Over the past nine months, the word “uncertainty” has cropped up time and time again across the news and social media worldwide. The pandemic has created uncertainty in nearly every aspect of daily life.

This is not only due to worries over exposure to COVID-19 and access to medical care, but also due to concerns about the stability of the economy, job security, the availability of food and household supplies – and even when to book a vacation. We have needed to adjust and readjust our behavior continually in response to changing risks and government guidelines.

Uncertainty makes it difficult for us to make decisions about how to act. This is why it is common to find uncertainty upsetting, confusing, and frustrating. But some people tend to find uncertainty particularly distressing and challenging to cope with. They worry excessively and avoid situations with uncertainty. Such people suffer from obsessive-compulsive disorder (OCD).

OCD is a neurologically based anxiety disorder that is characterized by intrusive, unwanted thoughts (obsessions) and repetitive behaviors and/or thoughts (compulsions) that the sufferer feels compelled to perform. OCD is often called “the doubting disease.” But what does doubt have to do with obsessions and compulsions?

A lot. Doubt is what fuels the fire for OCD, as sufferers feel the need to have total control over everything in their lives….for sure. This leaves no room for doubt or uncertainty. The irony is that this quest for control invariably leads to just the opposite; the loss of control over one’s life.

Constantly checking is to make absolutely sure that everyone and everything is okay, and will stay that way. Once this is verified there may be some relief for the OCD sufferer, but it is nothing more than temporary. The need for reassurance returns even stronger, and the vicious cycle begins again.

So it follows that the exacerbated uncertainty which has become a hallmark of COVID will heavily impact those individuals who already have clinically significant symptoms of OCD.

Exposure Therapy

One of the most effective treatments for those suffering from obsessive-compulsive disorder is to learn how to deal with their challenge through therapy. Cognitive Behavioral Therapy (CBT), more specifically Exposure Response Prevention (ERP) Therapy, helps those plagued with the disorder face their fears and gives them the tools needed to function normally with uncertainty.

This therapy, which initially could be anxiety-provoking, offers a huge payoff — the ability to live with uncertainty. It allows one to discard the “what ifs” of the past and future and live more mindfully in the present. This often results in becoming liberated from OCD.  Exposure therapy is a must at the moment for those suffering from OCD.

Controlling Fear of Contamination

At-risk individuals with concerns about becoming contaminated themselves or who fear unknowingly spreading contamination and causing harm to others are naturally anxious. However, OCD compounds this anxiety as those with the disorder are continually seeking reassurance by excessively searching for news on COVID-19 and how to prevent the spread of the virus.

Those suffering from OCD can inadvertently fall into the trap of compulsive hand washing, having found that the repeated and timed handwashing advocated during the crisis serves to relieve their anxiety. However, what begins innocuously as “preventive measures” can quickly strengthen the OCD itself.

Those vulnerable to OCD need to receive clear, specific, and authoritative information regarding the prescribed way and frequency of effective handwashing, the risk of contracting the virus or inadvertently causing harm to others, and the appropriate procedure for information seeking.

Spreading the Virus

When it comes to the concern about spreading the virus, those susceptible to obsessive-compulsive disorder may also be concerned that they could inadvertently spread COVID-19 despite being asymptomatic for more than 14 days, being out of physical contact with anyone who is ill with COVID-19, and strictly adhering to social distancing guidelines. The boundaries just seem to disappear!

Although there is still much unknown about the spread of the virus, it is necessary to help those with obsessive-compulsive disorder recognize that one can only catch the virus from those who already have it, and only from respiratory droplets expelled when someone coughs or sneezes. Other imagined ways need to be shown as false.

Most importantly, when someone is observing social distancing, and no one in their household is displaying symptoms the chances of contracting the virus are certainly less. The facts need to be presented clearly, and perhaps often, until it is understood that the constant worry and anxiety are actually baseless and only OCD run amok.

Risk Estimates

The bottom line is that those susceptible to obsessive-compulsive disorder need compassion and assistance in establishing a more realistic estimate of their risk, if they have any hope of managing their anxiety during the pandemic. Included in this would be to emphasize that most cases are not serious and that many people manage at home or are treated successfully in the hospital.