How Does Media Coverage of Infectious Disease Outbreaks Affect People with OCD?

What you need to know

• Media coverage of infectious disease outbreaks like COVID-19 can trigger or worsen OCD symptoms in some people, especially those with contamination fears.
• People with OCD may be at higher risk for anxiety, isolation, and unsafe behaviors during pandemics due to their symptoms.
• Alternative treatment approaches like telemedicine may be needed to help people with OCD during infectious disease outbreaks.

Understanding OCD and contamination fears

Obsessive-compulsive disorder (OCD) is a mental health condition that affects about 2% of people at some point in their lives. People with OCD experience unwanted, intrusive thoughts (obsessions) and feel compelled to perform repetitive behaviors or mental acts (compulsions) to relieve their anxiety.

One common type of OCD involves fears about contamination and excessive washing or cleaning behaviors. For example, someone might worry excessively about germs and feel compelled to wash their hands dozens of times a day. These symptoms can significantly impact a person’s daily life and cause great distress.

While the exact causes of OCD are not fully understood, research suggests it likely involves a combination of genetic and environmental factors. Brain imaging studies have found differences in certain brain circuits in people with OCD compared to those without the disorder.

How the COVID-19 pandemic affected one patient with OCD

This case study describes a woman in her 30s with a history of OCD who experienced a severe worsening of her symptoms after seeing media coverage about the emerging COVID-19 pandemic in early 2020.

The patient had previously received treatment for OCD focused on contamination fears and excessive hand washing. With medication and therapy, her symptoms had been well-controlled for several years. However, after seeing news reports about COVID-19 spreading in China, her OCD symptoms rapidly intensified over just a few weeks.

Some of the ways her OCD worsened included:

• Becoming reluctant to leave her home due to contamination fears
• Intensifying her hand washing and cleaning rituals, spending several hours per day on them
• Avoiding almost all social interactions, even with family and friends
• Dropping out of an educational course she was taking
• Only eating canned foods due to fears about contamination of fresh foods

These changes represented a major deterioration in her daily functioning. She also experienced increased anxiety, panic symptoms, and thoughts of death.

Importantly, this relapse occurred even before any COVID-19 cases had been reported in Europe where she lived. This suggests the media coverage itself was enough to trigger her symptoms, rather than an actual increased risk of infection in her area.

Why infectious disease outbreaks may worsen OCD symptoms

For people with contamination-related OCD, infectious disease pandemics like COVID-19 can be especially challenging for several reasons:

1. Increased attention to contamination: Public health messages emphasize hand washing and avoiding contamination, which can reinforce OCD fears and behaviors.

2. Blurred lines between “normal” and “excessive” precautions: It becomes harder to distinguish between appropriate safety measures and OCD symptoms.

3. Difficulty challenging OCD thoughts: When there is a real disease threat, it’s harder for people to recognize when their fears are irrational.

4. Isolation: Staying at home more can increase anxiety and provide fewer opportunities to practice coping with OCD triggers.

5. Media saturation: Constant news coverage about disease spread can fuel obsessive worries.

Potential risks for people with OCD during pandemics

The case study highlights several risks that may affect people with OCD during infectious disease outbreaks:

Excessive isolation: People may isolate themselves far beyond public health recommendations due to contamination fears.

Unsafe cleaning practices: There is a risk of injury or poisoning from excessive use of cleaning products or disinfectants.

Nutritional issues: Severe restrictions on foods due to contamination fears could lead to nutritional deficiencies.

Avoiding medical care: People may avoid seeking necessary medical or mental health treatment due to fears of contamination in healthcare settings.

Increased suicide risk: The distress and feeling of being trapped by OCD symptoms may increase suicidal thoughts in some cases.

Treatment challenges and adaptations

Providing effective treatment for OCD during a pandemic presents some unique challenges:

Safety concerns: In-person therapy sessions may not be possible due to social distancing measures or patient fears about contamination.

Exposure therapy limitations: A common OCD treatment involves gradual exposure to feared situations. This may need to be adapted when there are real disease risks present.

Distinguishing OCD from appropriate caution: Therapists and patients may struggle to identify which precautions are excessive versus appropriate during a pandemic.

To address these issues, mental health providers may need to adapt their usual approaches:

Telemedicine: Providing therapy and psychiatric care via video chat or phone can allow treatment to continue while minimizing infection risks.

Imaginal exposure: Rather than real-world exposure exercises, patients may need to practice imagining feared scenarios when actual exposure isn’t safe or possible.

Flexible CBT approaches: Cognitive-behavioral therapy techniques may need to be adjusted to account for real versus imagined risks during a pandemic.

Medication adjustments: Changes to psychiatric medications may be needed to help stabilize symptoms during periods of increased stress and OCD triggers.

Conclusions

• Media coverage of infectious disease outbreaks can trigger severe OCD symptoms in some people, even before actual disease spread occurs in their area.
• People with contamination-related OCD may be especially vulnerable to psychological distress and unsafe behaviors during pandemics.
• Mental health providers should proactively check in with OCD patients during disease outbreaks and adapt treatments as needed.
• More research is needed on the mental health impacts of pandemics, especially for people with pre-existing conditions like OCD.

This case study highlights the complex ways that public health crises can affect mental health. While the COVID-19 pandemic has impacted everyone’s lives, it may pose unique challenges for people struggling with conditions like OCD. Increased awareness of these issues can help healthcare providers better support vulnerable patients during times of heightened stress and disease risk.