Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fear of COVID

By Arielle Speer, LCSW

Aug 19, 20228 minute read

Reviewed byPatrick McGrath, PhD

Excessive fears about contracting or spreading COVID can be a sign of Contamination OCD, in which people are concerned about contracting COVID/giving other people COVID and the potential consequences of these events. Individuals that experience Contamination OCD related to fear of COVID may spend a great deal of time researching or attempting to prevent the transmission of COVID.

People that experience various subtypes of Contamination OCD report a wide range of health anxieties that can include concerns about the transmission of germs, being unclean, feeling dirty, or worries about potentially having fecal matter or other bodily fluids on their body. OCD is highly varied, so these are only a few examples. Contamination OCD is commonly rooted in individuals’ fears of becoming ill, making others ill, feeling contaminated, or contaminating items or people.

Contamination OCD, including COVID themes, can also include worries about physical, mental, and emotional contamination. People who experience Emotional Contamination OCD frequently report worrying about experiencing unwanted emotional experiences like panic attacks, anxiety, stress, depression, or the feelings of a previous illness. People with emotional contamination will frequently avoid returning to places or using objects that remind them of an event or experience.

Contamination OCD and COVID-19

Contamination OCD is common and can be very time consuming. People with Contamination OCD frequently report experiencing their obsessions, or intrusive thoughts and fears, in situations at home, at work, and unexpectedly in any circumstance. They then engage in compulsions, or behaviors done to reduce the anxiety caused by obsessions, which can occupy several hours every day. Common compulsions like hand washing or skin picking can lead to cracked and bleeding hands. Other frequent negative outcomes related to Contamination OCD include avoiding leaving the home, avoiding all community facilities, and being unable to complete recreational, health, or productive activities. Unfortunately, Contamination OCD can also add strain to relationships, as loved ones struggle to understand time-consuming compulsions and rituals, leading sufferers to report weakened and stressed relationships.

As it pertains to COVID, individuals may worry that items or people have been exposed to COVID or are carriers of it. Frequently reported feared items include things other people have touched or that things may not have been sanitized properly. People may avoid touching or sharing things they feel could have encountered other people’s germs or bodily fluids. These concerns can have various sources related to COVID: an individual might worry about their own health and sense of well-being, or worry due to the responsibility they feel for the well-being and health of others. 

People with COVID 19 themes in Contamination OCD commonly share that they go to great lengths to ensure things are clean both before and after handling items or engaging in tasks where COVID could be transferred from objects to themselves and from themselves to other objects. Further, they may do things that go beyond all recommendations for COVID safety, such as wearing a mask when they are alone in their car, staying over 20 feet away from anyone else, or not leaving their home at all to reduce risk as much as possible. 

  • I can never be clean enough
  • I might get sick and die
  • I might make my family sick
  • I might give someone COVID and they might die
  • I feel gross or “germy”
  • People might blame me for getting COVID
  • People might blame me for giving them COVID
  • People might think I have COVID
  • I do not feel safe unless I wash or sanitize a certain way
  • I do not know who touched that last, so it might be contaminated with COVID
  • I cannot know who has COVID, so I’d better stay away from everyone
  • If I touch something contaminated COVID and I do not wash my hands/body/clothing, then I will contaminate other things with COVID
  • What if life always stays this way? What if I never go “back to normal”?

Common triggers

People with Contamination OCD related to COVID may be triggered by situations involving anything one might encounter that could carry COVID. For some people, a chief concern is focused on potential transmission through specific methods like doorknobs or bathrooms. Other people might be focused on not inhaling when they pass someone in the grocery store or washing their hands in a specific way each time they return to their home. A person’s obsessions/fears related to COVID frequently involve worrying about themselves or others becoming ill or dying, or anxiety about other consequences from having or spreading COVID. Contamination OCD related to COVID can be very time consuming, as individuals find themselves engaging in compulsions/behaviors to reduce their anxiety about contracting or spreading COVID.

