Covid-19 pandemic led to relapse of recovering OCD patients, say Mumbai doctors

Obesession with cleanliness has emerged as the most prominent symptom

Over the past two years, Dr Sonal Anand, psychiatrist with Wockhardt Hospital, Mira Road, has received calls from patients with Obsessive Compulsive Disorder (OCD). What's surprising though, is that most of the SOSes have been from previously recovered patients. "Although they were doing just fine, the Coronavirus outbreak led to a relapse. For many living with OCD-related fear of germs and other contaminants, the pandemic has exacerbated their panic and is leading to excessive precautions," says Dr Anand.

The International OCD Foundation defines the condition as a mental health disorder that occurs when a person gets caught in a cycle of obsessions and compulsions. While obsessions refer to the intrusive thoughts that trigger distressing feelings, compulsions are behaviours an individual engages in, to get rid of the distress. According to the National Institute of Mental Health, OCD is caused principally by excessive activity in the amygdala, a walnut-sized structure at the base of the brain that processes fear, danger and the fight-or-flight response. New research shows that OCD symptoms have grown more severe for many people during the pandemic, and new diagnoses have increased. "In the new cases that I have seen, the symptoms are rather extreme. Due to excessive handwashing, patients have developed rashes. The symptoms, however, vary depending on the individuals. They can fall in the mild, moderate or extreme category," she says. Dr Anand pegs the increase in cases since 2020 to 30 per cent.

Dr Milan Balakrishnan and Dr Sonal Anand

A Goa-based photographer, who did not wish to be identified for this article, says OCD may involve an obsession with cleanliness, but it's not restricted to that alone. "It could be a near-constant fear of a break-in, or that the doors weren't locked. It doesn't matter how many times I check the door, the anxiety creeps back in." The 23-year-old was diagnosed with a mild form of OCD in his teens. To mitigate the symptoms, he had created a daily regimen for himself that included exercising at the gym without fail. This, along with therapy, put him in a better place. According to research, exercise helps with the release of "growth factors," which trigger neurons to make new connections. These new connections may help reduce symptoms. "There's technically no cure for this [condition]. So, you have to find ways to channel the thoughts and break the loop. For me, gymming and socialising with friends had become outlets. But due to the lockdowns and temporary closure of gyms, the routine got upended, so I resorted to home workouts. It helped to an extent," he says. His symptoms are triggered in stressful situations, which could be during an illness, high pressure at work, or at busy social gatherings.

While the photographer found a way to work around it, Dr Milan Balakrishnan, consultant psychiatrist at Masina Hospital, says convincing patients to seek treatment has become more challenging in the pandemic. "It's almost like reality matched their fears. The COVID public service communication which says that we need to be extra careful to keep the virus at bay, is justifying their actions. Which is why symptoms linked to cleanliness were most prominent." While all of us have experienced anxiety on some level in the pandemic, the distress was much higher for people with the condition. "Let's say, a person with OCD would take 20 minutes for a shower earlier, that time had now increased to two hours. From washing hands five times in an hour, it became 20," he shares. The effect of OCD often spills into the household, thinks Dr Anand. "If the principal member in the family, for example, the mother suffers from it, she may expect her children to wash their hands as often as her, and they in turn grow up thinking this is normal."

It's important to differentiate between obsessive-compulsive personality disorder (OCPD) and OCD, warn experts. The former is defined by strict orderliness, control, and perfectionism. "Someone with OCPD will likely try to stay in charge of the smallest details of their life. These ‘anal' personality quirks aren't the same thing as having a personality disorder. If this obsession starts interfering with your functioning and leads to irrational, repeated behaviour and uncontrollable thoughts, you may want to seek help," she says. Treatment depends on the severity of the disease. In many cases, Cognitive Behavioural Therapy (CBT) remains the treatment of choice. It involves helping the patient explore alternative ways of thinking and challenging their beliefs through behavioural exercises. "For moderate to severe cases, medication helps. The good part is that now there are newer medications available in the market that are not habit-forming or sleep inducing and help straighten your thoughts."

The Famous also obsess with cleanliness

Actor Deepika Padukone who was the first among the young crop of actors to open up about depression, spoke about her OCPD traits in an interview. "When I was in school, my friends' parents would call me to sleep over for a girls' night because they knew that the minute I come home, I will start cleaning their rooms making their lives easier. I am still that person. When I go to somebody's vanity van, I start cleaning spaces around me."

Actor Ajay Devgn is said to have an intense disgust for smelly fingers, which is why he doesn't use his fingers to touch food. In an interview, he admitted that he even eats dal and roti with a knife and fork.

In an interview, former US President Donald Trump admitted to having "germ phobia" and that he washes his hands as many times a day as possible.