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Key points
- Obsessive-compulsive symptoms and OCD have increased in the general adult population since the COVID-19 pandemic began.
- University students have experienced an increase in obsessive-compulsive symptoms, and have increasingly sought treatment.
- Exposure and response prevention (ERP) therapy and antidepresants can be highly effective treatments for OCD.
“Mom and Dad, I think I’m going crazy.”
Avery, a 20-year old sophomore, calls his parents in the fall of 2022 in great distress. Life is getting back to normal on campus with in-person classes. However, he feels uneasy going out in public. He has a sense of dread that he will do something that will harm others, even though he has never intentionally injured anyone. He specifically worries that he will get COVID-19 or another infectious disease which he could spread to his roommates or family, thus harming or killing them. He washes his hands 30 times a day and sometimes is too anxious to leave his apartment to attend class. If he steps on a crack, he thinks his mother will die, and he calls her several times a day to reassure himself she is okay. He feels compelled to copy his notes from each class over three times; if he does not follow this rule he believes he will fail. His father, who is taking medication for obsessive-compulsive disorder (OCD), recommends he come to see me for an evaluation.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR), OCD is the presence of obsessions and/or compulsions that consume at least one hour per day or cause major distress or dysfunction in a person’s life. An obsession is a repetitive thought that is hard to get out of one’s head and causes anxiety. A compulsion is a repetitive behavior or mental act that one feels driven to perform in response to an obsession or according to a rule that one must follow with the goal of reducing anxiety or preventing a dreaded event. The mean age of OCD onset is 19.5 years, and the prevalence of OCD in the United States is 1.2 percent.
Many people have some obsessions or compulsions, like fearing your home will be robbed and checking the locks three times before leaving the house, but those symptoms don’t rise to the level of a disorder because they take minimal time and do not cause significant distress or dysfunction.
Avery’s obsessions focus on fear of harming others through spreading disease or stepping on a crack. His compulsions in response are to wash his hands excessively and stay in his house. Copying his notes unnecessarily is a compulsive rule he needs to follow.
I have seen an increasing number of students in my office with obsessions and/or compulsions that are interfering with their ability to do their schoolwork, as they can consume several hours per day. I think part of the impact of COVID-19 was a specific fear of disease but also a general loss of control over our lives. Obsessions and compulsions developed to provide order but ended up interfering with some students’ functioning.
Increased Rates of Obsessive-Compulsive Symptoms Since the COVID-19 Pandemic
My observation of increasing obsessive-compulsive (OC) symptoms during the pandemic is backed up by data. A review of several international studies demonstrated an increase in OC symptoms in the general adult population as well as those with OCD, with people in remission experiencing increased rates of disorder recurrence. Contamination/washing symptoms were particularly impacted.
In university students, the rate of OCD and OC symptoms, as well as treatment for OCD, has risen. A longitudinal study of college students demonstrated an increase in contamination OC behaviors and intrusive/unacceptable thoughts from 2016 to 2021. National College Health Assessment data showed an increase in students reporting a diagnosis of obsessive-compulsive and related conditions from 4 percent in the fall of 2019 to 6 percent in the fall of 2022. In 2022, 66 percent of those with an obsessive-compulsive and related condition had contact with a healthcare or mental health professional for this condition, up from 61 percent in 2019.
As a psychiatrist, I am concerned about this increase in OC symptoms. I am also hopeful as there are effective treatments for OCD, ranging from therapy to medication.
Treatment for OCD
Avery and I review OCD treatments that can include therapy, medication, or both. Avery is not sure he wants to take medication, so I refer him to an intensive outpatient clinic where he will go three times a week to do a therapy called exposure and response prevention (ERP). With this kind of therapy, a patient is encouraged to take the action that makes them anxious, and then not perform the compulsion that relieves the anxiety. Eventually, the anxiety lessens, when the patient realizes the act will not lead to catastrophe. For example, Avery’s therapist has Avery touch the floor and not wash his hands right away. When he does not get sick or spread illness to others, his anxiety lessens.
Therapy is initially helpful, but then his anxiety becomes overwhelming to the point that he cannot do his schoolwork. I consult with his therapist, and we decide he will take a pause in therapy. Avery agrees to start medication to lessen his anxiety and OC symptoms, so he can better engage in therapy. I prescribe sertraline, an antidepressant commonly used to treat OCD, and his anxiety and distress decrease significantly. About a month later, he resumes ERP therapy and makes great progress. He attends the clinic for about three months and eventually reduces the sessions to once per week. Avery continues to take sertraline, but he may not need medication forever for his OCD. In my experience, patients who have received ERP therapy sometimes can eventually taper off medication with the guidance of their psychiatric provider.
I have worked with many people like Avery who benefit from treatment and support, including an OCD specialty clinic, local therapist, or counseling center therapist who has trained in ERP; and antidepressant medication approved for the treatment of OCD including sertraline, fluoxetine, paroxetine, fluvoxamine, and clomipramine. If your child experiences OCD, there is help for them that is highly effective. Help them access resources that they need and tell them they will be okay.
To find a therapist, visit the Psychology Today Therapy Directory.
©2023 Marcia Morris, all rights reserved. Details have been altered to protect patient privacy.
