Many people diagnosed with contamination-related Obsessive Compulsive Disorder (OCD) have been experiencing a substantial increase in symptoms during the COVID-19 pandemic. Experts predict the pandemic could also initiate an increase in those newly diagnosed with OCD. This article explores OCD’s manifestation and helpful ways to decrease anxiety caused by underlying fears.
“Obsessive-Compulsive Disorder (OCD) is a neuropsychiatric disorder characterized by recurrent distressing thoughts and repetitive behaviors or mental rituals performed to reduce anxiety,” (Fenske & Petersen, 2018). “Symptoms are often accompanied by feelings of shame and secrecy.”
Level of functioning and quality of life are both impacted by OCD, typically causing chronicity. Without effective treatment, clients can be significantly impaired due to a substantial delay in diagnosis and therefore treatment, at an average of 11 years (Fenske & Peterson).
Early identification and intervention is key with the onset of any symptomotology of mental illness. Synthesis of literature shows that silent suffering can lead to significant impairment with OCD.
Adapted from Fenske & Peterson (2018).
Clinical experts from the Obsessive-Compulsive Research Network of the European College of Neuropsychopharmacology, and the International College of Obsessive Compulsive Spectrum Disorders have released very practical guidance to help clinicians manage the complexity of OCD during COVID-19 (Fineberg, Amerigen, Drummond, et al., 2020), including suggesting clinicians:
Take a compassionate, calm, multicultural approach through the use of technology
Are certain the diagnosis of OCD is accurate and evaluate deferential diagnoses such as hypochondriasis and other obsessive-compulsive related disorders, and ensure history by evaluating level of insight, as well as pre-COVID-19 symptomotology
Assess suicidal risk especially for clients with comorbidities
Provide psychoeducation with balanced factual information about COVID-19, enhancing stress management
Evaluate internet and news usage and consumption which can exacerbate OCD and anxiety, limiting use to ½ hour in the morning and another ½ hour at night through “trusted sources” such as World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC)
Some of the approaches for remote treatment during COVID-19 include: a) medication management; b) cognitive behavioral therapy; c) mindfulness, and d) some aspects of exposure and response, such as working through the urge to check, obsessive thoughts of harm, symmetry and order obsessions. All of these can be managed at the client’s home, remotely while maintaining social distancing.
The guidance includes clinicians taking a supportive stance, as well as the safety of clients to ensure they are getting proper sleep, nutrition, and they are following CDC guidelines about washing. Careful consideration and guidance to clients to not go beyond the CDC guidelines about hand-washing and sanitizing. It is also recommended to help clients structure a daily routine which also includes physical activity, social connections with personal family or friends, and the use of a national helplines or professionals when in acute distress.
Family members may also need support during this time if their spouse or child is experiencing worsening symptoms. Coaching and support can be helpful for family members, while also sharing resources for families, such as National Alliance on Mental Illness (www.nami.org).
As a clinician, I have found CBT tools to be particularly beneficial for the clients I work with who are diagnosed with OCD. Two websites come to mind: Therapist Aid and Psychology Tools offer a variety of tools for clinicians to use, including: OCD thought recording logs; treatment toolkits; OCD exposure hierarchy; Socratic-questioning; core beliefs-examining the evidence, and more.
Though many clients diagnosed with OCD have sustained extra-difficult challenges during COVID-19, an active and intentional approach is helpful to enhance client knowledge, and empower intentionality through behavioral activation. These approaches have proven to be beneficial with the clients I work with.
OCD stems from deep-rooted fears, has a genetic component, and can be very difficult for someone to manage. It’s important to know it is not uncommon to have an increase in symptoms in the midst of the COVID-19 pandemic. It may also be helpful to know counselors can help lead you to experience smooth sailing. You and your family are not alone.
Providing a compassionate approach to every client, Teresa Jacobson is a Doctor of Behavioral Health and Licensed Professional Clinical Counselor Supervisor, who launched a private practice in April and is offering HIPAA-compliant telehealth counseling with substantial discounts to all Ohio adults through 2020. She is currently credentialed with UnitedHealthcare, OPTUM, and UMR, (Medicaid and private insurance). You can reach her by emailing firstname.lastname@example.org, calling (513) 234-9184, or visiting her website, www.jacobsoncounseling.org
Fenske, J.N., and Petersen, K. (2015, November 15). Obsessive-compulsive disorder: Diagnosis
and management, American Family Physician. 92, 10: 896-903.
Fineberg, N.A., Van Ameringen, M., Drummond L., et al. How to manage obsessive-compulsive disorder
(OCD) under COVID-19: A clinician's guide from the International College of Obsessive
Compulsive Spectrum Disorders (ICOCS) and the Obsessive-Compulsive Research Network
(OCRN) of the European College of Neuropsychopharmacology, Comprehensive Psychiatry (2020),
National Alliance on Mental Illness (NAMI). NAMI helpline: 1-800-950-NAMI (6264)
Psychology Tools (www.psychologytools.com)
Therapist Aid (www.therapistaid.com)