Obsessive Compulsive Disorder in the times of COVID 19
Updated: Jun 14, 2020
Sarah heard the doorbell ring, it was her husband. It was protocol for him to hand over his office bag to her and enter the bathroom for a shower and wash his clothes on his way out. He was then allowed to greet the children. She scrubbed his bag, the doorbell button, the entire floor from the main door to the bathroom. As she finished scrubbing all the surfaces, it was time for her to bathe too. She first cleaned the bucket, mug, soap case, door knob where she had touched before she started bathing. It had to be clean because she had to touch these surfaces after her bath. After the first bath, she felt a sense of incompleteness and negligence. She told herself, “I didn’t scrub enough, I was too quick, it isn’t enough time to kill the germs.” So she did it all over again. While bathing the splashes of water must have contaminated the wall in the bathroom as well. So she took to cleaning the walls, scrubbed them 3-4 times as doing it just once didn’t suffice. She then realised, “ The dirty water splashed on my body as well, while cleaning the wall.” She had also touched the water faucet while cleaning the wall. The charade began again, she cleaned the water faucet, bucket, mug and took a bath all over again. She thought to herself, “It has been a while since I have been inside the bathroom. My son has knocked on the door twice; it must be an hour atleast. ”She decided to leave the bathroom, “I am going to just wear my gown and leave. I am tired of this cleaning.” She washed her hands once but the thought of leaving filled her with anxiety, restlessness and panic. Her thoughts started racing, “I don’t want to acquire an infection. I cook in the house, feed my children and negligence will cause me and my family to fall ill.” The moment she decided to stay back and opened the tap once more to wash; her anxiety diminished but it was replaced by a sense of helplessness and disgust. She was well aware that she was stuck in a vicious cycle. “I am a slave to my thoughts; I have tried to stop, distract or even ignore but nothing works. I don’t want to take so long” Her hands had begun to peel; this was the third bath since morning. What is OCD? How can I know if I have it?
In today’s time people use the term OCD very loosely. It has become an internet diagnosis. It is often used interchangeably with perfectionist or tidiness. OCD or Obsessive Compulsive Disorder is a psychiatric diagnosis and can be made by a mental health professional only after history and mental state examination. Obsessions are episodic, irresistible, uncontrollable, repeated thoughts which are often unwanted in nature. Compulsions are actions which follow the obsessional thought and render temporary relief to the patient from the obsession. After the completion of the compulsion the obsessional thought emerges again and the vicious thought cycle continues.
What is OCPD (Obsessive Compulsive Personality Disorder)? How is it different from OCD?
OCPD is a personality trait of being very meticulous, particular and rule bound. It is present since early days and unlike a disorder does not have a time of onset. OCD and OCPD are distinctly different diagnosis but often misunderstood.
What is Contamination OCD?
Contamination OCD is a type of Obsessive Compulsive Disorder, where you are afraid that a surface, thing or hands may not be clean and germ free, and may contaminate something else, which ultimately could cause illness, and you will be responsible.
The compulsions consist of excessive and multiple hand washing, cleaning surfaces repeatedly, taking hours to bathe or visit the washroom, etc What are the difficulties faced by OCD patients due to COVID 19? In the current times, people suffering from OCD of contamination are finding it the most difficult to cope. It is infact true that OCD may take advantage of your COVID 19 fears Anxiety associated with OCD may be replaced by Fear. Now all their hand washing compulsions are justified and a fear of contracting a deadly illness grips them. There is a very high possibility of developing depression secondary to the helplessness created by the thoughts and compulsions
The current public health directives create a lot of indecisiveness for OCD patients. They are constantly caught between what to do and how much is too much.
There is a very fine line between caution and over reaction. Thoughts commonly haunting patients of OCD currently are:-
“I am the only one stuck like this, everyone around me is managing so well” “I am never going to get better” “All my fears have seen the light of day” “I want to stop washing REPEATEDLY but the anxiety is too much if I avoid it” “I will make a mistake; me and my family will suffer because of it.” Stressful periods bring out the best and worst in people.
What rules can an OCD patient bear in mind while washing hands?
- Wash your hands for 20 seconds only at a time and then close the tap/faucet. - Wash your hands only once at a time, if you’re tempted to go back and wash again DON’T. - You don’t need to wash hands every hour if you’re at home.
What are the cues to wash hands if one is staying at home?
You can wash your hands:- -Before and after a meal -Before and after visiting the washroom -Before, during and after cooking -After sneezing or coughing -If you have returned from outside -Touched an item which has come from outside -Caring for a sick person -After handling waste
What precautions should I observe regarding disinfection of the house?
- If you or any of the members in the house haven’t left the house all day and there has been no item from outside that has come into your house, you need not wash your hand repeatedly. - Frequently touched items can be disinfected once a day - Parts of the house which are not accessed or touched daily need not be disinfected daily.
What are the things to be borne in mind regarding news, social media and public health guidelines?
- Keep in mind that Public health guidelines are made keeping in mind the general population who may not wash hands very regularly - Stop your temptation to learn everything in the news. Spend only 10 minutes a day on following the news. - Do not read forwarded messages, videos, memes and random news based on COVID 19 - Keep yourself informed from reliable sources only, Do not avoid the news - Do not resort to checking on social media often. - Set temporary goals for this ‘new normal’ that we live in. What precautions to be taken while talking to family members and friends? - During conversations with people stay focused on facts not predictions about future and emotional disturbance. - Stay connected to your loved ones through various modes on the internet.
What are some general guidelines which I can follow for better mental health?
-Don’t ignore your own thoughts and feelings -Stick to/create healthy habits in this lock down period
-Drink plenty of water. -Maintain a good sleep hygiene, which includes:- 1 Going to bed at a fixed time daily, waking up at a fixed time. 2 Meals to be taken 2 hours before bedtime. 3 Avoid caffeine and alcohol few hours before bedtime. 4 Keep all Gadgets away at least an hour before bedtime. 5 40 minutes of physical exercise daily. (At home only) 6 Daytime sleep if required less than 30 minutes. - Maintain a gratitude diary- write down daily atleast one thing that you are thankful for. - Be compassionate to yourself, don’t hate yourself or your mind. - Relaxation and Meditation exercise. There is a link provided for a 3 minute meditation exercise.
- Dr Nahid Dave