How Do OCD Patients and Families Cope During a Pandemic?

What you need to know

• OCD symptoms initially increased slightly at the start of the pandemic but then decreased over time, contrary to expectations.
• COVID-19 related stress and depression symptoms increased and decreased in line with pandemic severity.
• Family accommodation of OCD symptoms followed the same pattern as OCD symptom severity.
• OCD symptoms were strongly associated with depression, anxiety, stress, and COVID-19 related distress at all timepoints.

Background

The COVID-19 pandemic has had significant impacts on mental health, particularly for those with pre-existing conditions like obsessive-compulsive disorder (OCD). This study aimed to examine how OCD symptoms and family accommodation changed during different phases of the pandemic in Belgium, from the initial lockdown through subsequent waves.

How OCD symptoms changed over the course of the pandemic

The researchers assessed 49 OCD patients and 26 family members at four timepoints:

1. One month after the start of lockdown (T1)
2. During gradual relaxation of restrictions (T2)
3. Between the first and second waves (T3)
4. During the second wave (T4)

Contrary to expectations, OCD symptoms did not consistently worsen as the pandemic progressed. There was a slight increase from T1 to T2, but then symptoms decreased at T3 and T4.

This pattern differed from COVID-19 related stress and depression symptoms, which did tend to increase and decrease in line with the severity of the pandemic (as measured by hospitalization rates).

The researchers suggest a few potential explanations for why OCD symptoms improved over time:

• Patients may have initially been sensitized to pandemic-related triggers, but then habituated to them over time.
• As the pandemic continued, patients may have developed better insight into their obsessions and viewed them as less threatening.
• Some patients may have continued isolating even when restrictions relaxed, avoiding typical OCD triggers.
• Increased hygiene protocols may have made some OCD patients feel safer.
• Treatment availability increased after the initial lockdown as therapists moved to online platforms.

Family accommodation followed OCD symptom patterns

Family accommodation refers to ways that family members adjust their behaviors to accommodate a loved one’s OCD symptoms. This can include things like:

• Participating in rituals
• Providing excessive reassurance
• Modifying family routines
• Taking on tasks the person with OCD finds difficult

The study found that family accommodation followed the same pattern as OCD symptoms - increasing slightly from T1 to T2, then decreasing at T3 and T4.

This aligns with previous research showing that family accommodation tends to increase when OCD symptoms are more severe. While accommodation may provide temporary relief, it can ultimately reinforce OCD symptoms and behaviors.

Associations between OCD and other mental health symptoms

At all timepoints, OCD symptom severity was strongly associated with:

• Depression symptoms
• Anxiety symptoms
• Stress levels
• COVID-19 related distress

This highlights how OCD often co-occurs with other mental health challenges. The researchers note it’s important for clinicians to assess and address these related symptoms when treating OCD.

Interestingly, family accommodation was associated with the OCD patient’s depression, anxiety, and stress symptoms at various timepoints. However, it was not associated with the family members’ own mental health symptoms.

The researchers suggest this could mean family members accommodate more when they see their loved one in greater distress. However, more research is needed to clarify the causal relationships between accommodation, OCD severity, and other mental health symptoms.

Conclusions

• OCD symptoms may not necessarily worsen during a pandemic and may even improve over time as people adapt.
• However, related mental health challenges like depression and anxiety may fluctuate more in line with pandemic severity.
• Family accommodation remains closely tied to OCD symptom severity, even during a pandemic.
• Clinicians should assess and address co-occurring depression, anxiety and stress when treating OCD.
• Involving family members in OCD treatment remains important, even during a pandemic, to address accommodation behaviors.

This study provides valuable insights into how OCD manifests during prolonged periods of heightened health anxiety and disruption. The findings highlight the complex interactions between OCD, related mental health symptoms, and family dynamics. While the results are encouraging in terms of OCD symptoms not inevitably worsening, they underscore the ongoing need for comprehensive treatment approaches that address the full range of challenges faced by those with OCD and their families.