Obsessive compulsive disorder - OCD treatment and therapy from NOCD

“I’m constantly taking COVID tests. Is something wrong?” A therapist’s take

Oct 26, 20238 minute read

Reviewed byApril Kilduff, MA, LCPC

We have been living in a world where COVID is a fact of everyday life for over three years now. Whether cases are on the rise or declining, many of us want it to just be over and not have to think about it again. 

On the other hand, some of us might still experience unmanageable levels of anxiety about it. If you find yourself obsessively taking COVID tests, even multiple times per week or per day, you’re certainly not alone.

As one Reddit user said, “I am addicted to COVID testing and it’s hurting me. I test for COVID daily at home. Sometimes multiple times a day…I test with no symptoms at all, I test when I haven’t left my house in days. I’m hiding tests from my partner. I am no longer excited to see people because what if I give someone COVID?”

And while you’re not alone in this excessive worry, it can be important to explore why you might be having this experience and if you could find relief from therapy. You deserve to live with freedom and confidence, rather than being constantly burdened by health worries.

Why am I obsessively taking COVID tests?

One rather likely explanation for why you can’t stop taking an excessive number of COVID tests is obsessive-compulsive disorder (OCD)

True to its name, OCD has two diagnostic components: obsessions and compulsions. Obsessions are repetitive, unwanted intrusive thoughts, images, urges, or sensations that bring extreme distress, anxiety, worry, and other uncomfortable emotions.

There are many possible themes of OCD. One of them is health/contamination. This can involve intrusive thoughts and fears about contracting germs, spreading germs, and contracting or spreading illness.

If you’re struggling with OCD and repeatedly taking COVID test, you may experience obsessions that sound something like this:

  • What if I get sick and die?
  • What if I have asymptomatic COVID? 
  • What if I give COVID to my family, and they die?
  • What if I somehow got COVID while I was sleeping?
  • What if COVID comes in via the air coming in through the window?
  • What if every item I touch at the grocery store has COVID on it?
  • What if I don’t take a test every single day, and then I wind up spreading COVID?
  • What if there are ways COVID can be spread/contracted that we don’t know about yet?
  • What if I’m actually a horrible person because I forgot to test today?
  • What if there was something wrong with that test? I should take another.

Compulsions are any mental or physical actions done to relieve oneself of the uncomfortable, distressing emotions brought on by obsessions or to gain a level of certainty that’s impossible to gain. Compulsions done by someone with contamination OCD focused on COVID could include:

  • Taking an unreasonable number of COVID tests, or taking them frequently
  • Excessively cleaning the surfaces of your home
  • Excessive hand washing
  • Urging your family members or roommates to wash their hands, even when they haven’t left the house or just recently washed their hands
  • Wearing a mask when you’re alone
  • Seeking reassurance from others or yourself (asking a loved one, “did I touch anything when we rode in the Uber?” or repeating to yourself, I’m fine, I did everything possible to not get sick, so I can’t possibly have COVID
  • Avoiding any possible situation where you could contract COVID (grocery store, restaurants—even if you can sit outside, a friend’s house, going for a walk where you might pass by people)
  • Mentally reviewing every item and surface that you came in contact with that day and ruminating on whether or not it could have been contaminated

A global pandemic is pretty much the worst case scenario for sufferers of this theme of OCD. At the beginning of COVID, there were endless unknowns. There was a lot of uncertainty around how it was spread, and OCD thrives on uncertainty.

OCD wants to be 100% certain that your intrusive thoughts will not come true. In reality, even when we take appropriate and recommended precautions, we can never reach 100% certainty. This is no different in any part of life—COVID included. But for people with contamination OCD, the uncertainty they feel about contracting or spreading COVID can feel unbearable, while other uncertainties don’t.

Could you be obsessively taking COVID tests and NOT have OCD?

While two distinct conditions, OCD shares similarities with anxiety disorders. Anxiety disorders include generalized anxiety disorder (GAD), social anxiety, panic disorder, illness anxiety, and specific phobias. 

Both OCD and anxiety disorders are fear-based. They cause their sufferers to anticipate bad things happening, whether or not it’s grounded in reality (oftentimes, it isn’t). 

However, OCD is distinct in the presence of intrusive obsessions and compulsions. 

