To Wash or Not to Wash: How the Coronavirus Crisis Affects Those with OCD

The coronavirus crisis affects most of us in various aspects. Many of us have experienced stress, anxiety, or distress due to concerns for health, economic challenges, and restrictions on our ability to move freely and meet others. We found ourselves having to deal with uncertainty regarding our health, social, and economic future.

However, for those dealing with Obsessive-Compulsive Disorder (OCD), the coronavirus crisis can have unique impacts due to the nature of the disorder. In this article, we will discuss some of these characteristics and suggest how to effectively cope with them.

Yossi, a 9-year-old boy, is very intelligent, and his mother describes him as the "pedant" of the family from a young age. He is orderly and clean, always ensuring an organized environment around him. He is a very conscientious and ethical child. Recently, since the onset of the coronavirus pandemic, his mother has sensed that something is not right. According to her, "Yossi 'strictly adheres' to the health ministry regulations, using a timer to ensure he washes his hands for the required 20 seconds and even adds another 10 seconds, saying: 'Just to be sure, because maybe I didn't wash thoroughly enough...'. It seems lately that the sink area has become a regular hangout for him, almost every hour. Yossi's mother feels that this behavior is extreme, and when she asked him why he washes his hands so often, he replied: 'I feel like there's unseen dirt and germs on me, and the soap and water clean them off.' Yossi's mother emphasizes: 'In principle, I'm glad I have a clean child. He also started cleaning the house, and I enjoy that, but I feel this preoccupation takes a lot of time.' So she wonders: 'Is this normal? Is this okay? Should I comment on it?'

What is Obsessive-Compulsive Disorder (OCD)?

This disorder, OCD, is characterized by the presence of intrusive and obsessive thoughts and compulsive behavior which follows these thoughts in an attempt to dispel or calm them.Obsessive thoughts are intrusive and involuntary thoughts or impulses that often cause distress or anxiety to those experiencing them. The person suffering from intrusive thoughts, also known as obsessions, feels a lack of control over the appearance or disappearance of these thoughts and makes efforts to ignore or repress them through other thoughts or actions. These thoughts often carry an irrational nature, and despite the individual's awareness of their lack of logic, it is difficult to stop obsessing over them. Obsessive thoughts often involve a fear of contamination or illness, concerns about harming others, or concerns about properly fulfilling commandments, and more.Compulsivity,compulsive behavior, is repetitive physical activity that the sufferer feels driven to perform in response to an obsessive thought. These physical actions take on the form of a "ritual" that cannot be deviated from, with the goal of alleviating anxiety or preventing the occurrence of some terrible event. For instance, repeatedly checking that the gas is turned off to prevent leakage and avert disaster. Common compulsive behaviors include repeated hand-washing, repeatedly checking that doors are locked, arranging objects in a specific, rigid manner, repetitive counting. Repeating words in prayer out of fear they were not said correctly is also considered a known compulsive action. Sufferers of the disorder spend significant portions of their day engaged in compulsive rituals, which cause them considerable distress and inconvenience. Diagnosis involves five key dimensions: the daily time spent on the disorder; the level of mental distress it causes; the extent of OCD's impact on daily functioning (studies and social relationships); the level of behavioral resistance towards obsessive symptoms; and perceived control over the problem.

Though those suffering from OCD continually deal with repetitive intrusive thoughts and/or compulsive behaviors which they find hard to stop, the content of these thoughts and the purpose of these behaviors vary greatly from person to person. Therefore, the coronavirus crisis has had vastly different impacts on different people. For example, some dealing with OCD unrelated to disease or cleanliness report being so preoccupied with their issues that they are not at all concerned with the coronavirus crisis and are not bothered by it; while others, the general stress surrounding the coronavirus crisis has led to an increase in their symptoms, for example, regarding issues of morality and the like. Those with OCD may experience a worsening of their condition, as the current preoccupation with cleanliness and sterility exacerbates their OCD symptoms, significantly increasing intrusive thoughts about contamination, obsessions, and washing, disinfecting, and cleaning actions. The crisis has created a real dilemma in coping and preventing worsening. On one hand, there is importance in adhering to the health ministry's recommendations, requiring heightened diligence by all, but on the other hand - excessive adherence, which may seem beneficial in these times, can lead to a gradual worsening of OCD symptoms related to contamination, disinfecting, and cleaning.

Therefore, the recommendation for coping at this time: adhere to the official instructions as they are, but do not exceed them. For example, when the health ministry's current guideline was to wash hands for 60 seconds every three hours - this should be implemented despite the urge to wash for longer and more frequently. So that the person with OCD can say to themselves: "Even though I followed the instructions precisely, I still feel the urge to continue washing, or still feel doubt whether I washed exactly as I should have. However, being familiar with the nature of OCD, I know these are obsessive thoughts and doubts, so I choose not to respond to them and not to add anything beyond carrying out the exact instructions". It is likely that when they turn off the tap after 60 seconds, those with OCD will still feel unsatisfied with how they washed. But the more they prevent themselves from washing further than necessary according to the guidelines, they are likely to discover that the discomfort dissipates by not cooperating with the obsessive intrusions. In this way, they can maintain their health on one hand, and not reinforce their OCD symptoms on the other.

In conclusion, the coronavirus crisis represents a complex period for many of us, presenting challenging health, mental, social, and economic realities. For those with OCD, this period may pose a unique challenge as it could intensify intrusive thoughts and compulsive behaviors. To assist those with OCD, it is important to recognize when actions are necessary to cope effectively, responsibly, and within accepted norms, and when behavior gives free rein to obsessions and allows them to control the individual.

Dina Ruda is a Cognitive Behavioral Psychotherapist T.B.C, Educational Consultant, Didactic Diagnostician and MOXO test evaluator.