“I’m so OCD” – Reality of Obsessive-Compulsive Disorder during the COVID-19 Pandemic

You’ve likely heard your family, friends, or even yourself describing behaviours using the term obsessive-compulsive disorder (OCD), for instance: “That’s such an OCD thing” or “I’m so OCD”. Whilst it is fun to throw the term around, OCD is ranked as one of the top 10 most debilitating illnesses by the World Health Organisation (2018) and cost $8.4 billion in 1990, 18% of anxiety disorder costs (DuPont et al., 1995), in the USA. This means that anything that worsens OCD is something of the upmost concern, both psychologically and economically. This detrimental and costly disorder is at risk of being worsened by COVID-19, with negative consequences that may outlast the pandemic (Asmundson, 2020), making them vital research areas. At present, there are only a handful of studies that have investigated this topic, such as case studies and a recent survey, but first: what is OCD?

Since its identification by Wilhelm Griesinger (1817 – 1868), OCD has become a world-wide known disorder, with prevalence rates of 2% (Ruscio et al., 2010). This disorder is characterised by obsessions, recurrent thoughts and urges causing anxiety, which are accompanied by compulsions, behaviours and/or mental acts to reduce said anxiety. You might be wondering; how do we know OCD patients are at risk during COVID-19? The risk of increased symptom severity of OCD, particularly the contamination subtype, has been linked with past pandemics, such as Zika Virus (Blakey and Abramowitz, 2017). This makes OCD a prime suspect for worsening during this pandemic. So, what do we know so far about OCD during COVID-19?

OCD during this pandemic has been investigated using case studies, as these can be complete reportedly give an insight into OCD sufferers. One example is a case report on an OCD patient known as ‘AB’ by French and Lyne (2020). This report highlighted that increasingly new reports of COVID-19 cases within Europe resulted in intensification of compulsive rituals, stress, and avoidance behaviours (French and Lyne, 2020). This case study indicates that COVID-19 leads to exacerbation of OCD behaviours. However, this is only one individual, how do we know that everyone with OCD experiences the same?

Thankfully, an online survey with 252 OCD suffers by Wheaton et al. (2021) published in June has investigated this. Around 76% of OCD patients reported the worsening of symptoms since the outbreak began, indicating that COVID-19 has had a drastically negative impact on OCD patients. Examples of change in OCD behaviours includes more ritualistic cleaning and increased experience of obsessions. The OCD patients also reported experiencing elevated COVID-19-related anxiety. This recent evidence gives a small glimpse into the damage that COVID-19 is having on individuals with OCD, which may undo any progress from treatment prior to the pandemic.

However, even this study has generalizability issues as there is a lack of representation of non-white OCD patients. In Wheaton et al.’s (2021) study, 60% of the sample were white, indicating a severe lack of understanding of how Black, Asian, and OCD patients of different ethnicities are impacted by the pandemic, tis especially important considering the neglect of minority groups during COVID. For instance, the death rate of indigenous people in Brazil because of COVID-19 is double the national average (Fellows et al., 2021). One potential implication of this could be that non-white OCD patients are more impacted than white OCD patients because the threat of death is higher in their ethnicity, resulting in increased anxiety and rituals. We currently only have an insight into the effect of COVID-19 on white OCD patients, limiting our understanding of the pandemics impact on all OCD patients.

Research into the reality of COVID-19 on OCD thus far only gives a short-term insight because of the recency of the pandemic. To understand OCD during this pandemic, we need to look at what happens long after COVID-19 is controlled, and begin research into the development of new OCD causes as a result of COVID-19. Therefore, we won’t know the damage done to OCD sufferers for years to come. In sum, it appears that COVID-19 has lead to an increase in symptom severity and anxiety, but the literature has a long way to go before we understand the reality of OCD during COVID-19.

References

Asmundson, G. J. G. (2020). Coronaphobia: Fear and the 2019-nCoV outbreak. Journal of Anxiety Disorders, 70, 102196.

Blakey, S. M., and Abramowitz, J. S. (2012). Psychological predictors of health anxiety in response to the zika virus. Journal of Clinical Psychology in Medical Settings, 24, 3 – 4, 270 – 278.

DuPont, R. L., Rice, D. P., Shiraki, S., Rowland, C. R. (1995). Economic costs of obsessive-compulsive disorder. Medial Interface, 8, 4, 102 – 109.

French, I., and Lyne, J. (2020). Acute exacerbation of OCD symptoms precipitated by media reports of COVID-19. Irish Journal of Psychological Medicine, 37, 4, 291 – 294.

Ruscio, A. M., Stein, D. J., and Chiu, W. T., and Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 53 – 63.

Wheaton, M. G., Ward, H. E., Silber, A., McIngvale, E., Bjögvisson, T. (2021). How is the COVID-19 pandemic affecting individuals with obsessive-compulsive disorder (OCD) symptoms? Journal of Anxiety Disorders, 81, 102410.

World Health Organisation. (2018). Social and economic impact of OCD, retrieved from: https://www.ocduk.org/ocd/world-health-organisation/

Illustration taken from The Washington Post; iStock.