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Out of 100 individuals, obsessive compulsive disorder (OCD) affects only one, yet we commonly hear about it among our families or peers. OCD is characterized by obsessions such as intrusive thoughts, impulses, images, ideas, or doubts, as well as compulsions like behavioural/mental actions or avoidance aimed at reducing discomfort or preventing a bad outcome from happening. And it’s unfortunate that COVID 19 has added a new level of stress to our daily lives, increasing our vulnerability for obsessional thinking.
There is a belief that has gone on for quite some time that those afflicted with OCD must have a fear of dirt and germs. And while this has some truth to it, obsessions can actually focus on any subject matter, resulting in a sense of fear, dread, or disgust with anything.
There is much written about OCD on the Internet and on social media. OCD themes are often referred to with the following non-clinical labels: contamination OCD, existential OCD, and relationship OCD, among others.
Obsessional themes can focus on anything that is contrary to an individual’s values. The gentlest person you know could have graphic thoughts about forcing their grandmother’s hand into a meat grinder if they have a certain type of OCD. A person who has always wanted to be a schoolteacher could have sexual thoughts about children, or the person who prides themselves on being meticulous starts to doubt if they have missed something important and could henceforth be responsible for a grave outcome. All types of OCD follow the same prescribed formula.
Meanwhile, for those with obsessions focusing on dirt and germs, it doesn’t help that the pandemic has led to a worsening in fear. Increased cleaning and washing, as well as a mandated avoidance of contact with humans or objects that are suspected to be full of pathological microorganisms leads to more obsessional thinking, and not less. For those with non-contamination themes of OCD, the pandemic may have worsened their symptoms just by adding to the individual’s daily stress.
As psychologists, we have seen a degree of COVID fatigue faced by several of our clients that is too high to ignore. The second wave of COVID and subsequent lockdown in Ontario corresponded with a rollercoaster of varying moods.
More than ever, we have been normalizing the experience of having low mood and feelings of depression during this unprecedented time. It seems now that feeling down and tired is somewhat of a normal reaction to an abnormal situation, which is the pandemic.
COVID-19 has affected most of the world negatively. Many people have suffered unimaginable losses, such as deaths of their loved ones, job losses, homelessness, and poverty just to say a few. For others, it has led to a change in “life as we know it”: an abrupt shift to remote learning, limited social connections, loss of a daily routine, no travel, and uncertainty about the future.
The pandemic is indeed a major life stressor, and especially if economically, socially, and/or psychologically vulnerable, it can increase one’s risk for developing clinical depression.
Feeling down when faced with a life stressor is not unusual. It is important, however, to monitor for “major depressive disorder”, a technical term used to diagnose “depression”. According to the Canadian Mental Health Foundation, approximately 8% of adults will experience depression in their lifetimes.
More than just “feeling blue”, a major depressive disorder lasts more than two weeks, and includes several different symptoms. To diagnose depression, you must be experiencing 5 or more symptoms during a 2-week period with at least one of the symptoms 1) depressed mood, or 2) loss of interest or pleasure in the things you like doing. Meanwhile, other symptoms include:
Anyone experiencing suicidal thoughts should reach out to a mental health professional or call a crisis phone line (see below).
COVID 19 has negatively impacted our lives, and experiencing a large-scale change like this can be especially hard for those who suffer from anxiety, and for those afflicted by OCD.
It seems to be that when OCD recognizes worry, stress, anxiety, or fear, it seizes the opportunity to make life worse for the one suffering from it. When obsessions increase in strength and frequency, and compulsions (or avoidance) worsen, feelings of hopelessness and depression are likely to follow.
Yes, you can have both. In fact, a recent study showed that depression is the most commonly occurring psychiatric disorder alongside OCD, affecting approximately half of those with OCD. This same study found that the risk for depression increased if the individual with OCD experienced a stressful life event during the last six months.
Dealing with a significant stressor like the pandemic could contribute to developing clinical depression. When both OCD and depression are experienced together, treatment recommendations are determined on a case-by-case basis.
Typically, OCD would be targeted first, in the hopes that depression would indirectly remit. However, both conditions can be addressed simultaneously with a tailored treatment plan.
Always beginning with careful behavioural formulation, OCD treatment is performed by a trained expert who catalogues the obsessions, maps out the client’s reactions to these (i.e., compulsions, avoidance, selective attention), and examines the client’s beliefs about the obsessions themselves. The current gold standard treatment for OCD is a type of cognitive-behaviour therapy (CBT) called exposure with response prevention (ERP).
Meanwhile, medication is also considered an evidence-based treatment for OCD. Medication for OCD may be prescribed either in lieu of ERP or as an additional treatment method. When considering professional help, it’s good to find an expert who has demonstrated experience and training in ERP, because other types of therapy (e.g., standard CBT, supportive counselling, hypnosis) could actually worsen the symptoms of OCD.
The International OCD Foundation provides a list of recognized OCD providers that can help you choose the best fit for you and your needs. For clients with OCD who have started a course of ERP, the following tips are useful to remember when the going gets tough:
Practicing ERP is effective at getting OCD under control. Once better managed, continued practice of ERP (even without a therapist) provides some protective measure against worsening of the obsessions, and even the development of new obsessions.
As for depression, there are only two types of psychological treatment considered evidence-based: cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT). Medication has also been demonstrated through research to be an effective treatment for depression symptoms, and a combination of pharmacotherapy and psychotherapy can also be considered.
CBT for depression also starts with a careful assessment: examining negative thoughts, identifying core beliefs, and cataloging current daily activities. Once the client’s situation is better understood, cognitive therapy is used to shift negative thoughts and beliefs, and targeted “behavioural activation” increases engagement in productive and pleasurable activities. When administered effectively, CBT can help individuals get well and stay well.
Serving as some level of protection against stress and potential depression, there are some steps you can take to improve your resilience. Ask yourself how much you are attending to the following areas:
Setting some realistic goals for yourself is an excellent way to get started. These strategies are especially recommended for anyone struggling with OCD and/or depression.
COVID 19 is a major life stressor that has worsened OCD for those who suffer from it, and not just for those with obsessions with dirt and germs. But when clients with OCD are feeling more grounded and mentally strong, they are better able to disregard the obsessions and resist engaging in compulsions.
However, when individuals are feeling worn down and vulnerable, they tend to fall back into their old patterns of engaging in their compulsions, inadvertently worsening the OCD, and increasing vulnerability for depression. During this era of COVID-19, it is important to keep up the fight against OCD, and to combat stress and feelings of depression by building resilience.
This article was written by: Joanna Jeffers, M.A., C.Psych., Director, Archways Centre for CBT
If you are in distress or need emotional support immediately, please call 1-833-456-4566 (Canadian Suicide Prevention and Support Line). If this is an emergency, please call 911.