Anika has struggled with OCD since the age of 15. Though it’s difficult to pinpoint exactly why someone might develop the condition, she believes it was at least partly down to a period of intense stress she experienced during her teen years: problems with friends and relationships, bullying and her parents' divorce. It began with intrusive thoughts, and then the compulsions started.
"I was completely obsessed with hygiene," she says. "I was absolutely convinced that if I wasn’t clean enough or I didn’t wash my hands enough that somebody was going to die as a result; that I would be responsible."
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Contamination was a key focus of Anika’s compulsive behaviours long before the coronavirus crisis. While much of her therapy focused on the fact that her worst fears were unlikely to become a reality, with COVID-19 the exact opposite is true.
"A lot of my obsessions were related to infecting or contaminating people – that I’d pass something on to my mum in particular," she reflects. "And obviously now that is happening: there is actually a possibility that I could pass on a potentially deadly virus to somebody I care about. That’s stressful for anybody to think about but with OCD it’s very, very difficult to cope with."
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So much of therapy, for OCD and other mental health conditions, focuses on the fact that a person's worst fears are very unlikely to become a reality. With COVID-19 the exact opposite is true.
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Implicit in the 'stay at home' messages shared online or in the news is the idea that going outside or failing to wash our hands could make any one of us responsible for transmission of the virus.
The last time Anika’s OCD peaked, she was at university.
"I was washing my hands probably hundreds of times a day," she says. "At points they were absolutely red raw, so dry I was literally bleeding. I was away from home for the first time, in not especially nice surroundings, terrified about making friends again. Washing my hands and obsessively cleaning my room started as a way of feeling in control of everything but after a while there was no real logic to it. I just felt compelled to do it and I couldn’t stop."
Post-uni, Anika found a way past her compulsions with the support of her partner and a therapist. But with coronavirus constantly in the news, she has really struggled to stay on top of her intrusive thoughts and her compulsions.
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"All anybody has been talking about is hand washing," she says. "How long we should be doing it for, whether or not we’re using the right technique, what song we should be singing while we do it... It is very, very hard not to go back into a spiral about these things."
If you suffer from a mental health condition which causes you to obsess over a particular fear or fixate on an outcome, it can be paralysing when the news confirms everything you’ve ever conjured up in your head while catastrophising or caught in a spiral of compulsion.
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All anybody has been talking about is hand washing. How long we should be doing it for, whether or not we're using the right technique, what song we should be singing while we do it... It is very, very hard not to go back into a spiral.
Anika
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Vasia Toxavidi is a therapist and a member of the British Association for Counselling and Psychotherapy. She says that those with OCD may find themselves drawn back into old cycles during this period.
"For many people with OCD [who have obsessions around hygiene or contamination], part of the treatment is to try to stop doing that compulsive behaviour," she says.
"But at the moment that goes against government advice. So it can really bring people back into that cycle of behaviour."
"The fact we all feel so uncertain can increase anxiety, too."
This is a difficult time for everyone, Toxavidi says. "People are dealing with a huge change and a loss at the same time – a loss of freedom, loss of connection, loss on so many different levels." For those with pre-existing conditions, this change can be even harder to deal with.
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It’s not just those with OCD who are being forced to confront their deep-seated anxieties. Many people with depression struggle to leave the house; others have agoraphobia, an anxiety disorder which, in some forms, can prevent people from doing things outside the home.
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People are dealing with a huge change and a loss at the same time – a loss of freedom, loss of connection, loss on so many different levels.
Vasia Toxavidi, therapist
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The common conception of agoraphobia is that people simply can’t leave their homes but it can be deeply context-specific. Some people with agoraphobia can leave the house with no anxiety but may struggle to get onto public transport, be in crowded places or visit certain locations.
Like OCD, some treatment focuses on exposure: slowly getting people to expose themselves to the situations they fear. But with government advice suggesting we stay at home as much as we can, some of that treatment has fallen by the wayside.
"Leaving the house is something I have struggled with for a very, very long time," says Ally, who is in her late 20s. "But it was part of my recovery – I was trying to go out every single day, sometimes for 10 minutes down the road and back and sometimes into town, to go to busier places."
"Sometimes I hated every second of it," she laughs. "But I was slowly getting better at being outside with at least slightly less anxiety."
In the last few weeks, however, her anxiety has ramped up considerably.
"I understand why we have to limit how much we’re going outside – to be clear, I have no problem with that," she says. "But on a personal level, it has meant that I’ve slipped back into old behaviours that feel comfortable but aren’t actually very good for me. Being told that staying at home as much as we possibly can has basically been the permission I needed to stop doing it full stop."
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Ally feels lucky in a way. "I’m obviously much better equipped to deal with [lockdown] than some of my friends – I’ve spent a significant part of my life not leaving the house for weeks and weeks at a time, so being indoors or on my own is not something I’m struggling with," she says.
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I understand why we have to limit how much we're going outside. But on a personal level, it has meant that I've slipped back into old behaviours that feel comfortable but aren't actually very good for me.
ALLY
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It’s an uneasy comfort, though. "I know that the way I’m feeling is not 100% healthy or good for me," she says. "I know that I should be doing things like going for a short walk every day or going out into my front garden, even."
Toxavidi has several pieces of advice for those struggling with their mental health during this period.
"Try very hard to cut down on how much news you’re reading or seeing," she says. She suggests selecting one or two reputable sources – the World Health Organization, for example – and only reading information from them. Constantly updating news sources, social media or live blogs are only going to increase anxiety, she says, so staying away from them as much as possible can be beneficial for those with OCD, agoraphobia or other anxiety disorders.
Keeping in touch with those around you can also be of benefit; speak to friends about what you’re going through and remain as connected as you can.
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Try very hard to cut down on how much news you're reading or seeing.
VASIA TOXAVIDI, THERAPIST
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Setting yourself limits, as recommended by OCD UK, can also help. Decide how often and for what length of time you want to be washing your hands and attempt to stick to it. If you have agoraphobia or otherwise find it difficult to go outside, give yourself a goal: five minutes outside every day, for example.
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If you can attend remote therapy, do – it’s a standard offering for many therapists already, though coronavirus has widened the market considerably.
There is no doubt that when the news confirms your worst fears or reinforces the very things you’ve been working to overcome, the implications for your mental health are serious.
"I’m very worried about what will happen when lockdown is over and we’re allowed to carry on our lives as before," Ally says reflectively. The period of her life when she felt okay leaving the house was so recent and lasted so briefly that she’d barely begun to be able to enjoy it, she says.
"What happens next for me?" she asks. "I have no idea and that really terrifies me."
If you are struggling with mental health issues please contact your GP or mental health charity Mind for more help.
The World Health Organization says you can protect yourself by washing your hands, covering your mouth when sneezing or coughing (ideally with a tissue), avoid touching your eyes, nose and mouth and don’t get too close to people who are coughing, sneezing or with a fever.