One of the best and most effective ways to try and stay healthy during the Covid-19 outbreaks is to wash your hands. Wash them for at least 20 seconds, and be thorough—get all the spaces between your fingers, and underneath your nails. After you touch something, wash your hands again. Then wash them again before eating or picking at your face. Also, carry around alcohol-based hand sanitizer.
Experts additionally advise that people don't get too close to others who appear to be sick—they can spread virus particles through droplets that will get into your nose and mouth. Be wary of surfaces in common areas, and disinfect those surfaces frequently.
These are evidence-based recommendations, but for someone with Obsessive Compulsive Disorder (OCD) and contamination and health anxieties, this advice can start to veer into uncomfortably familiar territory. It sounds an awful lot like the anxious thoughts they have on a daily basis, even when there's not a new virus spreading around the globe.
For many people with anxiety and OCD, the news and well-meaning (and accurate) CDC and WHO guidelines can trigger bouts of intense anxiety and compulsive behavior. It can spark intense worries about getting coronavirus, feeling like you already have it, obsessing about what might happen if you get it, cleaning, checking, or experiencing physical symptoms of anxiety: like dizziness, breathlessness, tingling, chest pains, and more. After all, even people without OCD or anxiety are exhibiting compulsive-like behavior: buying out stores of hand sanitizer and canned goods, overstocking on masks that don't help much if you're not sick yourself.
I know a bit about this firsthand. When I was a child, I obsessed over whether or not my hands were clean, washing them constantly. After I washed them, I told myself I wasn't allowed to touch anything, lest I infect them again. I would clench my fists and avoid opening doors or touching tables. If my hands even touched the insides of my shirt, they would feel contaminated to me. As an adult, I've also obsessed about getting various diseases, from rare autoimmune disorders to MS to bronchitis—when these obsessions would take hold, I used to sit in doctors offices weekly to try and diagnose what I thought I had.
I've been in therapy for OCD for several years now, where I've made a lot of progress on not responding when anxious thoughts arise. (Thoughts don't ever really go away altogether, but you can get better at reacting to them.) Even though I've made big strides in recovery, the coronavirus outbreak can bring on a little voice in my head that says things like: A ha! See, I was right that every surface is an infected cesspool that will kill you. And: I knew it wasn't safe to touch anything, and also you should start showering in bleach.
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These outbreaks are serious: There are more than 82,000 cases of coronavirus diagnosed worldwide so far, and almost 3,000 people have died. There are currently 135 cases of coronavirus in the U.S. in 16 states, but likely many more to come as testing for the virus becomes more widespread. But how can a person with OCD manage, when suddenly confronted with messaging coming from all directions that sounds almost exactly like intrusive OCD thoughts?
Understand the reason why it's so triggering
Covid-19 demands us to pay attention to the concepts of cleanliness and disease. And the advice to constantly wash your hands or clean surfaces gives people more reasons to think about those behaviors, said Jon Abramowitz, a clinical psychologist at the University of North Carolina.
People with OCD are often trying to do the opposite: "T[hey] take their attention away from cleanliness and get through their day acting as if the worries in their head about germs and contamination aren't relevant," said Shala Nicely, a therapist specialized in treating OCD. "Then the media and authorities say, actually—this is relevant."
The CDC can also use words like "frequently" or "often" to describe how often hands should to be washed. This can cause a lot of distress to people with OCD because they can worry about the specific meaning of those words, said Jon Hershfield, the director of The OCD and Anxiety Center of Greater Baltimore. "How do I know that I am washing my hands 'frequently' as opposed to every hour or after every contact with a public surface?"
All this attention to germs, hand-washing, or illness can bolster anxious thoughts on those topics, and so if you're having more of them, that's completely normal. The trick is to not let it trickle out into your behavior, which validates those thoughts.
Follow official guidelines, but don't go above and beyond
Of course, there is validity in the need to wash your hands while a virus is spreading, so how to toe this line? Nicely suggests borrowing a technique used in OCD therapy called exposure and response prevention, or ERP. In ERP, a person is exposed to something they're anxious about, and then tries to not do the response that makes the anxiety go away. For example, not washing your hands after you touch the ground before eating something.
During an outbreak, Nicely said she wouldn't recommend people to stop washing or sanitizing things entirely, but consider the exposure in a different way. The "exposure" becomes to pick one legitimate source for prevention, like information from the CDC, and follow it—but that's it. Don't do anything above and beyond what they advise and don't listen to the guidelines and rules that OCD starts to set in your brain.
"OCD thinks it's an authoritative figure on all things having to do with safety, and then it tells you what you should do," Nicely said. "But I think it's important to understand that OCD is not the authority on this. It does not have the knowledge to be telling you how to wash your hands."
To make sure you're staying within the realm of adaptive behavior, Hershfield said it can be helpful to observe what you're doing and whether it's changing over time. "If on Monday I am washing for 30 seconds before eating, but on Tuesday I am washing for 60 seconds, this is something to be concerned about," he said. Once you follow CDC recommendations, tell yourself it was enough. If thoughts like, did I do it right, are you sure we did it for long enough, or let me check what I cleaned one more time come up—acknowledge them, but then let them go.
Don't be glued to the news
Coronavirus articles are everywhere, and yes it's important to stay informed. But Nicely also suggests not becoming too entrenched in the media coverage, and finding what works for you in the balance of being up-to-date versus knowing too much.
People with OCD can tend to be overly informed. "We become experts at whatever subject our OCD wants us to Google," she said.
Figure out how infrequently you can check the news and still get the information you need without making you too anxious. Maybe it's once a day, maybe it's once a week. It could be that the best thing for you is not checking at all, and relying on and trusting friends and family to give you updates that you need to know, like any cases in your area.
"Compulsively checking the news, ruminating over what will happen in the future, or mentally reviewing what you've heard about the virus all create opportunities for obsession," Hershfield said. "Focusing on the present moment, even if that includes being anxious, and working with 'OK, this is where things are for me right now in this moment' is your best bet."
Accept that there is going to be uncertainty
OCD and anxiety are rooted in an intolerance of uncertainty. Ultimately, all exposures in therapy are about teaching a person that they can handle not knowing what's going to happen when they do something that scares them.
"You can't see viruses, so it’s impossible to know if you’re 100 percent safe," Abramowitz said. "People with OCD tend to assume danger unless there’s a clear guarantee of safety; and hearing about the virus every time you turn on the news makes it seem like it’s easy to get."
That's why you might be tempted to wash your hands again, or read another news article. Because you're trying to be more certain that you won't get it or give it to someone else.
"We feel like if we know something we can control it, but that's unfortunately an illusion," Nicely said. "Knowing the current stats about the outbreak doesn't give a person any more control over it."
If you can accept that there are a lot of unknowns and try to live with the discomfort, it will go a long way to managing stress during the outbreak.
Don't be too hard on yourself
All of that is easier said than done. Nicely and Abramowitz said this is going to be an extremely difficult time for many people with anxiety and OCD, and so it's important to be kind to yourself during this process.
"Say to yourself, I'm going to do the best I can but sometimes I'm going to mess up," Nicely said. "I'm going to be super anxious and that's all okay. The other problem all of us with OCD can face is we want to do it perfectly. We might think: I didn't perfectly follow the CDC guidelines and I should beat up on myself. Instead, be really nice to yourself and say, wow, this is a really hard situation for everybody."
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