INCREASED RISK OF OCD IN COVID-19 PANDEMIC

INCREASED RISK OF OCD IN COVID-19 PANDEMIC

Introduction

The Coronavirus pandemic is of Great concern as it may have a serious impact on the mental and physical plane of the population.Till now 43.9 million cases has been reported worldwide .Although the frequency of mental disorders is expected to increase during pandemics, the COVID-19 pandemic can directly impact the clinical course of obsessive compulsive-disorder (OCD). It is possible that the fear and anxiety caused by the pandemic will trigger various anxiety disorders, OCD and similar negative outcomes.

            A study of the relationship between fear of COVID-19 and OCD was investigated in a Turkish sample of 598 adolescents and the mediating role of emotional reactivity, depression-anxiety in this relationship was examined. Research results showed that fear of COVID-19 has a positive and significant effect on OCD.  OCD manifests in different forms, from ritualistic obsessions to suicidal compulsions. Therefore the fear created by the pandemic carries the risk of secondary consequences in the long term.The risk of developing OCD subtypes, such as washing, hoarding and control, is considered highly during this COVID-19 pandemic.

What is obsessive compulsive disorder (OCD)?

Definition – This disorder is characterised by obsessions and compulsions. Obsessions are unwanted thoughts repeatedly coming to the mind in spite of a strong will to get rid of them. There is the subjective compulsion to act accordingly. Though the patient is fully aware of this absurdity, he is helpless. He is unable to resist this action.

Etiology: Obsessions usually occur among obsessive personalities. Such individuals are usually very meticulous and methodical, and are very particular about cleanliness and orderliness in everything.

Many give a family history of obsessive disorder. Obsession may also result as a sequel of head injury and intracranial infections.

Major subtypes of OCD in relation to COVID -19 pandemic

Contamination

• The fear of being dirty. Contamination is an obsessional worry. There is often fear that contamination might cause harm to himself or his family members. The common compulsions are frequent washing or cleaning and avoidance of shaking hands due to fear of contracting germs from other people
• Avoids being in a crowd fearing that he might be contaminated from other people.
• Some people fear places where there are increased numbers of cases, so will not only avoid going to those places, avoid all contact with such places including accepting mail from those locations, avoid ordering items from companies in the particular affected areas.
• Some people believe that they will become contaminated just by being outside in the air, so either avoid going out or after returning home will shower many times.
• The cleaning or washing is often carried out multiple times often accompanied by rituals of repetitive hand or body washing until they ‘see’ they are clean especially the hands where people will scrub until the hands are bleeding.

Mental contamination-

• Mental contamination is now increasing especially in COVID-19 pandemic. The persons are made to feel like dirt, which creates a feeling of internal uncleanliness ,even in the absence of any physical contact with a dirty object so the person will engage in repetitive and compulsive attempts to wash the dirt away by showering and washing .

Hoarding –

• The anxiety and fear experienced during COVID -19 pandemic may lead to a serious risk of the hoarding of masks, soaps, disinfectants, antiviral drugs, allergy medications and protective clothing, and cause panic in grocery shopping because of the unavailability of items needed for quarantine measures.
• The prevalence of hoarding, which occurred at a rate of 2–5% before the pandemic period, may increase significantly due to the virus and related quarantines imposed. Although there is not yet enough data in this direction, it has been reported in the news that the number of individuals seeking hospital care because of OCD symptoms has increased in many countries.

PREVENTION

• The American Psychological Association (APA) advises that people who notice that they are checking the news more than usual must set a limit for themselves. Defining a specific limit, such as reading the news only once per day, may help ease anxiety
• Take breaks from watching, reading, or listening to news stories, including those on social media. Hearing about the pandemic repeatedly can be upsetting.
• Knowing the facts about COVID-19 and stopping the spread of rumors can help reduce stress and stigma. Stigma is associated with a lack of knowledge about how COVID-19 spreads, a need to blame someone, fears about disease and death, and gossip that spreads rumors and myths.

Homoeopathic approach –

As Homoeopathy always considers the person as a whole, suitable constitutional remedies might help these patients.The patients must be studied in all three planes viz., mental,physical and emotional.most kinds of obsessions are manifestations of sycotic miasm. Psychic disorders are characterized by incoordination and exaggeration. Obsessive neurosis and compulsive neurosis comes under sycotic miasm.

1)Arsenicum album:

