For people with OCD and illness anxiety, the coronavirus outbreak is a ‘worst-case scenario’

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The coronavirus pandemic is a “worst-case scenario” for Natalie, a Whitby, Ont., resident who was diagnosed with obsessive-compulsive disorder (OCD) as a child.

Global News has chosen to omit her last name to protect her privacy.

“I suffer from multiple OCD ‘themes’ but [the main two] that cause me the most distress are contamination and health,” Natalie, 31, said. “I’m on constant high alert and my mind never rests.”

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Natalie isn’t alone — roughly one to two per cent of Canadians will have an episode of OCD in their lifetime, and around five per cent of the population will develop an anxiety disorder.

Such disorders can be overwhelming in normal circumstances, but a global emergency like the coronavirus pandemic can make them debilitating.

Since the virus arrived in Canada, Natalie has struggled to find peace.

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She typically has difficulty untangling “normal” and “abnormal” ways to act. Now, with ever-changing safety recommendations from public health officials, Natalie feels even more disoriented.

“Right now, a lot of people are being overly cautious, but am I being too paranoid about avoidance?” Natalie said.

“I go for walks in the suburbs, but I’ll completely avoid others to the point that I will turn around or cross the street.”

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She’s also engaging with her compulsions — defined by Anxiety Canada as repetitive behaviours or mental acts — at a higher frequency.

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“I’m no longer trying to hide them,” she said. “When I come back into the house, I change my clothes and may have a shower, but I often did this before coronavirus.

“Handwashing is a huge thing for me and I’m definitely handwashing even more.”

Natalie’s reaction to the pandemic is quite common because people with OCD and similar illness anxiety disorders often struggle with contamination fears.

“[They] feel a need for perfect certainty that they’ve neutralized harm,” said Christine Purdon, a psychology professor at the University of Waterloo.
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Although contamination fears are common in people with OCD, not everyone with OCD will have them. OCD ‘themes’ — or triggers — are different for everyone.

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How it feels to have OCD, illness anxiety

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OCD and illness anxiety are all-encompassing disorders that can dictate every decision a person makes.

“Individuals with OCD experience obsessive thoughts [and] compulsions to act out certain behaviours, despite efforts to ignore or confront them,” said Joshua Peters, registered psychotherapist at the Centre for Interpersonal Relationships.

These obsessive thoughts and compulsions are often triggered by situations where the person lacks control.

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“People usually rely on compulsions as an escape from their obsessive thoughts, but relief is only temporary and intrusive thoughts soon return,” Peters said.

Coping behaviours — like handwashing — can appear logical in the beginning, but they can quickly become more rigid and compulsive.

“People who experience these symptoms often report feeling out of control, afraid and isolated from others,” Peters said.

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According to Purdon, it’s also common for people with OCD to attach a moral value to compulsions like handwashing.

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“The person with OCD is heading into [handwashing] thinking, ‘I have to make sure I get rid of all the germs,’ but of course, that is unverifiable,” said Purdon.

“And yet, they feel like if they don’t do that, ‘I’m a bad person, I’m a careless person, I’m a lazy person, I’m a dangerous person.'”

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They need to keep engaging with their compulsions, like handwashing, as an attempt to protect themselves and others from harm, but they can never verify if they’ve succeeded — so they can’t stop engaging in the compulsion.

The result is a vicious cycle — one that can be severely compounded by something like a global health crisis.

Coronavirus compounds pre-existing worry, fear

Add to those feelings a global pandemic that has cost thousands of lives and, this time for some becomes much more challenging.

“With the coronavirus, it’s the case that you could be carrying it on your hands and touch somebody and infect them and then they could die,” Purdon said.

She recognizes that this is simplifying the process of how COVID-19 is transmitted, but this is how a person with OCD might think about the virus.

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“The connection between having dirty hands and someone dying is a lot more distilled,” Purdon said.

“There’s certainly a much more direct route to harm somebody than prior to the pandemic, when we just had normal viruses to worry about.”

The lack of control an individual has right now can also be jarring for people with OCD.

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In absence of ways to control the situation, those with OCD are likely to see an increase in both the severity and frequency of their symptoms,” said Peters. 

“Perhaps most dramatically, this will affect individuals whose obsessions or compulsions were already related to cleanliness.”

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The flood of information from public health officials urging people to wash their hands and avoid contact with others will leave these individuals even more vulnerable.

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Unfortunately, these feelings can often spill over and impact family.

I think about people with severe OCD living at home with their family members … They [can] become very adamant about other people following their rules in order to reduce their own anxiety,” Purdon said.

“So they drive tons of rules for all the people in the house that are very excessive … and what can happen is that the family accommodates because they don’t like to see the person in distress, but then the rules just get more and more elaborate over time.”

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Taking it day by day

Many of the interventions recommended for people with OCD and other illness anxiety disorders during the COVID-19 outbreak can be helpful for “anyone who might be experiencing distress,” Peters said.

“Avoid causing other experiences of loss of control by sticking to as many routines as you would if [the outbreak] was not happening.”

He recommends a consistent sleep, eating and exercise routine.

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You should also limit your news consumption to “twice a day for about 20 minutes, from respectable, reputable news sources,” Purdon said.

“You’re not missing out on something major … but then walk away from the internet and go do something that you can control.

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Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

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