One Of The Major Psychiatric Concerns Posed By The COVID-19 Pandemic Is The Impact It Has Had Globally On Patients Suffering From Obsessive Compulsive Disorder(OCD).
One of the major psychiatric concerns posed by the COVID-19 pandemic is the impact it has had globally on patients suffering from Obsessive Compulsive Disorder(OCD).2-3% of the general population suffer from this condition which is prevalent among children as well(boys being represented more than girls).The current guidelines mention washing hands for 20 seconds,showering,cleaning contaminated surfaces with a sanitiser at least 60% alcohol,social distancing and covering mouth with elbow during coughing and sneezing.These guidelines act as reinforcers for patients with OCD leading to the misconception that "having OCD is OK".This has to be dispelled.Hence this post to clarify some of the myths.
1.Covid-19 may increase OCD because of the information overload,fear of uncertainty and specific cognitive distortions that lead to fear mongering.
2.Health anxiety lies along a spectrum ranging from NORMAL to Pathological
(as in OCD,Generalised Anxiety Disorder,Panic Disorder,Phobias and Hypochondriasis)
3.The following subset of individuals are predisposed to develop OCD
•Pre-existing subclinical OCD
•Anxiety disorders
•Anxiety sensitivity
•Disgust sensitivity
•Positive family history
4.Impact of COVID-19 on OCD may manifest as New onset as well as relapse of OCD triggered by
•Anxiety,stress and depression
•Discontinuation of medicines
•Discontinuation of Behaviour Therapy
•Fear of infection and COVID-19 guidelines
5.Typical symptoms of OCD in the current context include
•Fear of getting infected
•Fear of spreading infection
•Fear of quarantine and its consequences
•Fear about self and close ones
•Fear about no access to treatment
•Fear about being careless and negligent
6.OCD is different from normal health anxiety and is characterized by
•Excessive cleaning,washing,bathing
•Compulsive checking of TV and Internet
•Seeking reassurance repeatedly
•Visiting clinics repeatedly,asking for tests
•Increased perfectionism
7.Hallmarks of OCD in the current scenario
•Morbid preoccupation with autonomic arousal
•Time consuming(more than 20 seconds of handwashing) and often until they are "satisfied" and "anxiety reduces"
•Distressing and impairing
•Exaggerated threat perception
•Increased avoidance and safety behaviours
•Newer methods of handwashing
•Trying to be "perfectionist"
8.Treatment options for OCD
•Drugs-SSRIs,Clomipramine
•Cognitive Behaviour Therapy
•Drugs+CBT
•Surgery(in rare cases)
9.Management principles in the current context
•Discourage safety behaviours and compulsions
•Avoid family accomodation
•Encourage essential safety measures
•Do not validate exaggerated fears
•Eliminate risks
10.How not to fall into the OCD trap?
•Only 5-10 minutes a day on gathering information
•No need to wear mask all the time
Dr Anshul Mahajan
Consultant Psychiatrist