In the unusual context of confinement, some anxiety and phobic disorders stand out, or those related to obsessions, traumas and stressors, which for the most part are not triggered by unwanted confinement or fear of Covid-19. In addition, many people have mental health disorders that have been exacerbated in these weeks. On the contrary, they favour a better adaptation to the new hygiene and social distancing protocols.
Clean on clean
There are different types, and degrees of obsessive-compulsive disorders (OCD is already popular for appearing in movies like Better Impossible, The Aviator, Knock Knock…), but the obsession with cleanliness and personal hygiene falls squarely in the field of the pandemic. “In this context, people with OCD can continue with the methodical customs they already had or go beyond what is reasonable to accentuate precautions and avoid contact with others,” explains José Manuel Menchón, head of the Psychiatry Service at the Hospital de Bellvitge and full professor at the University of Barcelona.
They are patients who may need a clock hour to shower, repeat rituals, or constantly interrupt their tasks to wash their hands. “We are facing an OCD when this excessive behaviour occurs. The patient knows that his rituals do not make sense, but he cannot avoid them, making him feel ashamed and flee from family or social relationships”.
Menchón points out that during the pandemic, people with OCD are very busy avoiding getting infected and that from a labour point of view, confinement does not make things any easier either. “The obsessive can even be late for telecommuting, even if they get up early to perform the characteristic rituals. And these are likely to intensify when you have to go outside again because you will be extremely worried about getting infected
at work or on public transport.” On the contrary, the psychiatrist believes that a subgroup of patients can benefit from forced confinement because they feel more protected and even more integrated into the family nucleus, seeing that now everyone complies with certain cleaning rituals.
Another group of TOC focuses on checks. For example, if the person already used to compulsively check if the door was properly closed, now he has to reinforce the ritual so that the virus does not enter, and he does it knowing that it is irrational. “These days, they can increase that type of checkers and also the magical thinking of the order of ”if I repeat this three times nothing bad will happen to me”. When you engage in these behaviours obsessively, it is convenient to seek a professional diagnosis“.
Menchón asserts that this behaviour must be separated from small quirks (wearing the lucky sweater, for example) that do not interfere with time or the avoidance of situations. “There is a disease when if the ritual is not followed, symptoms appear, general anxiety, which creates dysfunction in the vital routine.
During confinement, some OCD has avoidance behaviours and get away from relatives who go out to work or shopping for fear of getting infected. They even seclude themselves in a room. “Family interference occurs beyond what is reasonable, but the obsessive person may feel relieved by the confinement as there are no face-to-face social relationships.” According to the psychiatrist, some refuse even to talk on the phone.
The most direct interference occurs when family members are forced to wash constantly, even taking off their clothes when entering the house entrance to wash them immediately. The person with this disorder will feel great anxiety. “In extreme cases, they are patients who throw all their clothing in the trash after just one use,” adds Menchón.
Mild OCD does not require treatment, but those who suffer a lot from these behaviours and need to hide them, or when it affects their work, family or social capacity, do. One of these two criteria is sufficient, considering the time spent on obsessions and compulsions and the need for avoidance. According to international studies, those affected take between 8 and 10 years to seek help.
Only in cases where the obsessive disorder is very severe, lasts more than five years and is refractory to other treatments would brain surgery be performed. For example, the Hospital de Bellvitge has 24 cases of deep brain stimulation, of which 60 per cent have experienced improvement. In 15 per cent of non-severe patients treated with conventional therapies, the disorder disappears, while 40 per cent improve markedly.