Last month, as many of us were singing along to hand-washing songs to hit the recommended time of scrubbing our hands clean of coronavirus, 32-year-old Manal had started a routine that left her hands raw and red. The Dubai resident would wash her hands with soap for a good 55 seconds (over double the recommended time), leave the bathroom to try get on with her life, and then immediately come back and rewash. “And it still wouldn’t feel enough,” she says. Straight after, she’d rub a lot of alcohol-based hand sanitiser on her hands, but inevitably have to touch something that “felt risky to me, like the groceries I’d ordered a few days back, even though I’d thoroughly washed them all myself”. So, she’d go back and repeat the whole hand-washing-and-sanitiser cycle again.

“It got to a point where I was spending more time standing over the kitchen sink or bathroom washing my hands than anything else. Even eating and sleeping.”

It’s no secret that the pandemic has had a devastating impact globally. But it’s a different kind of devastation for those living with obsessive-compulsive disorder, or OCD.

Ghania Kabbara, a clinical psychologist who treats patients for OCD at the Priory Wellbeing Centre, Dubai, terms OCD a common mental disorder where people experience “intrusive and distressing recurring thoughts, urges, or images, which we call obsessions”. She lists common examples of obsessions as fear of contamination, a fear of things not being in order, or out of their control.

For anyone at risk of OCD, key symptoms to look out for include raw hands from over-washing and repetitive showering, says clinical psychologist Ghania Kabbara

And as the current pandemic plays on many of these concerns, it’s likely to exacerbate symptoms in those already living with OCD, or encourage the re-emergence of symptoms in those who have overcome it. “OCD sufferers may believe a pandemic even validates their behaviour,” she says.

Cue an overwhelming obsession with hand hygiene, cleanliness in general and an avoidance of situations that they might perceive to be high-risk. And an increase in the tendency to doubt the completion of their compulsive behaviour – a defining feature of OCD. “Combined, this behaviour can have a debilitating effect on the daily lives of those affected,” says Ghania.

Wash, wash, wash

Debilitating it was for Manal, and it didn’t stop at handwashing. The groceries she ordered home were given no less a sanitising treatment. “I’d dunk everything in soapy water. Yes, everything, even vegetables and fruits, and even packets of crisps. I’d then wash and dry them, then wipe them down with Dettol liquid, and then wipe them clean again with anti-bacterial wipes. Then I’d repeat the whole process again, because I was afraid I’d missed some spots that would contaminate me.”

She would take bread and butter and cheese out of its plastic covers, milk out of its packaged bottle, and transfer them to her own boxes and bottles; mop the floor with disinfectant day and night, “even though my husband and I weren’t receiving any guests at home”. The door knobs were sprayed with sanitising liquid twice a day. “I’d spray so much, my husband would have a coughing fit. The one time I was going out for some urgent groceries, I wrapped my feet in plastic bags, put socks over them, then my shoes. And after I was back I spent the rest of the night sanitising myself and our entire home.”

This fear of contamination and a compulsion to sanitise is nothing short of a very real nightmare for sufferers. Ghania’s colleague and clinical psychologist Imane Bougueffa says sufferers could also experience an intensified focus on not going out in public or leaving the house through a fear of being contaminated by germs, increased anxiety and the need for reassurance that everything will be okay. And for those who have already undergone therapy to help manage their conditions, there is a real concern they will experience severe setbacks in terms of their progress. “For many, the virus could throw into question everything they’ve been encouraged to believe whether via counselling or therapy programmes.”

There is the added worry that some may take this ritual a step further and use harmful cleaning solutions or abrasive materials in the belief this will help rid them of contamination, says Ghania. This is dangerous on a whole other level besides injury. “The breakdown of the skin’s natural oils will then affect the skin’s ability to protect itself from infection,” she says.

Symptoms to watch out for

If you or a family member is at risk of OCD, key symptoms to look out for include raw hands from over-washing, repetitive showering due to an over-riding focus to be constantly clean, lack of sleep due to over-worrying/anxiety, difficulty sticking to any kind of work/school schedule due to an excessive amount of time being spent on hygiene rituals, and angry outbursts and general misbehaviour, especially if the person is not able to carry out desired rituals, Ghania says.

For those who have already undergone therapy to manage their conditions, clinical psychologist Imane Bougueffa says there is a real concern they will experience severe setbacks in terms of their progress

Families of those suffering from the disorder can show their support by preventing the disorder from being the centre of communication and main focus of everyday life. “It’s important that family members offer high levels of compassion and understanding, but not to such an extent that it dominates all conversations, and risks reinforcing the behaviour,” Imane says. “Also, avoid blame. OCD is a very real illness, so refrain from blaming the sufferer for his/her obsessions, fear and anxiety. Even at the most testing of times, show compassion and understanding and offer continual support.”

While it is always recommended that people suffering from symptoms of OCD seek professional help, this takes on added significance during the current health outbreak. Imane says it’s more vital than ever that sufferers opt for therapy to ensure symptoms and certain behaviours can be kept in check. “More and more organisations are now offering tele-health services (such as virtual therapy), 1:1 sessions from the comfort of our homes, so sufferers can share and discuss their symptoms and work on the skills needed to manage them on a day-to-day basis,” she says.

Tips for coping with OCD symptoms

It is also vital for those with anxiety to be proactive in caring for their mental health, Ghania and Imane say.

Stick to routine. Despite the many changes to our lifestyles, sticking to a “‘normal” routine as much as possible is vital – getting up and dressed, mealtimes, bedtimes, relaxation time, etc., can all help to encourage a feeling of normality.

Learn to relax. Meditation apps, deep-breathing and mindfulness exercises can all help to focus and calm the mind.

Limit access to news related to the pandemic. A constant barrage of news-related items even when just in the background will leave OCD sufferers in a permanent and higher state of anxiety. But ensure you keep up to date with current advice, perhaps once or twice a day.

Focus on the present. Avoid sharing concerns and worries related to the future and the impact of Covid-19. Instead, stay focused on those aspects you have control over. Be present and connected with others. Share simple, everyday tasks with your family. This will help sufferers to understand how it is possible to cope with the situation in a positive manner.

Reduce possible triggers/stressors, such as certain physical objects and situations. The more anxiety experienced, the more likely OCD symptoms will emerge.

Don’t be afraid to seek help. Ensure a family member/partner/friend is aware of how you are struggling during these unprecedented times, to help offer regular reassurance and support.

Seek professional help where available online or by phone. Psychotherapy, cognitive-behavioural therapy and medications may be recommended depending on the severity of the symptoms.

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