I have been debating about whether or not to write this article since COVID-19 has not triggered my Contamination OCD. I’m triggered by things like insects, but not diseases or cleanliness. Given the above, I did not feel qualified to write an article about this pandemic. But then someone from the OCD community stated on Twitter that they’d rather die than deal with how intense their intrusive thoughts had become. Their statement was not hyperbolic, they genuinely wanted to die (they’re okay now). At this point, I realized I do have something to say concerning COVID-19 and OCD, and that I need to say it.
This article is more emotionally driven than my usual writings. I have serious concerns over how people are appropriating and downplaying OCD during this crisis. Some passages may appear accusatory. Note that I am not accusing anyone in particular, and especially not the reader, nor am I trying to inflame. Most of the issues addressed herein highlight unintentional damage done by the public to those with OCD due to a lack of education. My use of second-person in certain section aims to make the message more direct, and hopefully more emotionally impactful. Separately, it will be useful, though not necessary, to read my article “What is OCD Really?” before reading this article.
Alright everyone, clap through this sentence together:
Washing. Your. Hands. Properly. Does. Not. Make. You. Feel. Like. You. Have. O.C.D.
Let’s perform a second sentence:
Cleaning. Your. House. Does. Not. Satisfy. Your. O.C.D.
Obsessive-Compulsive Disorder centers around involuntary, intrusive thoughts that often attacking your moral character, and causes harmful, ritualistic compulsions to temporarily, and ineffectively, hold back the intrusive thoughts. People with Contamination OCD that clean repeatedly do so compulsively, i.e. they don’t want to constantly clean, they feel compelled to do so lest some terrifying, sufferer-specific danger occurs. COVID-19 now dominates that fear for many sufferers, and confounds their treatment.
Exposure and Response Prevention (ERP) remains one of the most effective and widespread treatments for OCD. ERP centers around intentionally approaching obsessive fears, and then actively preventing compulsive responses. The treatment often takes a long time, as each individual threat must be addressed, and each fears’ treatment must be done in steps as to not overwhelm a patient. For Contamination OCD, ERP often involves coming into contact with the perceived contamination, and then not cleaning up or washing your hands afterward. Using my fear of insects as an example, ERP may consist of the following steps:
- Gently placing a cotton ball on the back of a cockroach, putting it in a zipped bag, and carrying the bag with me
- Take out the cotton ball, and mindfully hold it
- Sit in the same room with the cockroach
- Attend coworkers’ presentations about the cockroach
- Place my hand on the substrate next to a cockroach
- Let the cockroach crawl over my hand if it chooses to do so
- Hold the cockroach
- Present with the cockroach
I cannot wash my hands during any of these steps, and must not repress what that cotton ball has touched. By acting in opposition to my obsessions and resisting my compulsions, my brain learns to disassociate the two since nothing negative happened.
The current pandemic requires hand washing, which affirms a sufferer’s obsessions and encourages compulsive behavior. Imagine that you have severe Contamination OCD, and have been practicing touching doorknobs before shaking someone’s hand without washing your hands beforehand (that’s a lot of hands). COVID-19 health protocols require we wash our hands frequently and stay six feet away from everyone. Now your brain connects your obsessive hand washing with your lack of COVID-19, and starts to re-believe the intrusive thoughts about all surfaces containing disease:
I have to wash my hands or I’ll get COVID-19.
I don’t have the virus, so my excessive hand washing has always worked.
I can’t get sick, I might kill people!
I need to wash my hands more. It worked, so it must work again.
I touched that doorknob, what if someone with COVID-19 touched it?
I have COVID-19. I know I do.
Nope, I have it.
I need to wash my hands.
What if I kill someone?
I need to wash my hands.
I need to wash my hands.
I need to. I have to.
I can’t kill.
You were over-washing your hands before the pandemic, almost overcame the compulsion, and now the framework collapsed under your feet. You’ve not just reverted to old compulsions, but slammed the car into reverse on the freeway.
