Protective Behaviors to Avoid COVID-19 May Aggravate Symptoms of Obsessive-Compulsive Disorder and Other Conditions in Some Patients

Published in Brain Wise - Brainwise Spring/Summer 2022

While wearing masks, washing hands and social distancing are measures recommended by public health authorities to minimize transmission of the coronavirus that causes COVID-19, these behaviors can contribute to development or exacerbation of obsessive-compulsive disorder (OCD) symptoms in some patients, according to new research from the Johns Hopkins Department of Psychiatry and Behavioral Sciences.

In September 2020, researchers conducted an online survey to assess the clinical features, COVID-19 risks and COVID-19 contamination prevention behaviors of 2,117 U.S. adult residents. The mean age of the participants was 46, and 9% reported having been diagnosed with OCD, 28% with another anxiety disorder and 36% with depression.

Results showed that contamination prevention behaviors were significantly associated with contamination obsessions and phobias. The work, published in the Journal of Psychiatry Research, demonstrated a significant tendency toward those behaviors in those with and without prior OCD, and in people with different levels of doubt and risk of contracting the virus. Men in the sample had greater odds of contamination obsessions and phobias.

companion study, looking at COVID-19-related worry and published in the same journal, found that worries were markedly higher in younger (ages 18–49) than in older participants, and moderately higher among men, people who were married or living together, people with post-college education and those living in large urban areas. Worries related to the pandemic were markedly higher among participants diagnosed with a psychiatric disorder and were associated with current depression symptoms.

“We found that the degree of compliance with recommended behaviors to reduce the risk of exposure to and transmission of infection during the COVID-19 pandemic was significantly associated with contamination obsessions and phobias,” says senior study author Gerald Nestadt, director of the OCD clinic at Johns Hopkins.

The survey inquired about participants’ COVID-19-related behaviors, using an 11-item questionnaire evaluating the extent of changes that participants made in daily activities because of the pandemic. These behaviors included hand-washing, use of hand sanitizer, house cleaning, disinfecting household surfaces, disinfecting or wiping down groceries, disinfecting or wiping down mail or packages, stocking up on food and supplies, avoiding domestic or international travel, not ordering takeout food from restaurants, and wearing a mask in public.

Researchers assessed current contamination obsessions using five questions from the contamination section of the Dimensional Yale-Brown Obsessive-Compulsive Scale. These questions asked about time spent thinking about contamination and engaging in behaviors to reduce contamination, contamination-related avoidance, contamination-related distress, contamination-related disruption of daily routine, and ability to resist contamination-related thoughts and behaviors. They also assessed other OCD symptoms.

“Obviously, we don’t want to reduce people doing those necessary behaviors during the pandemic, but psychiatrists, mental health professionals and epidemiologists should be aware that having these types of behaviors can induce or increase these symptoms, which can be very disabling and distressing,” Nestadt says. “If they persisted, it would be an increased burden on the mental health system and deleterious to the mental health of these persons.”

Learn more about the Johns Hopkins Obsessive-Compulsive Disorder Program.

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