Anxiety and Depression

Managing Obsessions and Compulsions during COVID-19

BY DR NATASHA FONG

21 July 2020  |   7 min read

What is Obsessive Compulsive Disorder?

Obsessive Compulsive Disorder (OCD) is one of the most common mental health conditions in Singapore. In 2019, almost 3 in 100 people were diagnosed with OCD1. About 4% of the population may be affected by OCD at least once in their lifetime.

OCD is an anxiety disorder in which a person experiences obsessions and compulsions driven by anxiety. Obsessions are intrusive, persistent, and often unwanted thoughts, images, urges, doubts, or impulses about something perceived as threatening or dangerous. Compulsions are physical or mental actions taken to prevent the perceived threat or danger from happening. A person with OCD finds it hard to control their compulsive behaviours and will continue with the compulsions till the obsession or anxiety goes away and the person feels ‘right’. However, the relief brought by the compulsion is temporary. In fact, the obsessive thoughts usually come back even stronger, which prompts a drive to quell them again, creating a vicious cycle. Over time, as the compulsive rituals and behaviours become more demanding and time-consuming, they often end up causing anxiety themselves, further cementing the cycle.

Obsessions and compulsions become problematic when they are excessive, repeated and performed rigidly.

How does COVID-19 impact OCD?

The widespread coverage on the spread of COVID-19 and its impact inadvertently increases worries about the possible harm we could bring to ourselves and our loved ones from being infected.

The pandemic has increased the anxiety of a lot of people and it can be especially debilitating for persons already struggling with anxiety and experiencing OCD. The recommended safe distancing measures and personal hygiene reminders may add on confusion about whether the behaviours are driven by caution or obsessions and compulsions. Advice to practise greater personal hygiene may provide a rationalization for persons with OCD to engage in their compulsions. A person struggling with OCD symptoms may experience greater distress and worry that the condition could be worsening as they engage in more cleaning and avoidant behaviours.

The end of circuit breaker and transition into phase 1 and 2 can trigger more obsessions around contamination, safety, and harm. This is especially so when more are returning to work or school and people are making plans for small social gatherings. People with OCD may experience increased obsessions and feel driven to engage in compulsions to manage their anxiety.

Some examples of obsessions and compulsions related to the ongoing COVID-19 pandemic include:

Obsessions Compulsions
Thoughts

  • I am infected.
  • I will pass the virus to others.
Checking

  • Excessive checking of symptoms e.g. taking body temperature.
  • Constantly reading of news articles and updates on current pandemic.
Images

  • A loved one being ill or dying.
  • Something bad happening.
Maintain a Hopeful Outlook

  • Constantly checking in on loved ones.
  • Constantly asking others for reassurance.
Urges

  • To keep clean by constantly cleaning.
  • To move, arrange, or touch things in a specific way.
Washing or cleaning

  • Excessive hand washing and sanitising.
  • Decontamination of self or others in a certain way after returning home.
Doubts

  • Did I touch something dirty?
  • Did I clean enough?
Avoidance

  • Avoiding use of public toilets.
  • Refusal to leave the house.
  Repetitive Behaviours

  • Counting
  • Tapping

What is normal and what is not?

Almost all of us have experienced the above concerns and behaviours to some extent amidst this pandemic. But when do these concerns turn unhealthy? Obsessions and compulsions become problematic when they are excessive, repeated and performed rigidly. To meet the diagnostic criteria for OCD, a person at some point would recognise that the obsessions or compulsions are undue or excessive, but are unable to control their behaviour, causing marked distress. The person spends significant time (more than 1 hour a day) on the obsessions or compulsions which interfere with the person’s daily life, functioning and their relationships with others. OCD can leave people feeling mentally drained, out of control, and alone in their suffering.

The following table illustrates the differences between normal cautious responses and compulsive responses in various common situations as we fight COVID-19:

Situation Cautious response Compulsive response
Engaging in personal and hand hygiene to prevent infection. Washing hands for 20 seconds after touching potentially dirty surfaces. Spending extended time repeatedly washing hands, or using hand sanitiser after touching any object, until it feels right (i.e. when the anxiety is gone).
Following safe distancing measures Keeping 1 meter away from people not from the same household. Making long detours to avoid people or consistently keeping a great distance from others across different situations.
Keeping updated of COVID-19 developments Subscribing to government news channel for daily updates, checking news or information at specific times of day for a short period. Spending more than an hour each day repeatedly searching for news or information, and unable to stop reading information about COVID-19.

If you are struggling with OCD symptoms and have been finding it hard resist your compulsions, remember that every day is a new day to try again.

How to cope with OCD symptoms during COVID-19?

If you notice yourself experiencing more obsessions and engaging in more compulsive actions, here are some ways to prevent symptoms of OCD from taking over your life:

  1. Get updates and advice only from authorised authorities such as the Ministry of Health, and limit the sources of information you follow on the internet or social media platforms. This will ensure that you get reliable and timely updates without receiving incessant news alerts, which can feel overwhelming.
  2. Follow recommendations by the government on personal hygiene and safe distancing. These official recommendations were developed from scientific evidence on COVID-19, and would be sufficient to keep us safe. For example, keeping a meter distance from another person is adequate and there is no need to stay three metres away from others.
  3. Keep to a routine and strive to maintain your normal daily activities. A routine provides certainty and control over your day, which reduces anxiety by keeping your mind off obsessions. Make time for relaxing and enjoyable activities to keep yourself emotionally and mentally well.
  4. Practise self-care and self-compassion. This is a difficult period for a lot of people and increased anxiety is normal. If you are struggling with OCD symptoms and have been finding it hard resist your compulsions, remember that every day is a new day to try again. Fretting about controlling your obsessions and compulsions will not help your anxiety, and would exacerbate it instead.
  5. Stay socially connected and maintain your support network — even if it is just through text messaging. Social support will help us feel less isolated and make you feel like you are able to share your concerns and receive support.
  6. Monitor your anxiety level and pre-occupation with obsessions and compulsions. You can do an OCD self-assessment, observe your mental wellbeing, and your ability to cope and manage the symptoms. 

Where can I seek help?

If you are still worried about your OCD symptoms, seek professional support to help you manage the symptoms. You can reach out to the following:

  • Online self-help mental health resources and links to other support programmes and services
    https://stayprepared.sg/mymentalhealth/
  • Viriya Counselling Helpline
    Tel: 6256 1311
  • National Care Hotline
    Tel: 1800 202 6868

The contributor is a Clinical Psychologist at Viriya Community Services.

References

1 Subramaniam, M., Abdin, E., Vaingankar, J. A., Shafie, S., Chua, B. Y., Sambasivam, R., Zhang, Y. J., Shahwan, S., Chang, S., Chua, H. C., Verma, S., James, L., Kwok, K. W., Heng, D., & Chong, S. A. (2019). Tracking the mental health of a nation: prevalence and correlates of mental disorders in the second Singapore mental health study. Epidemiology and psychiatric sciences, 29, e29.
https://doi.org/10.1017/S2045796019000179