Triggers for people with OCD fear of COVID include:

  • Common triggers for people with Contamination OCD include:
  • Touching objects like door handles or other items frequently touched by others
  • Touching items in public spaces
  • Touching items the individual views as contaminated
  • Touching items the individual worries they themselves might have contaminated previously
  • Touching items likely to have encountered bodily fluids
  • Touching items that are difficult to sanitize or are not frequently touched or sanitized
  • Encountering items or places associated with COVID contamination or human bodily fluids
  • Going to crowded places
  • Seeing or hearing someone cough, sneeze, or say they feel ill
  • Finding out they were around someone that tested positive for COVID
  • An individual feeling ill or having a bodily experience like a fever, sore throat, or runnynose
  • Reading or viewing media about COVID trends or experiences

How can I tell if it’s irrational fear of COVID and not typical levels of anxiety?

OCD is characterized by people’s experiences of obsessions and compulsions. These two features of OCD make it easy to identify when every day concerns have crossed the line into the need for clinical treatment.

Obsessions are rooted in fears and are often intrusive, or seem to come into a person’s mind without a reason or desire. Individuals typically report struggling to stop thinking about their intrusive thoughts or fears, and spend at least an hour on an average day engaging in compulsions, such as thinking about the fear, avoiding thinking about the fear, or trying to do something to address or get rid of the fear. 
We call these efforts to control the anxiety related to obsessions compulsions. Compulsions are often described as incredibly strong urges to say, think, or do something, or not say, think, or do something, so that a fear subsides or an imagined outcome does not come true. Individuals who experience frequent worries without obsessive thoughts, images, or urges, or without compulsions may be experiencing anxiety, and could still benefit from discussing their symptoms with a mental health professional. Exposure and Response Prevention (ERP) therapy has been shown to be effective in treating anxiety disorders in addition to OCD.

Common compulsions

When people with Contamination OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may report spending a great deal of time trying to suppress these experiences, distract themselves from these experiences, or complete mental or physical rituals to reduce anxiety and discomfort, or to control outcomes. Compulsions vary widely person to person and can vary in complexity. Contamination OCD can also be present along with other subtypes of OCD when engaging in compulsions.

Compulsions performed mentally or physically include:

  • Avoiding touching items
  • Avoiding places, people, or objects
  • Needing to have or be around certain places, people, or objects
  • Touching items in a particular way or with barriers
  • Washing or sanitizing hands, body, or objects in repetitive or specific manner
  • Counting, holding breath, saying certain words or phrases, touching or avoiding touching self, others, or object(s) in a specific or just right way to avoid contamination, or spreading contamination.
  • Avoiding thinking about or intentionally thinking about certain things to avoid contamination or spreading contamination
  • Repetitively researching COVID symptoms, risks, population trends, or stories

How to treat fear of COVID

Contamination OCD related to fear of COVID phobia can be debilitating for people who struggle with it, but it is highly treatable. By doing Exposure and Response Prevention (ERP) therapy with an OCD specialist, you can regain your time, freedom, and ability to manage your OCD symptoms more effectively. 

ERP treatment takes place between you and a therapist who has been specialty-trained in treating OCD. Your therapist will work with you to identify your obsessions, compulsions, and any behaviors that may support OCD in your life. You will work as a team to develop a hierarchy of obsessions, fears, and exposures. Your therapist will help you to identify your anxiety levels related to triggers and obsessions and help you decide where to start with exposures, or exercises done to teach you how to experience obsessive fears and anxiety without resorting to compulsions. 

You are the expert on your own experiences, and you will be the driving force in your therapy journey. Your therapist is your coach; they are there to support and challenge you along the way. Treatment can be uncomfortable, like all new things, but ERP is backed by decades of clinical research, and is regarded as the gold standard treatment for OCD .

ERP will expose the individual to triggering situations specific to their symptoms, while guiding them in avoiding their usual safety seeking behaviors (compulsions). Over time the person will learn how to better tolerate the uncertainty that comes in relationships, and life in general. In this way, ERP therapy may also help someone avoid OCD relapses and new themes in the future.

An ERP trained therapist will gently guide the individual through the process using a hierarchy of exposures that is developed together beforehand. Once lower-level exposures are tolerated consistently, the person will move up to more challenging exposures. Ultimately, the person will learn the skills necessary to engage in ERP for the rest of their lives so that they don’t have to rely on a therapist long-term. Individuals who commit to the process of ERP typically find themselves less depressed, stressed, and anxious, and enjoy a higher quality of life. 

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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