“You think, ‘If 20 seconds is good, then 40 seconds is better.’ It’s a slippery slope.”
It’s impossible to watch the news, listen to the radio, or be online without encountering various public service announcements about the importance of “hand hygiene” (regular handwashing for at least 20 seconds).
These are well-intentioned and important reminders, but for some people with obsessive-compulsive disorder (OCD) — particularly those who have “contamination OCD” — it can be extremely triggering.
Dr. Chad Brandt, a clinical psychologist at the McLean OCD Institute in Houston, explains why.
“The ‘O’ in OCD stands for obsession. That’s essentially an unwanted thought that gives us feelings we don’t like and want to get rid of. So when someone with OCD has those unwanted feelings, they want to do something to make it go away. That leads to a compulsion, which is the ‘C’ of OCD,” he says.
“The strongest underlying mechanism of obsessive-compulsive disorder is the inability to tolerate uncertainty,” says Anna Prudovski, clinical psychologist and director of Turning Point Psychological Services in Ontario, Canada, which specializes in treatment for OCD and anxiety.
Uncertainty is a challenge for all of us, Prudovski says, but in people with OCD, it’s “very, very pronounced.”
Compulsive behaviors like excessive handwashing, she notes, are a cyclical effort to reduce uncertainty, which only exacerbates the existing anxiety.
Both Brandt and Prudovski stress that not everyone with OCD has “contamination OCD,” where the compulsion involves handwashing or cleaning, but many do. (Research has shown that up to 16 percent of people with OCD have cleaning or contamination compulsions.)
But even people with OCD who don’t typically have cleaning compulsions may be compulsively handwashing, Prudovski says.
“Some people with OCD have an overinflated sense of responsibility,” Prudovski adds.
“That can be very triggering right now, because there’s so much talk about protecting vulnerable people. Combined with the need to be 100 percent certain, this overinflated sense of responsibility is also a driver behind increased compulsion,” she says.
When vulnerable people need to be protected from a highly transmissible virus, that overinflated sense of responsibility might lead someone to not just practice responsible handwashing, but go above and beyond — all in an effort to increase the certainty that they won’t pass the virus to someone.
In that sense, this global environment can be activating for people with obsessive-compulsive tendencies.
One of the most effective therapies for treating OCD can be a little harder to do during a pandemic, too.
Dr. Patrick McGrath, a psychologist and head of clinical services for NOCD, a telehealth platform for treating OCD, explains, “The whole goal of ERP [exposure and response prevention] is exposing people to things that make them uncomfortable and then stopping them from doing their typical coping strategy,” McGrath says.
“Because we know that those coping strategies are often what keep people stuck. We want to encourage people to sit with the thoughts that make them uncomfortable without immediately trying to make it go away,” he adds.
For someone who has contamination or harm OCD, McGrath says, “I might say, for the next 24 hours, don’t wash your hands.”
But, of course, that would have been McGrath’s suggestion before the pandemic.
“Things are a little bit different now. If the person is staying inside their house, that might be fine, but if they go out and come home, they should follow the CDC guidelines and wash their hands for 20 seconds,” he says.
But, McGrath warns, it’s important to keep it to 20 seconds.
“Beyond that, we’re looking at obsessive-compulsive disorder trying to sneak its way back in,” he says.
Imposing limits, either on the number or length of time a person can engage in the compulsive behavior, is extremely important for people with OCD, Prudovski says.
“OCD takes advantage of logic. You think, ‘If 20 seconds is good, then 40 seconds is better.’ It’s a slippery slope,” she says.
The inherent unknowns of a new virus trigger the uncertainty that’s such a fundamental part of all OCD.
“Another compulsion is trying to achieve certainty by constantly watching the news or Googling for any little nuggets of information,” Prudovski says.
We all do this to a certain extent, but someone with OCD does it to a degree that interferes with their everyday life and functioning.
OCD or not, though, limiting the amount of time you’re consuming terrifying news is good for your mental health.
That’s why all the OCD experts I spoke to stress the importance of imposing limits and sticking to one source of information, like the Centers for Disease Control and Prevention (CDC).
“So our first recommendation is to find one source [of information]. Usually we suggest the CDC. Don’t go to any other news sites, just follow the recommendations of the CDC,” Prudovski says.
But not everyone with OCD is struggling right now, Prudovski notes.
“Some of our patients are laughing. They’re saying, ‘This is how we live our lives.’ Some of them actually feel good because people have stopped telling them ‘Oh, this is all in your head, you’re being ridiculous,’” she says.
Anxiety during a pandemic doesn’t necessarily mean you’re dealing with some kind of disorder.
“It’s OK to feel anxiety,” Brandt says. “But if you find that the anxiety is causing you to spend more time cleaning than you want to, or you’re having trouble sleeping or eating, you may want to look into getting professional help.”
Prudovski also stresses the importance of people with OCD finding a mental health professional who specializes in OCD.
“Therapists who don’t specialize in OCD will use more traditional methods of reassurance, which can be helpful for people who don’t have OCD, but can actually make people who have OCD worse. So, it’s very important to get someone who understands this disorder,” Prudovski says.
Her last piece of advice is something that’s useful for all of us during this time, regardless of whether we have OCD.
“Self-compassion is extremely important, especially now,” Prudovski says. “It takes a lot of effort to obey the rules and not listen to every urge. It’s very important to be kind to yourself, especially during this time.”
Katie MacBride is a freelance writer and editor. In addition to Healthline, you can find her work in Vice, Rolling Stone, The Daily Beast, and Playboy, among other outlets. She currently spends far too much time on Twitter, where you can follow her at @msmacb.