COVID-19 Q&A: Dr. Margo Thienemann on OCD
The prolonged uncertainty brought on by the Coronavirus pandemic has heightened the challenge of maintaining mental wellbeing, particularly for some with conditions that manifest in controlling outcomes, like Obsessive-Compulsive Disorder, or OCD. As part of our COVID-19 Q&A series, Dr. Margo Thienemann, Clinical Professor in the Department of Psychiatry & Behavioral Sciences and Director of Psychiatric Services at the Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) Clinic, shares how COVID-19 is impacting patients and ways to cope.
As the impacts of the COVID-19 pandemic press on, we see an overall increase of stress and anxiety in the general public at large, but how is this affecting those who were already navigating an Obsessive-Compulsive condition?
Dr. Thienemann: I know that we are all stressed. I imagine that it is a mixed picture for people with OCD. When stress increases, OCD symptoms generally increase. A colleague suggested that we limit news reading to a short period of time per day and focusing only on reputable sources.
No two people have exactly the same fears and compulsions. Overarching OCD is an attempt to control circumstances to avoid dangerous outcomes.
Because this crisis is one of contagion, it must be of particular trauma for people whose OCD is around germs. Is that the case, and what are you seeing in your practice?
Dr. Thienemann: In terms of avoiding the COVID-19 virus, some people with OCD contamination fears have said things like, “Now you understand what it is like for someone with OCD to have to keep such close track of what was touched, what and when… I have been living like this for a long time and am expert at it… You are having to learn what it is like.”
OCD fears can be very specific. Interestingly, I have patients whose OCD fear focuses on other infectious agents, but not COVID-19, so their contamination fears are not worse.
In terms of the impact of being sequestered, for some it can be a relief to not be expected to and not have to go out if aspects of leaving the house, being with others, driving, seeing others, going in to work or other of the myriad aspects of going out raises OCD fears.
What are you telling your patients to do to navigate this challenging time?
Dr. Thienemann: Patients should follow CDC guidelines when they are out and bringing items into their homes.
When they are in their home (where COVID-19 contamination is very unlikely), then they can still use the techniques they use in their cognitive behavior therapy, such as exposures that may include reduced washing or refraining from cleaning.
When following the CDC guidelines, OCD patients should work to notice whether their behaviors are excessive and limit the washing/cleaning to suggested guidelines and not fall into excessive cleaning.
With the public being urged to wash their hands often as one of the best ways to avoid catching and spreading the virus, how do patients whose OCD manifests in excessive handwashing or other cleaning rituals balance that?
Dr. Thienemann: Everyone, OCD or not, needs to wash their hands along guidelines. That may be more than before; if they touch things from "the outside world" and have been outdoors around others. Home should be a "clean space" due to sequestration and washing anything coming into the house, not having new people coming in. There, hand washing should be limited to the usual; generally before food prep and eating, after using the toilet.
Additional hand washing, such as that dictated by obsessions, should be limited as usual, to what the person and their therapist have decided would be helpful to treat their OCD. NOTE: If you are not in therapy, see resources below.
How are you, as a mental health care provider, finding your ability to care for your patients affected by the virus?
Dr. Thienemann: I feel fortunate that I have been able to use Telehealth for my visits. It is not perfect, but we can easily meet no matter where we are. It is interesting to get a bigger picture of people’s homes and families. OCD exposure therapy is often site-specific and the office is rarely the best place to do the therapy. Patients can bring their smart phones, tablets and laptops into the kitchen, bathroom, etc., for meetings to work on their site-specific OCD.
For those who may not have sought out care before, but find that the pandemic has triggered more severe symptoms, what advice do you have for them to begin finding help, or practices they might begin to help themselves?
Dr. Thienemann: A good resource is the International Obsessive-Compulsive Disorder Foundation website on COVID19.
You can also call our clinics to make and appointment:
General Psychiatry and Psychology Clinics: 650-498-9111 / Child and Adolescent Clinics: 650-723-5511