Anxiety disorders do often come with safety behaviors, or actions taken to relieve discomfort, but they’re different from compulsions. Safety behaviors done by those with anxiety disorders are typically less repetitive in nature and, most often, they take shape as avoidance; for example, avoiding public transportation or grocery stores.

It’s possible you are experiencing a more generalized anxiety, or even a phobia of germs. However, the presence of a repeated, specific action like testing yourself for COVID is a strong indicator of OCD. The best way to know the answers behind your experience is to seek diagnosis from a licensed mental health professional—one who is knowledgeable about OCD. 

How do I know what is reasonable precaution and what is obsessive?

The reality is that COVID is not over—it’s now a part of life, like the flu or common cold. So how do we live with that reality while also living our lives?

Everyone’s risk assessment, or the level to which they (or those close to them) are vulnerable to getting sick and being able to cope with it, will look slightly different. There are some helpful online guides to help you assess your risk, such as this one from Safer-COVID.

How you approach COVID will vary based on what activities you’re engaging in (for example, your COVID risk when traveling is going to be higher than the risk of going for a walk) and on what pre-existing health conditions you may have.

Get recommendations from online risk assessments, the CDC, and your primary care doctor. To avoid engaging in compulsions that only reinforce obsessive fear or doubt, don’t go above and beyond what medical professionals recommend. For example, a medical professional is not going to tell you to take a COVID test multiple times per day.

Consider your values and wishes alongside your risk assessment. How can you minimize risk while still living a life that is enriching? Obsessions and compulsions surrounding COVID are time-consuming, take a toll on your mental health, and may be affecting your social or work life. 

You can learn to contend with COVID in a healthy way without it unnecessarily hindering your functioning and daily life.

What should I do if I can’t stop obsessively taking COVID tests?

Whether you are experiencing OCD or an anxiety disorder, the best way to treat this compulsive behavior is through exposure and response prevention therapy (ERP). 

ERP is an evidenced-based form of therapy that is designed specifically to help people overcome their fears and triggers by carefully confronting them head-on, then resisting any compulsive behaviors they do to feel better, but which only make their fears stronger over time.

When beginning ERP, you and your therapist will develop a hierarchy of therapy exercises. Meaning, you will start small with exercises that bring a low-level of distress and work your way up to the scenarios that bring greater discomfort and anxiety.

Potential exercises done to treat excessive COVID testing in OCD:

  • Not taking a COVID test when you get home from the grocery store
  • Not washing your hands more than once when you get home
  • Not taking a test the moment you feel any physical sensation that could indicate illness (a headache, a tickle in the throat)
  • Buying just one COVID test at a time, rather than stocking up

Your therapist will give you tools to practice not engaging in compulsions before, during, or after exposures. Some of those techniques include: 

  • Delaying compulsions. Saying to yourself, “I’ll do it in 5 minutes.” By the time that 5 minutes is up, the urge to do the compulsion may have subsided altogether. Even if it hasn’t, and you do perform the compulsion, it is still progress to not give in to the urgency of compulsions. You may also ask yourself at the end of 5 minutes if you could go another 5 minutes, to keep increasing the delay and make greater progress.
  • Thought diffusion. This involves separating yourself from your intrusive thoughts. When you have an intrusive thought, you’ll practice saying to yourself, “I am noticing this thought.” This helps you to recognize thoughts as just thoughts, rather than as facts or genuine issues that need immediate solutions.
  • Non-engagement responses. There are a few different techniques for non-engagement, but essentially, it sounds like agreeing with your OCD. If your OCD says, “You might have gotten COVID when you passed by that group of people on your walk around the block!” You would respond with something like, “Okay, sure.” By responding with simple acknowledgment rather than fear, the intrusive thoughts are unable to escalate. 

The ERP process may at first cause an increase in anxiety, but eventually it reduces distress significantly. It’s an old adage that sometimes things need to get a little worse before they get better—in ERP, as discomfort decreases, your brain learns that the excessive testing was not actually providing any real form of protection. The ultimate goal of ERP will be to help you tolerate the inherent uncertainty surrounding COVID and other health issues, and give you far greater control over your own health behaviors and decisions. 

Where to get help for OCD or anxiety focused on COVID

No matter the why behind your experience, there is hope that you can get better and get your life back. I recommend reading more about NOCD’s evidence-based, accessible approach to treatment for OCD and anxiety. My specialty-trained colleagues and I have helped thousands of people like you overcome their struggles and live life on their own terms.

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