At the beginning of the COVID-19 pandemic, we were concerned infection control measures such as extra hand washing and social distancing might compound the distress of people living with obsessive-compulsive disorder (OCD).
Early anecdotal evidence and case studies reported an apparent increase in OCD relapse rates and symptom severity.
But a year on, we’re learning this is not necessarily the case, and research is giving us a more nuanced understanding of what it’s like to have OCD during a pandemic.
What is OCD?
OCD is a common and disabling condition, affecting roughly 1.2% of Australians.
It’s characterized by obsessions (repetitive intrusive thoughts) and compulsions (physical actions or mental rituals) that attempt to quell these preoccupations.
There are several subtypes of OCD, including:
- contamination: characterized by obsessions and compulsions centered around washing, cleaning and concerns around personal hygiene and health
- overresponsibility: encompassing pathological doubt, concerns over unintentional harm to others or oneself, and persistent urges to check things
- symmetry: obsessions about things feeling “just right” (for example, uniform and/or symmetrical), resulting in ritualistic behaviors including counting and ordering
- taboo: characterized by unwanted intrusive thoughts that are often violent, sexual or religious in nature.
Although we don’t fully understand what causes OCD, research points to abnormal activity of specific brain networks, including a network called the cortico-striatal-thalamo-cortical loop.
This network connects key emotional, cognitive and motor hubs in the brain, and it’s particularly important for higher-order cognitive tasks such as thinking flexibly.
No, people with OCD aren’t ‘quirky’
There are several prevailing stereotypes about what it means to live with OCD, such as a belief people with the disorder are just a bit quirky, overly particular, “neat freaks” or “germ-phobic.”
Such ideas are frequently promulgated in popular culture. For example, in 2018 Khloe Kardashian promoted her “KHLO-C-D” branding for an online miniseries in which she gave tips on home organization and cleanliness. The campaign was widely criticized.
While contamination fears and an affinity for symmetry are better recognized in the community (perhaps owing to portrayals in TV and film), the “taboo” and “overresponsibility” dimensions of OCD are far less understood and are therefore subject to higher levels of stigma.
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