OCD, Anxiety & the Pandemic
By Nicole McCue, Youth Program Coordinator
The pandemic has created feelings of isolation, stress, and fear. This experience has been overwhelming and exhausting for the vast majority of the population but has taken an especially large toll on those with pre-existing mental health conditions. The stressors brought on by the pandemic have caused both an increase in rates of mental health conditions and a worsening of existing symptoms. Of particular interest is the effect of the pandemic on those experiencing contamination OCD (Obsessive Compulsive Disorder) and health anxiety, two conditions that are directly related to fear of the spread of disease.
Contamination OCD
OCD is marked by unreasonable and obsessive thoughts and fears that lead an individual to use compulsive behaviors in an attempt to quell anxiety. The pandemic has had an especially large impact on those that live with contamination OCD. Contamination OCD, characterized by the obsessive fear of contracting or spreading disease, is the primary OCD subtype for 30 percent of those diagnosed with the condition. The worsening of symptoms in those with contamination OCD during viral outbreaks has been well documented throughout history; the increase of OCD symptom severity was observed during SARS, MERS, and influenza outbreaks. COVID has been responsible for a similar effect. When contamination anxiety overwhelms an individual it leads to an increase in behaviors used to make the feared outcome feel less likely, such as excessive sanitization procedures. COVID guidelines can cause a deepening of OCD fears as they may make intrusive thoughts about disease spread feel more justified and logical to the individual. A common experience of those struggling with intrusive COVID thoughts is following guidelines to an unreasonable degree. This can mean being constantly tested, excessively washing hands, and social distancing to an unnecessary degree. Making the situation even more difficult to navigate, the pandemic has affected the use of coping strategies for those with contamination OCD. A common coping strategy for someone with OCD is challenging intrusive thoughts with more realistic ones. Someone with contamination fears may challenge their belief that it is necessary to avoid others in public with the idea that their chances of spreading sickness to others are realistically low. However, current social distancing guidelines affect this thought challenge because they may serve to confirm the individual’s belief that sickness does spread easily, and therefore it is beneficial to avoid close contact with others.
Health Anxiety
Health anxiety (previously known as hypochondria) is a form of anxiety disorder characterized by an intense fear of developing a serious physical condition. Someone with health anxiety is likely to interpret the experience of minor symptoms or changes in bodily sensations as being indicative of an underlying physical illness. Health anxiety is fairly common, and while we lack accurate statistics, it is estimated to affect 4-5% of people to some severity. The beginning of the pandemic was particularly daunting for those with health anxiety as there was much that was unknown about the virus. This lack of research left people with primarily anecdotal stories that often were heavy on shock value, leading those with health anxiety to feel as though the outcomes of COVID were more debilitating than they often are. A common behavioral symptom of health anxiety is excessively researching perceived symptoms and being more easily led to believe that any of their symptoms could be a result of an underlying illness, such as COVID. Those with health anxiety are more sensitive and worried about minor changes to the body, so armed with Google results lacking clarity surrounding symptoms, effects, and outcomes of COVID, some found themselves consistently worried that they had contracted the virus. Adding to the fear of actually having COVID, those with this form of anxiety are more likely to overestimate the likelihood of developing complications from the virus. Similar to how COVID safety guidelines can justify someone with contamination OCD’s excessive sanitization measures, a focus on monitoring potential symptoms can serve to confirm someone with health anxiety that their preoccupation with physical health could be necessary.
Hope and Treatment
Many articles about how those with OCD and anxiety have been affected by COVID were written during the early months of the pandemic- a time when standardized safety procedures, research, and availability of vaccines were lacking. Newfound knowledge about the virus has given both mental health providers and affected individuals tools for coping with pandemic-related anxiety. There is hope: Therapy is proven to be effective in lessening the severity of symptoms that result from OCD and anxiety disorders. There are multiple ways in which mental health providers can help to treat pandemic-related fears.
The first is by addressing cognitive distortions, which are maladaptive thought patterns that both arise from and perpetuate distressing mental health symptoms. A common cognitive distortion for both discussed conditions is catastrophizing (overestimating how negative or problematic an issue is). An individual with contamination OCD may convince themselves that within the moments they were not wearing a mask at a coffee shop, they managed to spread the virus to everyone around them. Someone with health anxiety may believe that if they contract COVID, they will develop complications that they will not recover from. Both of these unrealistic beliefs about COVID are a result of catastrophizing, a cognitive distortion that can be challenged and replaced with a more realistic thought process with the help of a therapist. Another example of a cognitive distortion characteristic of both conditions is the minimization of positives related to the virus. For example, individuals may ignore statistics demonstrating that if fully vaccinated, it is highly unlikely that one will experience severe symptoms or complications related to the virus. A therapist can help clients to challenge their beliefs about how likely they, or those around them, are to be seriously affected by COVID. Another benefit of therapy for these individuals is learning to monitor and avoid triggers that worsen fears, such as looking up information about symptoms, repeatedly being tested, and consuming dramatized information about outbreaks. These behaviors can be replaced with coping strategies that help an individual to lessen rumination about the virus and embrace the uncertainty presented by the pandemic. Finally, specific to contamination OCD, experts explain that mental health providers often develop a basic COVID safety plan for clients. The individual is instructed to stick to this plan, and nothing more, so that they can follow guidelines without deepening maladaptive OCD symptoms.
Seeking mental health support during this time is a vital piece of the recovery process for those living with contamination OCD and health anxiety. Despite the multitude of challenges brought on by the pandemic, those experiencing COVID-related mental health symptoms are capable of both resiliency and healing.