• People who need arsenicum album generally have an extreme fear of germs, and may feel the need to wash their hands, shower, brush their teeth, or clean their rooms compulsively. All fears tend to be around security: in addition to fearing germs, they may have a fear of other types of illness (especially cancer), a fear of robbers or someone breaking into the house, or a fear of death. Because of this they always need someone nearby and are afraid to be alone. They can be critical, irritable, and demanding.
•  Compulsively fastidious, obsessed by the need for order and cleanliness to the point of expending inordinate energy, constantly cleaning and straightening. An Arsenicum housewife will be seen following after the guests who are entering her house, immediately repolishing the already meticulous floor so that even the slightest stepmarks will not be visible. An Arsenicum visitor will get up and straighten a picture which is hanging on the wall slightly askew. This same individual may not be able to restrain himself from repositioning a tablecloth in a restaurant which is not hanging symetrically. He will spend quite a bit of time symmetrically arranging his shoelaces; otherwise he will be bothered by their asymmetry. This excessiveness characterizes the Arsenicum fastidiousness.
• The wardrobe of the Arsenicum is something beautiful to look upon: everything is aligned with unbelievable precision. Such uncompromising attention to detail results in the well recognized immaculate, perfect appearance of Arsenicum
• Even if he has owned a suit for many years, so neat and clean does it seem on him that one is left with the impression that it was recently purchased. He attends to his clothing with great care and precision; on arriving home, for example, he will carefully and neatly fold his clothes and put them away so that on the following morning he will be sure to find them in an immaculate condition. He enjoys rendering such care and spends an inordinate amount of time at it
• This passion for order and cleanliness can be so great that in more mentally disturbed cases serious obsessive behavior concerning dirt and microbes can result. These people will wash not only their hands, but also their clothes many times over. Some slight contact with another person may precipitate an intense feeling of uncleanliness. Their concern about being contaminated may cause them to avoid physical contact with others. These individuals may suffer a similar sense of uncleanliness as a consequence of contracting some physical disease, especially a skin rash. If a doctor tells them, for instance, that they are suffering from a fungal infection, they will immediately feel dirty inside [their body] and begin a paroxysm of frequent bathing. No amount of washing, however, will eradicate the feeling. They are very easily disgusted, not so much when eating at a friend’s home, as in the case of Sulphur, but more by seeing or coming into contact with dirt.

2) NATRIUM MURIATICUM

Hypochondriacal anxiety about health emerges, particularly in regard to heart disease. This hypochondriasis is related to the fastidiousness seen in Natrum mur. The patient is driven by a compulsive need to avoid always cleaning, washing hands, disinfecting everything. In Natrum mur. fastidiousness is specifically a fear of microbial contamination, and not so much the feeling of disgust seen in other remedies (Sulph, Puls, Merc, Phos, Mezereum). Also, in Natrum mur. anxiety about health is much less significant than hypochondriasis, which is more of an anxiety -compulsive attention to details about health

3) SYPHILINUM

 IMPULSE TO WASH HANDS. Profound aversion to dirt or to touching dirty things.A curious symptom which is very real is that the patient very often washes his hands.Fear of catching cold – so strong will stay indoors Develop a tremendous aversion to anything dirty after sex with a prostitute. May become so strong that they will wash clothes if someone touches them on a bus. Will not even shake hands with you. Wash hands 50 – 200 times daily – shrivelled skin on hands. Successful being one-pointed in their profession – become very meticulous and very proficient.  If not able to wash hands will develop sweat, headache. Paranoid fear that if their children touch what they have touched they will be similarly tainted. Know this is ridiculous but do not have strength to stop

4)CARCINOSIN

Obsessive –compulsive streak. One child must tie four or five knots in his shoelaces to feel secure in his sneakers; another fearing contamination, insistently washes (several times) the already clean plate and cup he will be using at meals; a third, to satisfy the type’s self-critical vein and fastidious taste, is compelled to go over a penmanship.he goes through assignment in school so many times that it ends up looking worse and worse.

5) SULPHUR

Very forgetful. Difficult thinking. Delusions; thinks rags beautiful things-that he is immensely wealthy. Sulphur is indicated especially for hoarding OCD where he collects all the rags Which seems beautiful for him.Busy all the time. Childish peevishness in grown people. Irritable. Affections vitiated; very selfish, no regard for others. Religious melancholy. Averse to business; loafs-too lazy to arouse himself. Imagining giving wrong things to people, causing their death. Sulphur subjects are nearly always irritable, depressed, thin and weak, even with good appetite.

6)CALCAREA CARBONICA

Calcarea Carbonica is a Homeopathic remedy for patients of Obsessive Compulsive Disorder who are mentally exhausted and constantly think of going mad or insane. This thought of going mad prevails in the patient’s mind day and night and he or she is unable to put it aside even during sleep. This fear of going mad leads to great distress and to overcome it, the patient leaves all pending work aside and keeps himself or herself busy in breaking sticks or bending pins.

Calcarea Carb is very beneficial to treat cases of obsessive-compulsive disorder (OCD) with a marked fear of contracting germs and contagious diseases. It offers help in cases where there are great anxieties about the present, future and about health. The anxiety is attended with restlessness and palpitations, more so during the evening time. This remedy is also used to treat fears, where a person is plagued by thoughts of misfortune or terrible thing happening, fear of losing reason, fear that he/she is suffering from organic disease of the heart.

7)THUJA OCCIDENTALIS

          Thuja is one of the very good remedies for generalized anxiety disorders and obsessive compulsive neurosis. The patient generally gets anxious over trifles and cannot concentrate on whatever he does. He has many fixed ideas and he finds it difficult to get rid of them. Social phobia is also commonly seen in these patients who begin to get nervous and get twitching on being approached by strangers. They are obsessively preoccupied with issues of self-esteem, developing fixed ideas and entertaining worries about appearance, performance or health. Deep with-in, these patients do not feel worthy and hesitate to reveal themselves to others, fearing that they will not be liked

BIBLIOGRAPHY

1. Vithoulkas George ,Essence of materia medica
2. Krishna das K.V ,Textbook of medicine
3. https://doi.org/10.1007/s11469-020-00322-z
4. https://doi.org/10.1016/j.psychres.2020.113213
5. https://doi.org/10.1016/j.jocrd.2020.100558
6. http://dx.doi.org/10.1590/1516-4446-2020-11897)www.thelancet.com/psychiatry Vol 7 July 2020

Ms. B. Srinidhi

Fourth year BHMS