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by Patricia Thornton, PhD
Patricia Thornton, PHD

I’m a specialist in the treatment of OCD and anxiety disorders. OCD is a debilitating mental health disorder whereby patients experience unwelcome, intrusive, disturbing thoughts (obsessions) that create anxiety.

Consequently these patients engage in rituals or compulsions in a (futile) attempt to get rid of their anxiety. Obsessions can be about anything, but usually there is a sense that the person is in danger, or fears that they will harm someone else. People who struggle with Contamination OCD generally fear that they will be harmed, or harm others, by being contaminated with germs, viruses, or bacteria. They become hyper vigilant in detecting these often unobservable phenomena, and  perform  rituals  to insure themselves that they are 100% safe (which is never achievable). Those compulsions might include carrying a bottle of Purell with them at all times, washing their hands every time they think they may be contaminated, using paper towels instead of their bare hands to turn off bathroom faucets and open bathroom doors, pressing elevator buttons with their elbows, wearing gloves to touch subway poles, never shaking hands, never sharing food or drinks, never kissing anyone, perpetually sanitizing surfaces, and avoiding people they think might be contaminated. The treatment for OCD is to learn to accept that life is full of risk and uncertainty and engaging in those compulsions will actually perpetuate their fears. To get better, patients need to confront their fears, by not doing those things that they think will make them feel safe and sure. They need to embrace uncertainty. But now, during this pandemic, these  are  the very same behaviors we all need to do to stay safe and limit the spread of the virus! It’s a topsy-turvy world, especially for me, a clinician who treats OCD patients!

Last week, when I began to turn off the faucet in our office bathroom after washing my hands, I paused and wondered if I was re-contaminating myself. I know my Contamination OCD patients think about this all the time, but I never do. My OCD patients typically use their elbows or a paper towel to turn off the faucets in order to avoid contamination. Did I need to do that now – the very things that I advise my  patients not to do? Yes, I needed to do that now. It felt unsettling and bizarre, but I grabbed a paper towel to turn off the water and used the same paper towel to open the bathroom door. This started a cascade of noticing all the ways my behavior needed to change in order to minimize my chance of getting the virus or passing it on to others. I needed to adopt my patients’ compulsions and avoidance strategies!

Before the pandemic, I was quite cavalier when it came to cleanliness. I sometimes forgot to wash my hands before eating. I didn’t sanitize my phone. I touched the bottoms of  my shoes when I took them off and didn’t think twice about it. I traveled on public transportation and held subway poles with my bare hands. I didn’t avoid being close to strangers. I social danced a few times a week with many different   partners and never thought about washing  my hands between dances.

Now, we are all practicing social distancing and being hyper- vigilant about being contaminated. I avoid transportation of any kind, except my own two feet. I scrutinize the faces of those who walk past me and move even further away from them if they look sick or I’ve noticed them coughing or sneezing. I tell men I meet on dating sites that the only dates I’ll now consider are daytime walks in the park while maintaining a six feet gap between us. I evaluate the place and time to buy groceries when I think there will be fewer people in the store. I wash items that I know are probably clean, but still might harbor the virus, as there is still uncertainty as to how long this virus lives on surfaces. And I wash my hands often with lots of soap!

A further irony is that many of my Contamination OCD patients are doing remarkably well. They are generally following the CDC’s recommendations and not going overboard with hand washing and de-contamination rituals. They are not unduly afraid and not panicking. They don’t stockpile hand sanitizer. They have  learned to limit exposure to the news. They know how to curtail rumination and they don’t worry about things they can’t control. They engage in self-care through exercise, meditation apps, and getting enough sleep. They have learned, through their OCD treatment, to carry on with their lives even though they may  be anxious. They know they may get the virus. They may become sick. They may contaminate others. And they may die. Most importantly, they have learned, as we all must  learn, that there is no certainty in life. I will do my part, as best I can, to avoid getting sick and passing on the virus to others. I know there is no perfect way to do this. But I will employ the de-contamination and avoidance techniques my OCD patients have inadvertently taught me. And I will smile and appreciate the irony that really, truly, you have no idea where life will take you and who you can learn from.


About the Author

Patricia Thornton, PhD specializes in the treatment of anxiety disorders and OCD. She practices in New York City.

beth jonina halpern

March 19, 2020

Dear Patricia,
Yes, I have found my contamination OCD patients to be relatively sanguine. The precautions are familiar territory for them. Sadly, the background hum of anxiety and dread in NYC is increasing anxiety in my other patients. It is good to see a New Yorker on this site. Walks in the park have been my saving grace.
Beth Halpern

Dear Dr Thornton,

I am sure you mean well, but please pardon me for being very saddened by this take on the situation.

I have suffered from OCD my whole life, mostly in secret. I am sure you know what a poorly understood and terrible condition it can be. I commend anyone with OCD who can stay calm in our unprecedented time here. However, it should be OK and safe to admit that this is a terrible situation for someone with this disorder!

My compulsions are threatening to take over my life right now, precisely because the ambient anxiety of people around me is so much higher. I feel much safer when I am able to mutually affirm and build confidence with other people in my life...and all of that is gone right now. People are being compulsive in ways I could never achieve with a truly clinical presentation. Pardon a poor way of phrasing it, but this is really driving me crazy :(

Further, the science doesn’t necessarily support an “OCD” level of vigilance making any difference whatsoever. Wash your hands and try not to touch doorknobs, sure, but the can of soup at the grocery store is a mode of transmission too. There are way too many modes of transmission to keep track of. I should know, right? :(

So we need to focus on reasonable, but not overboard behavior. My compulsions are going to hurt me (or anyone), not help in this situation. Please do not imply this to a general readership.

Respectfully,

AnonymouslyOCD

I lost my job because I usually hide my OCD, but as a nurse in this unsure time, it peaked its dirty little head out. Which meant days without sleeping or eating. Seeming like I was drugged because I couldn't focus on anything but the outbreak, and the real fear of bringing it home to my 4 year old son. I begged for a drug test but was refused and told that something was wrong with me, and I definitely needed help. Wow. That really leads you to want to be open about something. I begged for a drug test, and still because of my behavior was fired without an actual cause. Only prejudices and foul thoughts. Now I am a single mom and umemployed in this crucial and unsettling time. OCD didn't keep me safe. Your safe hand practices are just that, and in no way can be compared with day to day life in this horrible disease.

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