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Obsessive compulsive disorder coronavirus COVID-19 coping
Illustration by Callum Abbott

How OCD sufferers are coping with the coronavirus outbreak

As the COVID-19 pandemic continues, those with obsessive compulsive disorders are turning to new methods to control their conditions

As the situation around COVID-19 continues to progress, I feel an eerie sense of calm, despite (or perhaps due to) being a lifelong obsessive compulsive. When I first heard about the coronavirus earlier this year, I had just read Ling Ma’s novel Severance, in which a pandemic called Shen Fever obliterates much of the global population. With the plot in recent memory, I went through every eventuality in my head: anticipating its arrival in Europe, a full lockdown, imminent plans being cancelled, and my loved ones getting sick or dying. I am not a pessimist by nature, but my obsessive compulsive disorder partly manifests as catastrophising, which essentially means I assume the worst outcome of every situation and prepare for it. Being a constant disaster planner is a mentally exhausting role that robs me of potential spontaneity or joy, but it does give me the illusion of control.

OCD presents in different ways for different people, and is complex to define as much of it is invisible. For most, it’s a case of having intrusive or unpleasant thoughts or images that appear to come from nowhere and won’t go away. A compulsion is an attempt to get rid of the thought or alleviate guilt if the thought is ‘bad’. Sometimes it’s as straightforward as checking the stove to ‘prevent fire’, but other times it’s less so, like repeating an unrelated action or mantra a certain amount of times. While the way they play out varies from person to person, most people’s obsessive compulsive disorder revolves around control: we want to stop bad things from happening.

Understandably, a crisis of any kind can be a trigger, regardless of how your OCD presents. Jeff Szymanski, Executive Director of the International OCD Foundation, says that this is partly because “a core struggle for individuals with OCD is an intolerance for uncertainty”. Craig Shirley, clinical lead of the OCD Treatment Centre, adds that right now, “the common drivers of wanting to feel safer, certain, and in control make rational sense for anyone,” but if you have OCD, “we demand that we must be 100 per cent safe, 100 per cent certain and 100 per cent in control,” which means we are “always going to fall short, causing feelings of hopelessness, helplessness and increased desperation.” This can cause even recovered people to fall back into old habits.

“We have been observing that some individuals who have received effective treatment in the past that are faring better than the average person. We think this might be because they have been practicing the skill of embracing uncertainty” – Craig Shirley

While OCD doesn’t manifest only as the stereotypical hand washing routines many have come to associate with the disorder, it is one facet that’s disrupting sufferers’ wellbeing. When you’ve trained yourself, either through CBT or alone, out of compulsively washing your hands, knowing that you have to wash ritualistically (with song!) and regularly to “keep people safe” is fuel to a preexisting fire, especially as sufferers often already feel an intense responsibility to others. Additionally, Shirley adds, “this reinforces that a compulsive hand wash at this stage is no longer an irrational thing to do.”

A key part of OCD recovery is understanding the difference between rational and irrational responses to thoughts. For those who are preoccupied with germs, death or illness, those obsessions have become less abstract spectres and more a very real threat. It’s hard to draw the line between a healthy amount of checking in on loved ones and following government advice and an obsessive compulsive amount. Rebecca, 29, has OCD that presents as repetitive thoughts of dying. She noticed herself becoming sensitive to the potential symptoms: “I became obsessed earlier this week with checking mine and my children's temperature,” she says, adding that under the circumstances, it was easy to dismiss these actions as normal.

Ruth, aged 27, suffers with Pure O, a type of OCD that solely consists of obsessive thoughts. She has intrusive thoughts about her own health and behaviour, as well as the wellness of her loved ones. “I know exactly how many times I usually pee a day, or how often I get hungry, or my usual temperature, so I’m hyper-fixated on any of those things being slightly off,” she says, adding that she’s found herself checking her own body more regularly and checking in on her family. “I’m having lots of intrusive thoughts about my mum and dad getting it, and experiencing those really clear and detailed visual intrusive thoughts of them in hospital, even though they’re both fine,” she says. 

“Most people are not washing their hands to rid themselves of a feeling, even in light of the pandemic. The anchor here needs to be: ‘what would I be doing if I didn't have OCD?'. Then stick to that as much as possible” – Craig Shirley

It’s the aforementioned uncertainty that’s most difficult for many. OCD often presents as an intense need to control an uncontrollable world through rituals, mantras, and actions that are hard to rationalise to non-sufferers. When everything around us is so rapidly spinning out of control with new developments every day, it’s understandable that even ostensibly recovered obsessive compulsives would turn to old, harmful coping mechanisms. “Struggling with OCD in the past was a lot about controlling things outside of myself,” says Rebecca, adding that with COVID-19, she’s been overcoming the urge to control with hypnotherapy and starting a support group to help others.

For those who’ve been diagnosed for a while, like Rebecca, employing usual coping methods can be second nature. But for those at the start of their journey, this is a huge curveball and a test of their resolve. Chloé, 26, says that she didn’t get diagnosed until a month before this. “I’m barely coping. I’m attempting to distract myself from intrusive thoughts, taking my medication, and trying to establish a routine,” she says, adding that she’s struggled to find a way to transition to teletherapy. After losing the support of her workout routine and therapy, Chloé is turning to anxiety-specific podcasts and facetiming with friends, but is still struggling with the uncertainty.

Many people are unable to access their usual coping methods right now. Face to face therapy is out, so a dependable release has been pulled from people who rely on it. Exposure therapy, which involves confronting fears in a controlled way, is also on hold, as we all need to stay in and be incredibly careful right now. For people who have a usual therapist, Craig says to reach out and ask whether they are offering online support via ZOOM or Skype. “If not, then there are plenty of online therapy services that offer such a service,” he adds. Jeff agrees, and says that teletherapy has been proven to be as effective as in-person treatment. Additionally, the foundation has put together several resources.

“Try to sit with your anxiety, rather than automatically take it away or reduce it” – Craig Shirley

Even for those who considered their OCD under control, this coronavirus is a test none of us could have anticipated. Craig reassures me that a certain degree of anxiety is totally understandable: “Try to sit with it, rather than automatically take it away or reduce it,” he says. One challenge for sufferers is identifying a normal level of precaution. Craig says that it’s important to follow government advice, particularly with handwashing, but not take it any further: “Most people are not washing their hands to rid themselves of a feeling, even in light of the pandemic. The anchor here needs to be: ‘what would I be doing if I didn't have OCD?'. Then stick to that as much as possible.” He says, adding that “if you are washing your hands, based on a sudden, overwhelming urge to do so, then it is likely to be OCD.”

On the surface, the disrupted routine, ritualisation and general terror right now seems like a recipe for OCD hell, but many are coping better than you’d expect. “We have been observing that some individuals who have received effective treatment in the past are faring better than the average person. We think this might be because they have been practicing the skill of embracing uncertainty,” says Jeff, but he adds that anyone struggling should consider seeking care

For some, the comfort comes from the false sense of security of being given rules: “as far as my brain’s concerned, I’m doing what I need to do to stay safe, so I will be fine,” says Ruth. Sufferers need to find a balance between sticking to government guidelines while being kind to themselves, reading the news but not too much news, and checking in to keep thoughts from turning to obsession. It’s normal, too, to feel a strange comfort: the entire world is anxious and following rigid rules right now, and if you’ve been living that way already, it might not feel all that different.