse stress during the pandemic.

Together, these alarming ramifications of the coronavirus have fundamentally shaken individuals’ sense of security, sending entire populations into a state of pessimism, helplessness, and fear.

Faced with a Disturbing Condition

Obsessive-compulsive disorder is a mental health disorder defined by disturbing, unwanted and constant array of thoughts. These cognitive fixations, or obsessions, are so unsettling that individuals experiencing them often develop repetitive, ritualistic behaviors that help distract them from their overwhelming thought content. Over time, though, these rituals become compulsive, so that the individual feels compelled to execute them. Together, such obsessive thoughts and compulsive actions form the bedrock of OCD, creating a stronghold on the individual’s well-being.

While it is widely accepted that OCD is mainly manifested through obsessions and compulsive symptoms, its emotional core is still disputed: originally, OCD was found to be an anxiety-centric disorder, and was listed by the American Psychiatric Association (APA) together with other anxiety disorders, such as panic and separation anxiety. And while nowadays the APA lists OCD under its own, separate chapter, it still considers the fear-like sensation and concern invoked by anxiety to be OCD’s main catalyst.

More recently, though, a new theoretical conceptualization of anxiety has garnered professional consideration. This theory suggests that distress—the unpleasant and nagging sensation due to the appearance of an incessant thought—to be at the center of OCD. The distress theory of OCD helps explain why OCD responds differently to certain medications, and seems to implicate its own, distinct neural structures, compared to those found to be related to the appearance of other anxiety-based disorders.

Roughly 2.3% of the US adult population and 1%-2.3% of US adolescents and children are diagnosed with OCD. Though the condition can develop at any age, OCD symptoms usually appear between ten years old and early adulthood. That said, patients with OCD are typically only diagnosed (begin receiving treatment) from ages 14-17: this is due to many OCD cases being hard to properly identify, due to many being rationalized as eccentricity, rather than receiving attention as an official mental health disorder.

The FDA has recognized several treatments for their proven safety and efficacy when treating OCD:

• Selective Serotonin Reuptake Inhibitors (SSRIs). FDA-approved for OCD treatment, SSRIs help keep the neurotransmitter active in one’s system for a longer period of time. Since serotonin has been found to be a mood elevator and stabilizer, its continued activation is believed to help assuage the ruminative tendencies and resulting adverse reactions that arise in OCD. Common SSRI side effects include weight gain and sexual dysfunction, which can prevent patients from continuing with this treatment.
• Cognitive Behavioral Therapy (CBT). Also FDA-approved to treat OCD, this form of talk therapy focuses on the symptoms of the targeted mental health issue, in an effort to offer relief. CBT has been hailed for its ability to guide the patient into acknowledging the different ways in which their OCD manifests itself, instead of attempting to push it out of their mind, as they often do prior to treatment. During a CBT course, the patient is able to examine the thoughts, feelings, behaviors, and physical sensations that arise due to their OCD. Over time, their considered exposure to these aspects of their conditions helps them become more accustomed to them, until they no longer hold such overwhelming control over their daily lives.
• Transcranial Magnetic Stimulation (TMS). FDA-cleared for its proven ability to offer safe symptom relief, TMS helps regulate the neural activity of structures found to be associated with the appearance of OCD. As a noninvasive treatment, TMS does not cause any long-lasting or significant side effects, and can be combined with other forms of treatment such as medication or psychotherapy. It also does not necessitate a lengthy recovery period, allowing the patient to incorporate the treatment into their daily schedule.

OCD in Light of COVID-19

As mentioned earlier, having a pre-existing mental health issue can strongly predict an increase in stress severity under COVID. That said, OCD as a whole has not been found to be more vulnerable to the threats of the pandemic compared to other mental health disorders. Rather, it is stress from living under the threat of COVID that causes those with OCD to worry more these days, and in some cases, exhibit more severe OCD symptoms, as do individuals with other mental health conditions.

It is nevertheless important to note that patients with different types of OCD have been shown to experience greater distress under COVID compared to non-clinical individuals. Indeed, distress seems to be a key role here, as it appears that intrusive COVID-related thought content is more related to distress than OCD-related thought content is. As such, it is likely that distress is more likely to appear when being confronted with COVID-related content, than it is when confronted with OCD-related content.

One significant and not very surprising finding is that OCD-related washing compulsions have been shown to increase in symptom severity under COVID. As such, those facing this type of OCD compulsion find themselves washing their hands significantly more times than those facing other types of OCD compulsions.

Interestingly, while those with OCD-related washing compulsions report greater OCD compulsion severity, they do not report an increase in OCD-related obsessions: this means that under COVID, OCD-related washing seems to experience roughly the same level of focus on the need for cleanliness prior to the breaking of the pandemic, than those with other forms of this disorder.

Finally, OCD-related washing also experienced an increase in dysfunctional beliefs. Though themselves a form of thought content, beliefs are more statements than ongoing, ever-present ruminations over a certain, obsessive idea. As such, individuals with washing and cleanliness OCD tend to believe that the COVID pandemic has proven to everyone else how important practicing good hygiene really is, so that their obsessions over contamination is really the best way to protect oneself from life-threatening illnesses.