The unprecedented pandemic COVID-19 has affected everyone badly around the globe. It is most importantly a public health emergency; however, it is likewise stressing the mental health of individuals over the world. Sadly, it has aggravated anxiety and Obsessive-Compulsive Disorder (OCD) among people.

In order to understand the link between OCD and COVID-19, I bring to you one of the foremost experts on a critical topic: OCD management during COVID-19. Ms Abia has more than 15 years of clinical and teaching experience in various prestigious institutions of Pakistan, and has served as a full time faculty in University of The Punjab, Government College University (Lahore), Punjab Institute of Mental Health and Beaconhouse National University. She is currently working in Forman Christian College University.

What is OCD?

OCD is clinical disorder consisting of a set of clinical symptoms like persistent and recurrent thoughts and or images.  Theses recurrent thoughts and images are very stressful for the person experiencing them as they cannot control nor wash those thoughts away.

Do obsessions always come with compulsions?

Yes, it is very much possible. However, many clients only experience obsessions in absence of compulsions. This is mostly evident in early stages of the problem.

What are some examples of obsessions?

Obsessions and compulsions are always based on a specific thematic pattern which is likely to be varied among clients. The obsessive themes also vary across cultures, for instance, in western cultures fear of catching illness, fear of being contaminated with germs, and sexual obsessions are common. In eastern cultures particularly in Asian countries sexual images, losing a loved one, cleanliness, and thoughts and images related to religion are more common.

What are some examples of compulsions?

Compulsions are actually combination of rituals that an individual carries out to undo the stress created by obsessions. Common examples are frequently and repeatedly washing hands or other body parts (or spending unnecessarily long time in washing), counting rituals (counting and recounting several times) organizing things several times and in particular order, following/ sticking to very rigid/inflexible patterns etc.

Does OCD have many facets?  Can OCD often arise in different ways depending on the individual?

Yes it does. Although, the basic symptom typography is likely to remain consistent (the condition is always marked with repeated, intrusive thoughts {likely to be accompanied by rituals}, significant anxiety and stress related to those thoughts, the themes of obsessions and compulsions, the symptom severity and frequency and comorbid conditions are significant different.    

What triggers OCD?

It can be result of interplay of multiple biopsychosocial factors, but in most the cases it is precipitated by extreme stress.

What are the risk factors for OCD?

The common risk factors include biological vulnerability (family history, personal vulnerability, past history of OCD), age (young adults are more vulnerable), stress (past and current stressful events/ experiences) and personality characteristics.

What causes OCD to worsen?

Stressful life experiences, lack of functional coping, and lack of emotional support.

What are different levels of OCD with reference to severity?

The condition can have different levels of severity like mild, moderate and severe or on the basis of duration like acute or chronic.

What happens in the type of OCD that is mainly related to contamination and health?

These clients remain worried and overly anxious to get exposed to different germs and contracting severe illnesses in result of that exposure.

Could the pandemic COVID-19 result in more people developing OCD?

There is high likelihood; the serious concern had already been shared by many experts on international professional forums right at the start of the current pandemic. Clinicians and researchers have also reported not only the significant rise in new reported cases but relapse of old clients (who are in different stages of recovery) and increase in intensity of the disorder in old clients as well. Detailed reports can be accessed at official websites of WHO, American Psychological and American Psychiatric Associations and Websites of Health departments of many countries. However, we do not have accurate statistical data of local clients but clinical psychologists working in public and private health facilities have been reporting the above-mentioned trend. Many old clients are also reporting to develop new psychological disorders along with OCD.

To protect ourselves from Covid-19, it is advised to frequently wash hands, but people with OCD could end up doing it too much. How can COVID-19 make OCD symptoms worse?

As a majority of OCD patients are worried about getting contaminated with germs, have feeling of being unclean/impure (“napaaki” as they report) and use washing rituals to undo their stress, the current pandemic can easily escalate their symptoms as it provides them a rationale to justify their rituals.

During self-isolation, almost everyone is too much exposed towards social media. Is social media playing negative role for people who have OCD?

Indeed it is. Due to lack of screening over social media, people generally end up getting invalid information which doesn’t do any good to them. And most of the protocols issued by reputed professional bodies advice clinicians to suggest their OCD clients to restrict the use of social media (particularly using material from social networking sites). Clients are most likely to get emotionally overwhelmed not only from inaccurate information but also due to an increased exposure to pandemic related statistics.

How can people with OCD use social media productively?

They can use it for maintaining positive social interaction and as a mean of strengthening effective social support but should strictly refrain themselves from using social media sites as a source of information.

What roles family members, friends and relatives can play to help person who has OCD?

They should help clients by providing emotional support, assisting them to keep their stress under control by engaging them in pleasant activities, by sticking to structured routines, and by showing compliance towards treatment regime.

Is self-help an option with OCD?

Only if it is used for some basic relaxation exercises. Otherwise, these techniques only provide a temporary distraction or relief and do not do any good in the long run.   

As the COVID-19 pandemic continues, what coping mechanisms OCD sufferers need to adopt to control their conditions? What is the advice for people with OCD during the pandemic?

• Staying relaxed, exercise, good quality of sleep and good nutrition will be helpful.
• Schedule a routine and stick to it.
• Limit access to COVID-19 coverage.
• Do not get worried about things that are beyond your control.
• Keep a track of your thoughts and feelings and share these with your family, friends or some supportive contact.
• Focus on positives and practice relaxation exercises (even deep breathing and basic meditation will help).
• Get involved in at least one pleasant / leisure activity a day.
• Get yourself involved in carrying out even some small domestic chores etc.

What should be done when self-help does not work and OCD symptoms get worse?

They should immediately get in contact with health professionals; clinical psychologists and in some cases psychiatrists. Most of the health professionals are available for online sessions (even in Pakistan professionals have shifted on online services to assist their clients.)             

Thank you Ms Abia for sharing your expert opinion and precious time.

Health disclaimer: This interview provides general information about mental health and related subjects. The information and other content provided in this interview should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. If you or any other person has a medical concern, you should consult with your health care provider or seek other professional medical treatment. Never disregard professional medical advice or delay in seeking it because of something that have read on this blog. If you think you may have a medical emergency, call your doctor or emergency services immediately.