These are uncertain times, and uncertainty is familiar territory for people living with obsessive-compulsive disorder (OCD). OCD sufferers have more difficulty tolerating uncertainty and are more likely to feel uncertain in situations where others would not (1, 2). Compulsions are driven by the quest for certainty.

This is Really Hard…

To some, this pandemic almost feels like permission to give in to OCD fears and urges. The need for quarantine and social distancing reinforces the fear that the world is a dangerous place. People with OCD may feel as if their fears and rituals are more valid or warranted, especially if they have contamination-related fears, health anxiety, or fear of harming others. With more free time and less external distraction, the brain has more space to ruminate and catastrophize, fueling OCD symptoms. 

…But You’ve Got This.

On the other hand, people with OCD, especially those who have been in treatment, may be better equipped to manage the uncertainty of this pandemic. OCD sufferers spend much of their time trying to figure out how to survive, how to manage in worst-case scenarios, and how to keep living life despite having a constant sense of dread and the fear that something has gone, or is about to go, terribly wrong. OCD sufferers are often very capable of moving forward despite these painful, constant feelings. During the pandemic, everyone has been anxious and stressed. The threat to health and one’s way of life is real. Thus, OCD sufferers have not only had more practice in managing uncertainty and a sense of dread, they are now not alone with their concerns.

It is important to remember that anxiety in and of itself is not pathological. It is an emotional reaction that is meant to help us survive. It drives people to follow shelter-in-place orders, to wash their hands appropriately, and to connect with those they love. However, people with anxiety disorders or OCD feel anxious even when there is no actual danger or when the threat of danger is fairly low or simply imagined. For someone with an anxiety disorder, it is difficult to disentangle useful anxiety from pathological anxiety, but the key point is that some level of anxiety is normal. Ride it out rather than trying to make it go away. If the anxiety becomes debilitating, it is important to seek help.

Tips for Coping with OCD

• Use friends and family and ONE authoritative source (like the Centers for Disease Control, not a website that promotes an entire decontamination ritual for groceries) to help you identify what you do have control over and action steps you can take that will be useful. Recognize that doing these things will not alleviate your anxiety - because your brain feels anxious at baseline. That is just your brain. Work on accepting and living with the feelings, rather than trying to make them go away by worrying, figuring out, fixing or avoiding.

• Go toward your anxiety, embrace it, and even try to make it worse. Find things that challenge your anxiety each day. The more you CHOOSE to be anxious, the less power it has over you, and you gain a sense of mastery over an otherwise potentially overwhelming and terrifying experience. 

• Just because everyone is being cautious about sanitation, doesn’t mean you can’t do exposures. You can find ways to make yourself anxious and challenge your fears, even if your fears are contamination-based – touch the insides of your own trash cans, wear the same clothes three days in a row, put raw meat juice on your pants, put bathroom germs on your remote control, or touch your mail without gloves.

• OCD lives in the past and future. Practice mindfulness, and focus on what you are doing in the moment.

• Allow for imperfection - you will have bad days, and that's okay. Just start over the next day. All you can do is your best, and no one will cope perfectly. Be kind to yourself, and practice self-compassion.

• Find ways to help people and take the focus off yourself. Offer to buy groceries for an elderly neighbor. Reach out to people who may be more anxious than you. Sign up with local volunteer efforts. Tip the delivery person a little extra.  

• Each day, write down at least one thing you are grateful for.

• Exercise, even if just by going for a brief walk around your neighborhood.

• Get outside each day.

• Keep a schedule. Get dressed and shower like you normally would, even if you aren’t going anywhere.  

• Continue to go to therapy, and take medications as prescribed. Most therapists have switched to offering virtual sessions.

• Journal. It will help you process, and it will be interesting to revisit when we recover from this. It is also a good way to allow yourself to process and experience the negative emotions you are feeling, rather than avoiding or trying to escape these emotions.

• Look for online support groups.

• Move to a new setting/environment if getting stuck with school or work.

• Find some consistency, e.g. a Netflix series you have enjoyed in the past, a comforting night-time routine, walking the dog, or touching base with family or friends each day.

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Things to Avoid If You Suffer From OCD

• Don’t seek reassurance constantly – this just reinforces the idea that danger is ever-present. The more you seek reassurance, the more feedback you give your brain that this really must be horrible.

• Don’t use substances excessively.

• Avoid playing video games or watching TV/Netflix all day long (moderation is key here).

• Don’t watch the news or surf the internet (and social media) constantly - set a limit, such as only allowing yourself to check for 30 minutes each day. Unfollow or mute any social media feed that is unhelpful or puts you in a bad/worse mood.

• Avoid staying up all night, staying in bed all day or throwing off your sleep schedule.

• Try not to isolate yourself. Reach out to family/friends via video chatting, calling or texting.

• Don’t give into compulsions – this just perpetuates the cycle and ultimately worsens the anxiety.

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If Someone You Care About Has OCD

• Don't minimize their fears, but also don't feed into the anxiety or exacerbate it. Validate their emotions and acknowledge that their emotions are very real and painful. For example, "I'm sorry this is so scary and hard for you right now. I see this is affecting you a great deal, and I'd like to help in the ways that I can."

• Ask your loved ones or friends if there are specific ways you can help. If you live with them, help them engage in positive distractions such as playing a board game or helping with projects around the house. If you don't live with them, help decrease isolation by reaching out to them via texting, phone calls, video calls or social media.

• Model effective and adaptive behavior. Don't go on and on about the news or all the terrible things that are happening. Just as important, don't repeatedly reassure them (constant reassurance just reinforces fears).

• Don't accommodate rituals like excessive cleaning or decontaminating. Help them stick within reasonable guidelines, like those recommended by the CDC. 

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There is no way around it, things are different and hard right now. If you have OCD, you’ve spent most of your life figuring out how to navigate uncertainty, and this is a chance to put into practice the more effective skills and strategies you’ve garnered. If you love someone with OCD, these strange times offer a glimpse into what it is like to live every day with an uncertain brain.