How O.C.D. and Hand-Washing and Coronavirus Collide

The coronavirus outbreak has turned many people into nervous germophobes, in search of to guard ourselves from an infection by washing our fingers methodically and continuously, avoiding pointless contact with so known as high-touch surfaces and methodically sanitizing packages, our houses and our our bodies.

For folks recognized with obsessive-compulsive dysfunction, or O.C.D., the concern created by the specter of coronavirus has the potential for extra intense and longer-lasting implications.

According to the International OCD Foundation, there are about three million Americans who’ve been recognized with O.C.D. It’s a situation characterised by undesirable ideas or urges that generate excessive ranges of hysteria and repetitive acts meant to neutralize the obsessional thought.

The cleansing and sanitizing practices that assist forestall coronavirus an infection are bringing folks with O.C.D. into nearer orbit to behaviors which can be a gateway to detrimental patterns that would intrude with their capability to interact meaningfully with the world exterior their houses for years to return.

She used to clean her apartment and her hands with pure bleach and cleaning solutions until the skin on her fingers started to peel off, which she would take as a sign that she was cleaning the proper amount.

Those who have successfully gone through treatment to overcome or manage a contamination obsession and sanitizing compulsion are working hard to cope.

Bella Ronan, a 19-year-old in Kirkland, Wash., was diagnosed with O.C.D. when she was 9. Her symptoms began, she said, after her younger sister, Frannie, was born. Ms. Ronan obsessively worried about germs coming into the house that could harm her sister, who has Down syndrome.

To avoid transferring germs from one room to another, Ms. Ronan designated a different pair of slippers for each room of the house. She would change her slippers three times as she went from the kitchen to the living room to the laundry room. If her mother wiped down a table with a cleaner that had chemicals in it and Ms. Ronan’s book was placed on the table, she would refuse to touch the book again for fear of being contaminated by the chemical.

“I was washing my hands 40 times a day, scrubbing them so they were raw and bloody,” said Ms. Ronan, who is living with her family while on a gap year between high school and college.

Years of intensive therapy and finding the right combination of medications offered short-term relief from the O.C.D., she said. But her life was changed after she turned 18 and was eligible for an adult residential treatment program.

She stayed for eight weeks and the treatment consisted of intense exposure therapy during which Ms. Ronan tested her fears that germs and chemicals could make her sick by touching various surfaces and liquids (for example, the bottom of shoes, bathroom countertops and laundry detergent) and then gradually extending the amounts of time before she could wash her hands.

The residential treatment was followed by a monthlong step-down recovery program, during which she lived in an apartment with other O.C.D. patients.

“The only way to overcome the O.C.D. is to learn to live with it, and that’s by living an exposure lifestyle,” Ms. Ronan said.

Now, she is focused on staying healthy mentally and physically. “I’ve spent almost 11 years having something inside my head tell me things that would cause my mom, my dad, my friends and my therapist to say, ‘That’s a little extreme.’” she said. “But now those same people are telling me to wash my hands all the time so I don’t get sick, and I’m trying to wrap my head around it all.”

Ms. Ronan has asthma, which makes contracting Covid-19 even scarier. She is taking her cues on sanitizing from her mother and father, who she trusts.

“If they say I should wash my hand for 20 seconds under warm water, I know there are facts causing them to tell me to do that and I’m relying on facts,” she said. She is also listening to advice from doctors and other experts she hears on TV or reads about in news articles.

Becky Ronan, Bella’s mother, is struggling with her own anxiety connected to her older daughter’s condition. “As worried as I am about anyone getting Covid-19, I’m equally worried about her having a backslide and having to go back into a residential program,” Becky said. “That is just as scary as Covid-19.”

Exposure and response prevention therapy is the most effective treatment, experts say. It systematically tests a patient’s worries that something will harm them by exposing them in a prolonged, repetitive and intensifying system to things that they fear.

When the exposure doesn’t cause significant illness or harm, the patients can begin to learn how to better cope.

But the unusual and urgent focus on sanitation to fight the spread of the virus is also creating concerns for health care professionals involved in the treatment of O.C.D., said Bradley Riemann, a psychologist and the chief clinical officer of Rogers Behavioral Health, which has mental health and addiction treatment centers around the country. (Dr. Riemann is also the clinical director of Rogers’s O.C.D. Center, in Oconomowoc, Wis.)

That’s why providing treatment for O.C.D. right now is especially complicated. “This is clearly a time when we have had to change the way we interact with one another and the way we interact with our environment — it’s a matter of public safety for all of us,” Dr. Riemann said. “But it really collides with the world of O.C.D., and in particular with patients with contamination O.C.D.”

Usually, Dr. Riemann and his staff work with patients by asking them to interact with germs, increasingly extending the amounts of time between washing their hands or otherwise sanitizing. In some situations, he said, patients are asked to touch toilet seats or bathroom floors, and then are given food to eat before washing their hands.

“As you can see, the world we live in today, that collides head on with that kind of treatment intervention,” he said. “It has been very challenging to try to achieve a balance where you are keeping your staff and patients as safe as we all can be, yet still providing effective treatment.”

A silver lining for some people diagnosed with O.C.D. is that the pandemic is showing them how far they have come.

Jeffrey Blitt, 21, a junior at Tufts University in Massachusetts, was studying abroad in Brisbane, Australia, when he and his fellow students were ordered to return home in March. The logistical complications of having to get from one side of the world back to his family home in New Providence, N.J., distracted him from focusing on any fears of germs.

When he was 11 years old, such fears dominated his thoughts so completely that he was not able to go to school and was sent by his parents to Rogers for residential treatment.

Since arriving home from Australia, however, even as the grip of the virus has grown more intense, he is taking note of how much progress he has made.

“At a certain point in time this would have been some of my worst fears realized,” Mr. Blitt said. “But my O.C.D. anxiety is almost completely under control. It’s almost weird seeing everyone do the things I used to do, like people watching hand-washing videos and my mom leaving packages outside,” he said.

(His mother, Lisa Blitt, who was in the same room as her son as he spoke on speaker phone, interjected in her own defense, “It’s safety versus O.C.D.,” she said. “Better safe than sorry.”)

Mr. Blitt, who has always relied on humor to help him cope — as a kid he once dressed as a bottle of Purell for Halloween — is still finding ways to laugh.

“More than anything I see a dark humor in it,” he said of the ritual hand washing and germ worrying being embraced by his relatives and friends. “‘I think to myself, ‘Oh, I was doing all those things and I’m past it and now everyone is doing it.’”

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