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.