When Ken was six years old, he’d come home from school and wipe down all of the counters. These behaviors were subtle, even helpful at first, but they escalated over the years. By the time he was in high school, he’d mop the kitchen floor every day, as well as measure that his bedroom lamp was perfectly centered on his desk (he eventually glued it down). At 22, he was officially diagnosed with OCD, an anxiety disorder characterized by unwanted and recurring thoughts, ideas and obsessions driven by repetitive behaviors or compulsions. Now 36 and in the midst of a global pandemic, Ken, a publicist in New Jersey, describes his symptoms as out-of-control.
“If I’m not sleeping or working, I’m cleaning. Clean, clean, clean,” he tells me. “That’s all I ever do, for hours each day.” His mom jokes that they should have a framed photo of him at Walmart because he goes there so often for “the big three” — Clorox Wipes, Dial Foaming Hand Soap refills and latex gloves. “I wash my hands more than 100 times a day, so the hand soap refills are critical,” Ken explains. “Because all that washing makes my hands crack and bleed, I often need to wear gloves.”
But while the pandemic hasn’t made him any less anxious about cleaning, he at least feels justified in his compulsions for the first time since he was a kid. “It’s funny, someone recently said to me, ‘You’ve been preparing for this your whole life,’” Ken says. For example, for as long as he can remember, he’s avoided touching doorknobs and sanitized his debit card until the signature rubbed off. “I had all of the cleaning and hand-washing protocols in place, just for different reasons. They’re coming in handy now, though.”
Many others with OCD are also feeling less alone as everyone else has generally become more heavily sanitized and anxious about germs in the face of COVID-19. “The majority of OCD patients are reacting along the lines of, ‘Welcome to my world!’ as they see so many Americans adopting the concerns and behaviors that they’ve had for years,” confirms Paul Greene, a clinical psychologist who specializes in OCD treatment and the director of the Manhattan Center for Cognitive-Behavioral Therapy.
Still, Greene is careful to note that this doesn’t mean that quarantine has necessarily been good for their mental health. Approximately 2.2 million adults in the U.S. (or about 1 percent of the population) have OCD, and with up to a third of Americans showing signs of clinical anxiety and depression as a consequence of the pandemic, that number will likely go up. Also, because there are many different forms of OCD — including forbidden, harmful or taboo thoughts and impulses as well as hoarding — it’s challenging to broadly categorize the impact in any overall sense. (Other variables, like having to quarantine in an unfamiliar place with people and circumstances out of their control, could exacerbate OCD symptoms as well.)
But for individuals with cleaning and contamination compulsions, Greene has found that the pandemic has had some positive effects, particularly if they’ve been responsive to treatment in the past. “My patients have all been doing therapy for OCD that teaches them skills to tolerate contamination fears,” Greene says. “So in that way, they’re well-prepared to deal with the coronavirus concerns that we now all share. Most OCD patients with contamination symptoms are doing well.”
Case in point: Chris, a 36-year-old in Bulgaria who’s had OCD since he was a teenager. He says that life in quarantine has made him calmer than ever. “I’ve always been more comfortable at home, even before the pandemic,” he tells me. “It’s just that now I prefer to stay at home even more. I work in marketing so I’m perfectly capable of doing my job remotely.”
As much as his apartment never feels completely clean, he’s able to control the environment he shares with his wife and cat much more than the outside world. For instance, under normal circumstances, he tells me, “I see my colleagues eating on their desks, going out for lunch breaks, touching pets and whatnot, and I keep thinking how dirty their hands must be. After every handshake, after every touch of someone else’s desk, I have the urgent need to wash my hands. I walk to the office, but I feel like exposure to the outside world already makes me dirty. It’s like I’ve touched something very icky, but I can’t wash my hands. Every five or so minutes, I take out my sanitizer and use it.”
On the opposite end of the spectrum, though, Ken’s contamination compulsions have only intensified with the pandemic. He’d always sanitize his phone, keys and credit cards and change into “inside clothes” when he got home from work, but now, “it’s like the decontamination scene in The Andromeda Strain.”
He immediately removes his gloves and mask over the garbage can, washes his hands and arms three times, disinfects his glasses, takes a hot shower for about 20 minutes, launders every garment that touched his body and cleans all of the surfaces where the decontamination took place — from the bathroom faucets to the top of the agitator in the washing machine. “It takes hours,” he says.
He’s not even worried about himself; it’s getting his mother or partner, who he lives with, sick that consumes him. “Some people with OCD will run over a twig on the road and go back a few times to make sure they didn’t hit a person or an animal,” Ken says. “I’m like that too. And I think the pandemic is heightening that fear of accidentally harming others.”
Greene concedes that the coronavirus has enabled some of these more extreme compulsions and blurred the line between what are considered reasonable behaviors and obsessive-compulsive ones. What hasn’t been muddied, however, is the distinction between behaviors that get in the way of healthy living and those that don’t, which is what an OCD diagnosis hinges on, not how much a person cleans.
“If you come home and wash your hands for 20 seconds, that’s fine. If you wash them twice, that’s unnecessary but harmless,” Green explains. “But if you wash them so much that it gets in the way of your life, relationships or job, it’s a problem.”
To find balance between healthy and harmful, Ken, Chris and many others with OCD are also looking for social acceptance of their decontaminating behaviors. Which again, the coronavirus has brought along with it, too. (“If people with contamination OCD feel less alone, that’s certainly a positive thing,” Greene says.) The thing is, they’re not convinced it’s going to last. In fact, as more shelter-in-place protests and mask-shaming incidents take place, Ken is increasingly terrified that there will be a violent backlash against the behaviors that make him feel safe — which is now yet another thing he’s obsessing over.
“I’m worried that the pandemic will do the opposite of de-stigmatizing OCD,” Ken says. “I’ve read all the stories about mask-shaming and the politicization of wearing masks and gloves in public. It makes me wonder if random strangers are going to give me a hard time for using paper towels to open doorknobs long after the pandemic is over. I definitely can see it now. I just hope I’m wrong.”