The media has emphasized the importance of good hygiene and staying away from those who may be ill in an effort to decrease the spread of the COVID-19 virus. While we should all practice regular hand-washing and deep cleaning of our homes and frequently touched surfaces, the overwhelming message is quite clear. We need to be cautious. We need to be proactive. For the average person, the repeated messages may be background noise, or maybe even a good prompt to do what is needed. However, for some individuals, this message is a confirmation that they should fear contact with anyone who is ill, or any surface that is commonly touched by others. Individuals with subtypes of Obsessive-Compulsive Disorder and Illness Anxiety Disorder experience a great deal of anxiety related to germ contamination and concerns about becoming seriously ill. How will the COVID-19 pandemic affect these individuals?
Illness Anxiety Disorder
When the DSM-5 (2013) was released, the diagnosis of “hypochondriasis” was renamed to Illness Anxiety Disorder. The new diagnosis was able to identify two subsets of individuals who comprised the “hypochondriac” category: Somatic Symptom Disorder (75%) and Illness Anxiety Disorder (25%, Kahn, 2018). Individuals with this diagnosis tend to be obsessed with the idea of having a serious medical condition despite having mild to no symptoms. It is estimated that 13% of the U.S. population experience this disorder (Scarella, Boland, & Barsky, 2019). By my own estimate, this disorder has the potential to increase by 25% or more in the next month.
One thing to keep in mind is that the threat of contamination is said to be quite high. I personally do not know of anyone who has tested positive for the virus, nor do I know of anyone who has come into contact with the virus. So, with the threat of infection being high, is it considered to be Illness Anxiety Disorder when the possibility is there? Between watching the news, reading articles online, or browsing social media, the concern is there. People are worried. Cities are being shut down. Stores are running out of supplies. Hospitals and ICUs are filling up. The anxiety is real. It appears to be warranted, though.
Nevertheless, until COVID-19 “disappears”, we are in this together. Some scientists suggest that this pandemic is more serious than we know, and it may take up to a year for things to return to normal (Resnick, 2020). While we are trying to “wait it out” by social distancing and practicing good hygiene, the anxiety will only continue to grow. Obsessive-Compulsive Disorder
Let’s face it. At this point, we are all a little “OCD” about being contaminated right now. But, there are millions of Americans and people around the world who are experiencing extreme distress and impairment due to the thought of being contaminated by COVID-19. Approximately 25% of people with Obsessive Compulsive Disorder (OCD) have contamination fears. Typically, the individual fears becoming contaminated “through one’s own actions, being contaminated by others, contaminating others, or different combinations of any of these.” (International OCD Foundation, 2010). The fear of contamination can be either real or imagined. Individuals with this type of OCD engage in excessive hand washing, showering, or disinfecting one’s body or possessions, throwing away or avoiding things that may have been contaminated or cannot be cleaned, avoiding certain people, objects, or places that may be contaminated, researching to find out whether certain things are contaminated, doing rituals to neutralize the contamination, or maintaining a clean environment within their home or workplace that others cannot touch (International OCD Foundation, 2010).
Personally, I look at the etiology of disorders through a biopsychosocial lens, which means that I believe there are multiple factors in various parts of someone’s life that can impact their condition, as well as their treatment. Research has shown that OCD is caused by genetic and hereditary factors, chemical, functional, and structural brain abnormalities, distorted beliefs, and even trauma. COVID-19 could potentially be considered a “trauma”. Yes, it is a small “t” trauma, but a trauma nonetheless. If you consider how this virus has shut down the country and caused masses of people to hoard toilet paper, and caused people to become (yes, I’m going to say it…) a little “crazy”, then yes. I think it’s safe to say that this event is unprecedented and traumatic. It’s also safe to say that this event may trigger a new generation of OCD patients.