Doctors Should Reach Out to OCD Patients During COVID-19, Experts Say

By Carolyn Crist

April 06, 2020

(Reuters Health) – People with obsessive-compulsive disorder and related anxiety issues may face greater stress during the COVID-19 pandemic, and doctors should reach out to them, the International OCD Foundation says.

Physicians can help patients focus on the "4 C's" to cope during this time: remain calm, create consistency, find containment for their compulsions, and care for themselves and others.

"The increased stress and uncertainty may trigger their symptoms or make them worse than they were before," said Jeff Szymanski, executive director of the International OCD Foundation in Boston.

The foundation created a COVID-19 resource at that provides advice about the virus itself, as well as tips and articles for managing anxiety around coronavirus-related news.

"It is important for all those in the helping professions to be mindful of this and keep an eye out for increased symptoms in their patients and to adjust their screening and questioning," Szymanski told Reuters Health by email.

COVID-19 news and uncertainty may affect OCD patients in different ways, he added, particularly those with specific obsessions about germs, contamination and cleanliness. Those who have harm-related obsessions may worry about giving the virus to their loved ones or community members. Others who experience perfectionism as part of their OCD symptoms may feel the need to stick to recommended health guidelines "perfectly" and go to "unreasonable extremes to do so," Syzmanski said.

At the same time, the core of OCD treatment revolves around learning to live with uncertainty, he explained, so this community may be particularly poised to cope and help others.

"Be proactive and check in with your patients specifically about their mental health," he said. "Be the one to ask the questions. Don't wait for them to bring it up on their own.

The International OCD Foundation recommends that patients follow guidelines from the Centers for Disease Control and Prevention and the World Health Organization, and physicians can help their patients by talking about a "basic safety plan" to disinfect surfaces, wash hands, and for consuming the news. As part of this, doctors should discuss what's necessary and what isn't, adding that the process shouldn't take more than a few minutes per day, the foundation says.

"All the handwashing and sanitizing everyone's doing to slow the spread of coronavirus feels compulsive to people with OCD. When someone with OCD does compulsions, those compulsions strengthen the OCD cycle and make it more likely that she will experience more obsessions and stronger urges to do rituals in the future," said Shala Nicely, a cognitive behavioral therapist for OCD and related disorders in Marietta, Georgia. Nicely created a COVID-19 resource page on her website, which is among those listed on the International OCD Foundation page.

"As debilitating as OCD can be, even in the pandemic it's still highly treatable with medication and a type of cognitive behavioral therapy called exposure and response therapy," which teaches people how to effectively manage uncertainty, Nicely told Reuters Health by email. "Learning ERP can not only help people with OCD reclaim their lives, but it can also give them skills to cope effectively with the unknowns inherent in the pandemic."

To provide a quick guideline for patients with OCD to follow, suggest the "4 C's" approach of focusing on what can be done instead of what cannot be done during the moment of stress, said Aureen Pinto Wagner of the Anxiety Wellness Center in Cary, North Carolina. Wagner created a COVID-19 resource with details about the "4 C's" approach, which is also listed on the International OCD Foundation page.

"The rapid development of COVID-19 has all the elements of the four U's - unfamiliar, unpredictable, uncontrollable, uncertain - the perfect recipe for anxiety and OCD," Wagner told Reuters Health by email.

"Patients with OCD and health anxiety benefit from being listened to, along with specific guidance such as a brief checklist," she said. "Encourage them to seek telehealth therapy."

SOURCE: International OCD Foundation.