Managing Contamination OCD amid the COVID-19 Pandemic

| Brianna Hicks, LCMHC

It’s been a year since we first heard about a new viral illness impacting the world and began to shift our lives in response to it. We’ve been provided with suggestions and best practices from the CDC, at times changing and conflicting information, and watched while different areas of the world and the country adjusted to managing a major outbreak of a widely unknown illness. For everyone, this has been a stressful, anxiety provoking and confusing time, but for folks struggling with obsessive compulsive disorder (OCD), and specifically contamination based OCD, this has been particularly hard. 

What is OCD, and specifically contamination OCD?

Obsessive Compulsive Disorder, or OCD, is a diagnosable mental illness characterized by a cycle of obsessive thinking and compulsive actions. Obsessions are unwanted thoughts, images or urges that can be extreme or disturbing. Often these thoughts are accompanied by uncomfortable feelings (such as fear, disgust or anxiety), and occur over and over again, often feeling out of control. Compulsions are excessive, repetitive behaviors or mental acts (such as counting, praying or suppression of thoughts) that a person uses to try to manage obsessions. Generally, compulsions are temporary actions to alleviate obsessions and the difficult emotions that come with those obsessions. Contamination OCD, in particular, involves obsessional thinking about being exposed to dirt, germs, and viruses, followed by engaging in compulsions that feel as though they prevent that exposure– including excessive handwashing (or sanitizing), disinfecting/cleaning, throwing things away, frequently changing clothes, and avoidance of touching or interacting with objects in our environment.  Compulsive actions can be ritualized, including following a specific pattern of handwashing or cleaning upon returning home, washing hands a certain number of times after using the bathroom, or they can be based on subjective feelings of distress, such as washing hands until a person feels clean.

How does COVID-19 impact folks with contamination OCD?

Understandably, COVID-19 has led to increased preoccupation with preventing the spread of illness through preventative measures. We’ve all been asked to wash our hands, avoid touching our faces, wear a mask or face covering, and avoid being close with and touching people we aren’t in a “bubble” with. Following these recommendations is necessary for the safety of ourselves and others. It’s important to note that not all individuals with contamination OCD worry about getting sick. Some individuals who struggle with contamination OCD won’t experience increased distress amid the pandemic, as this is not the type of contamination they worry about. 

However, for folks who are concerned about getting sick, or being responsible for getting others sick, directives from major health organizations are often a way to reinforce obsessions around contamination for folks with OCD.  This can lead to increased and excessive use of compulsive behaviors to manage those obsessions. Additionally, people struggling with OCD present with elevated anxiety about contracting the illness or spreading it, and can feel compelled to watch more news coverage of the pandemic, keep up with numbers of cases/deaths/hospitalizations/tests, and take recommendations from the CDC to the extreme. These things can both mediate and increase anxiety, leading to isolation, loneliness, fear, and distrust of strangers, family and friends alike.

What can I do if I struggle with contamination OCD amid the pandemic?

If you are a person who struggles with this particular type of contamination OCD, it’s likely you’ve noticed an increase in your own obsessive thoughts and compulsive behaviors in response to COVID. This lapse is understandable amid these unprecedented times, and can be managed. If you’ve previously sought treatment for your OCD, lean into techniques you’ve learned through Exposure and Response Prevention (ERP) and the plan you’ve set with your provider around use of cleaning, washing and sanitizing. Give yourself permission to set a basic safety plan, based on recommendations from trusted health organizations, and avoid adding to it.  Use only trusted sources for information on precautions to take, specifically the CDC and WHO. If you find yourself wanting to do more, utilize support from a trusted person (maybe even your therapist!), who can help determine reasonable and rational safety measures to take, and hold you accountable. Resisting the urge to engage in compulsive behaviors can lead to increased distress. The use of mindfulness techniques, self-soothing techniques, and intentional distractions can help. By facing the fear of contamination and tolerating discomfort, we are learning to live with and accept uncertainty, a key strategy in reducing overall distress.

Today's the day to make a change.