Coronavirus and obsessive-type conditions

Professor Craig Jackson is concerned for those who already have conditions around hand washing.

17 March 2020

There is a possible danger that the current uncertainty around COVID-19 could make things worse for those with obsessive-type conditions. For those with OCD or conditions involving cleanliness, neatness, germ-phobia, tidiness or some obsessive behaviours, the COVID-19 outbreak may actually reinforce to them that their problem-behaviours were actually what kept them safe during the outbreak. This could make their conditions even harder to treat or manage in the future. We know about false attributions and confirmation of our biases, but when people are desperate, they will make the 'connections' that suit them. It may be possible for some individuals to develop this excessive behaviour and maintain it throughout the epidemic period, as the successful avoidance of infection may be associated by individuals with the increased frequency of hand washing. This behaviour may be difficult to change, the longer it is in place.

At present, the official advice suggests the only positive action to be taken is washing – not wearing masks, or stockpiling supplies etc. So some people may overdo the hand washing as it is the only ‘active protective behaviour’ / action that is recommended. Some may therefore take comfort in an excess of hand washing. Some may even set alarms and reminders to wash on a regular basis e.g. every 30 minutes, even if they have not done anything to dirty their hands. This could become a habit and form of psychological ritual (possibly even a superstitious token for good luck) in some. This increased washing may also increase cases of irritant dermatitis of course and other forms of skin damage.There are various apps that allow video instruction of correct washing to be accompanied by music or lyrics of the user’s choice, and as such, this ‘gamification’ of washing may further encourage excessive washing also. 

We all have the power to be rational and think what we want, how we want to behave, what things will upset us and what we can do when we are upset to feel better quickly, even if that sometimes takes concerted effort to achieve. When we panic we lose the ability to take control. If we are able to replace doubt and worry caused by uncertainty, with knowledge and fact and sensible interpretations of media stories, we may cope better and be in a better place for making rational decisions, not just for ourselves, but for others we know who may not be able to do so. 

There will be may people feeling overwhelmed by the constant rolling news of the global Coronavirus/COVID-19 crisis, and this news coverage has showed few signs of abating. With graphics and on-screen logos that represent news as "emergency" covaerage, viewers would be well-advised to take a routine break and 'time-out' from consuming such media. Turning off the news for a while – or at least find a less sensationalistic new source, and perhaps try and find the real facts for themselves, will help. When journalists are provided with various projections from experts and epidemiologists, these projections may include a worst-case scenario, a medium scenario and a least-harm scenario as standard – but it is very tempting for journalists to publish the worst-case statistics and ignore the more comforting least-harm projections. This happened with reporting of the swine-flu epidemic in 2009. Not everyone wants to read the BMJ or NEJM but there are many qualified and sensible doctors and experts on social media who are making great efforts to communicate details about the situation in non-alarmist and easy to digest ways. They are worth looking up. Looking at reliable sources such as Public Health England; Public Health Wales or NHS Scotland will also be beneficial and less-alarming in tone and nature. The message here is for people to be critical and question the news they receive.

Professor Craig Jackson    PhD  MSc  CPsychol  AFBPsS 

Professor of Occupational Health Psychology 
Birmingham City University