Challenges of Compulsive Behavior

By on November 25, 2020
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The COVID-19 outbreak has had a profound impact on one’s mental health. Obsessive compulsive behavior is a common mental illness and the pandemic seems to have increased its occurrence

It is important to provide appropriate attention to psychiatric conditions that may be initiated or exacerbated by the COVID-19 pandemic. Perhaps no group of individuals with mental illness is as directly affected by the worsening outbreak of COVID–19 as people diagnosed with obsessive compulsive disorder (OCD).

Obsessions can be explained as ideas, thoughts or impulses that repeatedly enter the individual’s mind, causing distress and the person often tries, unsuccessfully, to resist them. Compulsive acts are repetitive behaviours done to reduce the distress or anxiety produced due to these compulsions.

The most common obsessions are  of contamination (excessive concerns with environmental or household contaminants, concerns with getting ill due to these contaminants or getting others ill by spreading the contaminants). These obsessions are anxiety-provoking and to reduce this anxiety, compulsive acts of repeated washing and cleaning behaviour is carried out.

Other obsessions include repeated doubts of leaving the front door unlocked or the stove on and therefore repeatedly checking to ensure safety, or the need for exact symmetry or exactness and repeated re-arranging of things to reduce the distress. We can now understand how containment measures implemented to reduce the progression of the COVID-19 pandemic can increase the risk of serious mental disorders, especially obsessive compulsive disorder (OCD). The general fear of getting infected and importance given to personal hygiene may have a negative impact on this clinical population.

Due to the emphasis by health advisories on washing hands, cleaning food brought home, symptoms of OCD might worsen, leading to excessive cleaning behaviours and spending most times of the day doing the same. The potential concerns faced by these people include: Worrying that you may have washed your hands one time less than you needed to or standing too close to someone who looks well but might be harbouring the virus, as a result of which you might get sick or spread the illness to others. They may rationalise their behaviours and claim to be taking precautions, however not fully acknowledging their distress. For them coronavirus can be all they can think about. They may be pre-occupied with watching news regarding the virus, searching online about the virus, how it spreads, how it can be controlled. It can go to as severe as washing money or washing tablets before consuming it. 

They may repeatedly ask family members to wash their hands or bathe or might have a bath themselves if they think others at home are not being hygienic. These practices could be very distressing for these individuals who do not know any other way out. There are various other disorders that have been included in the OCD spectrum because of similarities they share.

In hypochondriasis or illness anxiety disorder, the essential feature is a persistent pre-occupation with the possibility of having contracted a serious illness (in this case having coronavirus). Normal sensations are often misinterpreted and repeated investigations are carried out to rule out the disease. They feel relieved when the test results are negative, but again get similar thoughts and the vicious cycle begins. Another disorder, known as body dysmorphic disorder involves an excess and persistent 

pre-occupation with an imagined defect in one’s appearance which results in significant distress. When having to attend online video meetings, they could be constantly pre-occupied with this defect and avoid work meetings, shut off the video during meetings and feel anxious about it, thus cutting off the little socialising opportunity available.

It is very important to have balanced information about the known risks and impact of COVID-19 on physical and mental health. The right information must be obtained from reliable sources only to avoid myths, rumours and misinformation. Hand-washing videos from reliable sources may be helpful to guide patients about what is appropriate and discourage unnecessary excess. Individuals should not spend more than an hour a day (a half hour in the morning and half hour at night) to stay informed about the pandemic.

Patients need to manage their stress levels over time (by putting into play routines of meditation, mindfulness, spending time pursuing a hobby), have a regular time to sleep and wake up and maintain good sleep hygiene techniques. It is also important to have a well-planned day and a fixed routine.

Individuals must seek professional help if there is increasing distress since mental health cannot be neglected in this pandemic. 

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