Hand-washing and sanitiser are getting a lot of airtime lately. When you have Obsessive Compulsive Disorder (OCD), following public health advice gets a lot more complicated. Nicole speaks to Abigail about what it's like to have Contamination OCD during an international virus outbreak and gets advice on healthy practices from a psychologist experienced in treating the illness.
This story contains challenging themes. If the subject of mental illness raises any concerns for you, please contact these relevant support services.
With such hype over COVID-19, it’s easy to forget that the world goes on and there are still young people suffering from all sorts of different illnesses. Especially illnesses where mass fear and anxiety can pose great risk as well. I was diagnosed with Obsessive Compulsive Disorder (OCD) back in 2018, and while my compulsions are more mental than physical, the nationwide hysteria right now is enough to have me ruminating over my every move.
So what’s Contamination OCD?
To put it simply, the ‘obsessive’ in OCD is essentially something you obsess over. It often keeps you awake at night or interrupts your day-to-day life. The International OCD Foundation notes that for people with Contamination OCD, this involves “the fear of becoming personally contaminated through one’s own actions, being contaminated by others or contaminating others.”
The compulsive side of things is actively seeking out something that alleviates that fear. With Contamination OCD this can include, but is not limited to, repetitive hand washing, showering, disinfecting one’s body, throwing away things that are thought to be contaminated, or avoiding certain people, places or objects seen as contaminated.
The most effective form of treatment for OCD is Exposure and Response Prevention (ERP) which entails the patient exposing themselves to those fears repeatedly and refraining from performing compulsions until the fear subsides. They’re required to do things like touch door handles or surfaces that they believe have been contaminated, while learning to resist and control the urge to disinfect their hands.
What does it have to do with COVID-19?
On an ordinary day, managing OCD might sound simple, but things start to get complicated when the World Health Organization (WHO) declares COVID-19 a pandemic.
“Wash your hands frequently, maintain a safe social distance and seek medical care if you’re feeling unwell,” the international health organisation’s website advises.
But seemingly simple instructions like these can be loaded with grey areas for people with OCD. Did I accidentally step too close to someone? What if 1.5 metres isn’t enough? What if I’m a rare case and I do have COVID-19 without displaying symptoms? What if the soap wasn’t strong enough? What if I didn’t wash my hands properly?
Abigail, 26, has had OCD since childhood but was formally diagnosed in 2016. She says while she had been steady in her recovery, the COVID-19 outbreak sent her spiralling. “My hands look gross! They were already covered with eczema and super dry and now they are sore and red from the excessive hand-washing.”
26-year-old Abigail was diagnosed with Obsessive Compulsive Disorder in 2016 | Supplied: Nicole Liko
For people like Abigail, this is just the beginning of an extremely difficult journey as the government continues to promote and upgrade health regulations.
“Hearing the safety requirements make me feel really uncomfortable because then I latch onto them as a rule, and if anyone doesn’t adhere to them I freak out. I was almost going to wash everything we got from the supermarket and I can’t tell if I’m genuinely unwell or whether my cough is psychosomatic”.
Safe hygiene or obsessions? How to know the difference
I spoke with psychologist Alex Panagiotopoulos to find out how people can continue to work on their recovery while still abiding by hygiene advice, and how we can all differentiate between normal safety concerns and obsessions.
Alex said that “treatment of OCD can still be implemented as long as you aren’t automatically engaging in hygienic behaviours or rituals because of an intrusive thought. For example, washing your hands for extended periods of time in case you didn’t wash properly for the last 20 seconds.”
Psychologist Alex Panagiotopoulos | Supplied: Nicole Liko
People with OCD need to be vigilant about frequency, intensity and duration of hygiene measures. They also need to be mindful of clear, direct reasons to engage in hygiene practices, such as before and after food handling, after blowing your nose, coughing, or sneezing, after touching rubbish, or after caring for someone at home who is sick.
According to Alex, a healthy amount of precaution is okay
For example, if you’re on public transport or in a crowded area, it would be reasonable to engage in hygienic practices regularly or to limit exposure. However, if you’re avoiding even stepping outside when necessary or going to the supermarket or chemist if you need to, then this is where it starts to look similar to overly avoidant behaviour. This is what we need to be careful of not engaging in when we have OCD.
Alex suggested engaging in specific, logical hygienic practices. Twenty seconds of washing is sufficient, and hands should only be washed with warm water and soap, not bleach or extremely hot water, for example.
“OCD is defined as anything that pervasively impacts quality of life,” he said, “Although a change in lifestyle is recommended during this time, we can still work if needed and socialise with a little more vigilance including preplanning and effective management strategies that may limit or even eliminate close physical contact with others. Utilising technology can benefit us to prevent feelings of isolation or loneliness. Spare a thought for the elderly and try to keep in contact telephonically with loved ones as much as possible.”
COVID-19 has brought on a lot of distress for myself, Abigail and many other OCD sufferers, but it has also levelled the playing field somewhat. People are triple-checking that they have disinfected their workspace, making sure their hands are regularly washed and sanitised, and most are maintaining a distance when out in public. Simple measures that OCD sufferers obsess over every single day are now being performed by ordinary people, and this supports a wider understanding of what people with OCD face.
“I feel like my mum gets it a bit more now. Even just the fear,” Abigail said.
It’s easy to feel unsettled and overwhelmed in times like these. You’re not alone.
If you have questions or concerns, please call the Coronavirus Hotline on 1800 675 398. Please take care, look out for one another, and reach out to these support services if you need to talk to someone: Beyond Blue (Ph: 1300 224 636), Lifeline (Ph: 13 11 14) and Headspace (Ph: 1800 650 890).