What’s OCD Got to Do With It?

I really try not to be offended easily, and truly, I’m not. But as someone who treats patients with obsessive compulsive disorder, there’s something I need to say. Even in this unprecedented, high-stress, we-have-to-wash-our-hands situation, it is not ok to associate “crazy” with “germaphobe” as I heard a very well-respected reporter say. It’s not ok to encourage people to be “a little bit OCD” (because that’s not possible). In short, let’s not make events worse by (unintentionally) minimizing the experience of someone who’s actually struggling with OCD by perpetuating inaccurate myths about what it’s like to have it.

I’ve heard reporters, psychologists, and other experts use phrases like “… though it would be a good time to be a crazy germaphobe” or “… you have to be a little bit OCD.” Listen, I understand what they’re trying to say, and I know their intent is not to be offensive or insensitive — but it is. Offensive and insensitive.

A Brief Intro to Obsessive Compulsive Disorder
Obsessive compulsive disorder, or OCD, affects 1.2% of American adults — and those are just the ones diagnosed. The number increases when you consider how many people struggling are not diagnosed, receiving treatment, and/or have sub-threshold symptoms (i.e., not enough symptoms to actually classify for the diagnosis, and sometimes insurance reimbursement, but whose lives are consumed by their symptoms. And just like you cannot be “a little pregnant” or “a little schizophrenic,” no one can be a little OCD. Contrary to stereotypes, people with OCD are not “just worried about things being out of place” or “into cleaning.”

For someone with contamination OCD, they may be terrified, preoccupied, distressed, and unsettled that they or someone else will fall catastrophically ill if they haven’t cleaned their hands, body, clothes, home, thoughts, or possessions well enough (and “well enough” keeps growing). Or they may fear they’ll have a heart attack from anxiety if they don’t fix something, so it feels right. You have to understand that for someone struggling with these kinds of intrusive thoughts, their inner experience can feel like a living hell. To make it stop, they will do anything. Some behaviors you can see (like hand washing) and some you can’t (like excessive praying or mental reassurance).

It’s More Than Just a Fear of Getting Sick
In the past few weeks, I’ve seen many clients with contamination OCD whose rituals are driven by the fear that they will transmit the coronavirus to someone else — a family member with whom they live, someone they pass on the sidewalk during a walk, someone at the grocery store. That potential to have infected someone (sometimes greater than the fear of actually being infected) can FEEL intolerable. This leads to whatever rituals they’ve developed to take away that feeling. For these folks, going outside for a walk or to the store for their basic needs feels terrifying, though the relative risk may not be. We can all agree that no one wants to infect or be infected with coronavirus. Someone with OCD (or high anxiety about the coronavirus), however, wants a guarantee (or certainty) in a world where there is none. For others, they are more comfortable being “sure enough” they’ve done everything they can to reduce their risk of infecting themselves and exposing others.

Back to the germ comment.

Please Don’t Call the Mentally Ill Crazy
Just because someone may fear germs does not mean they are crazy. (What does crazy even mean, anyway?) People who struggle with clinical germaphobia are considered to have a pathological and disproportionate fear of germs and/or anything they consider dirty. In an effort to reduce their anxiety and distress, they will go to extraordinary and excessive means to wash themselves (rid themselves) of germs. We’re talking showering or washing in scalding water or until their hands are so chapped that they bleed. Or spending hours a day stuck in washing and cleaning rituals, living in a self-imposed quarantine, because what they consider to be a safe area is just their bedroom. This is not crazy — this is suffering.

I know I’m more sensitive to this kind of language, because I’m a therapist with a practice dedicated to treating OCD and OC spectrum disorders. That being said, I think it’s important that we, as a society, always treat those with mental illnesses with respect and the same way we’d treat someone with a medical illness. During a pandemic, we all need to support each other.

For those of you with OCD, here are some resources for dealing with the COVID-19 outbreak:
International OCD Foundation’s COVID-19 & OCD
Managing OCD About Coronavirus
Managing COVID-19 Anxiety