Whenever I here someone associating their new handwashing vigilance with OCD, I fill with a mixture of disgust, sorrow, and anger. So many people with OCD have been spiraling and panicking—scrubbing walls on repeat, hyperventilating whenever the news plays—that hearing such casual misrepresentations pain me. Empathy scratches at my heart for those bleeding, and anger swells at sheer lack of education and understanding by the majority. The physical actions and associated emotions of standard health practices cannot hold a candle to those of compulsions. What better way to demonstrate this discrepancy than via a media gallery? First, let’s go over how most people washed their hands before the pandemic:
Now let’s review the correct way to wash your hands (the method everyone should always be using):
- 20 seconds minimum
- Under fingernails
- Between fingers, make sure to alternate lacing to get all surfaces
- Turn faucet off with a towel, if applicable
And now for the hands of OCD:
A friend of mine sent me these images for this article. They’re in their early twenties. You can now see why calling proper handwashing “OCD” is just a bit paste. Let’s return to the first clapped sentence: “Washing your hands properly does not make you feel like you have OCD.” Moving from a terrible washing routine to the health standard does not mean you’re “totally OCD.” Rather, it means you’re finally doing the required minimum. You’re not feeling compelled by intrusive thoughts to wash. You’re not terrified that you’re going to personally infect everyone around you. You are simply doing what you need to given the current pandemic. Compulsive hand washing results in self-harm—not necessarily with the intent to harm, more often as a result of the excessive washing, but some cases may involve intentionality. Sadly, the COVID-19/OCD relationship doesn’t end with damaged hands.
Non-OCD Obsessive-Compulsive Behaviors
I need to make a quick, but important, note about people without OCD who have recently begun to wash their hands to the point of bleeding. People with anxiety or chronic mental health disorders can develop Obsessive-Compulsive Behaviors in response to high stress. A person with ADHD, bipolar, anxiety, etc. may now be washing to a fault. The message of this article fully applies to them as well.
Dana Jay Bein, a comedian, wrote a COVID-19 parody of “Bohemian Rhapsody” in a Twitter thread. There’s one line in the song of particular importance to OCD: “i didn’t stay inside in bed. I walked by him, now he’s dead.” Refer back to my Norovirus example in “What is OCD Really?” A person with OCD may literally believe that they have killed family, friends, and strangers by giving them COVID-19, regardless of actual infection. They have killed those around them, not the virus. In cases of high Thought-Action Fusion—believing that one’s thoughts carry the same moral implications as their actions—this pandemic can tear the sufferer into pieces as they take upon themselves the burden of many involuntary murders.
So I keep conjuring, sometimes I wonder where these thoughts spawn from“The Monster” by Eminem
Flippant comments about OCD isolate sufferers. When someone with OCD struggles with moral terror and bleeding hands, a remark like “My house is so clean now. I must have OCD.” leaves the sufferer believing that no one understands them: they’re a freak; they’re damaged; no one will care for or empathize with them. If the public dismisses OCD as a casual joke, then people with OCD will fear ridicule if they ask for help. I’ve had friends shunned by their friends or coworkers when they have tried to turn a thoughtless joke about OCD into a teaching moment. Now that they’ve been shamed for their disorder, why would they try again? They withdraw further into their windowless fortress, edging ever closer to the knife, the gun, the rope.
Fortunately, there’s a lot you can do to support your friends, family, and coworkers who suffer from OCD—especially during this pandemic. First, don’t make jokes concerning OCD. Humor has its place and its time, but uneducated remarks during a pandemic do not constitute either. If you’re loved one expresses obsessive-compulsive behaviors, support them, love them, and encourage them to seek professional help. The last point can be a difficult topic to broach, but therapy can work wonders over the long-term. Most therapy must be done online currently, but the benefits remain huge. Make sure to seek out a therapist with experience in OCD. Now is not the time to give a non-OCD-experienced therapist a trial run. If they refuse therapy, never force them to do so. Continue to love and support them. Stay in contact: a text or two a day helps remove the sense of isolation and grants them a lifeline. If they begin to express their fears, their thoughts, listen. Telling someone without OCD about your intrusive thoughts is terrifying. How do you explain to someone how you’re constantly fighting thoughts about how you’ll somehow kill people, abuse children, or cheat on a spouse? If they’re discussing their thoughts, they trust you immensely. Respect that trust, don’t betray it, and listen thoughtfully. Here’s the hard part: validate their fears without fixing them. Non-professionals attempting to “fix” compulsions typically do so via accommodation and reassurance, both of which make OCD worse. And finally, educate yourself and those around you about OCD. You’re currently reading a blog about OCD, so you’re three steps ahead of the curve already. My Resources tab contains links to mental health organizations such as the International OCD Foundation, government resources, and the National Suicide Prevention Hotline (1-800-273-8255). Through education, you can help eliminate damaging remarks, prepare for a loved one coming out, and know where to turn if they begin expressing suicidal ideations. Your support can make all the difference, and I believe in you.
Have a great day and always practice self-compassion!A Fantastic Friend of Mine