Obsessive compulsive disorder (OCD) is the focus of an upcoming research study to be conducted by the Universities of Stellenbosch and Cape Town in a collaborative effort.
The unit conducting the research invites adults with OCD, brothers and sisters of people with OCD as well as healthy people to take part in the study that is set to start soon.
OCD is a mental illness associated with the significant occurrence of other mental illnesses such as depression and anxiety.
“Characteristic symptoms include the presence of recurrent, intrusive, or disturbing thoughts or obsessions and/or repetitive behaviours or compulsions, which may also be mental rituals,” explains researcher Prof Christine Lochner of the University of Stellenbosch.
Examples are fears of contamination often associated with compulsive rituals such as repetitive hand washing, cleaning and taking disproportionate measures to reduce exposure to perceived sources of contamination.
Other intrusive fears, she says, may be centred around symmetry and order, leading to ritualistic arranging, ordering according to set rules, and repetitive counting.
In addition, worries such as fears of inadvertently hurting or harming someone else or causing harm or damage and checking whether those close to you are okay, whether the stove and other appliances are off and windows and doors are closed.
Lochner says people may present with some or all of these symptoms, or they may have symptoms solely from one of these symptom clusters.
During the pandemic social isolation resulted in loneliness, the loss of freedom, separation from loved ones and reduced social interactions, all factors that compelled the research.
“Social isolation associated with quarantine can also lead to many mental health sequelae even in healthy people. The consequences of the pandemic and consequent quarantine were anticipated to be of particular relevance especially in patients with psychiatric disorders such as OCD.
“Perhaps no group of individuals with mental illness is as directly affected by the worsening outbreak of Covid-19 as people living with OCD,” she says.
This, due to cleaning compulsions such as hand-washing.
Cleaning compulsions, according to Lochner, is the most frequently reported symptoms in OCD, affecting at least 50% of patients.
“Although frequent hand-washing and sanitizing of the environment is surely beneficial for preventing the spread of Covid-19, at the same time, the question may be raised how all of this are affecting people with OCD, specifically those with obsessions of contamination and compulsions of washing. “Experts assumed that the pandemic would be particularly affecting these people with contamination obsessions and washing compulsions.
“Paradoxically, OCD patients with contamination/washing symptoms are ‘experts by experience’ in their efforts to avoid dangers through excessive cleaning. The increased anxiety about the virus may be fuelling obsessive fears of contamination and harmful compulsive washing in some people with OCD. For these people, Covid-19 can become all they think about,” she says.
Due to fear of infection and the emphasis on hand hygiene by health advisories, symptoms of OCD might worsen.
“Constant bombardment by the media about the possibility of infection also doesn’t make it any easier for people with OCD.”
OCD affects approximately 2-3% of adults, suggesting, in theory, that in South Africa there would be about 1.2 million people with the condition at any point in time.
“Now that vaccination against the virus has become a reality for most countries including SA, pandemic-related concerns and anxiety may reduce. However, for some people with OCD, and specifically those with fears of being harmed for example by injection, by faulty vaccines, or those with fears of needles vaccination may also be a challenging experience,” says Lochner.
There has been little focus on the effect of the pandemic on people with OCD, but limited studies suggest that the majority of adults with OCD were adversely affected by the pandemic.
“These patients were also more frequently found to experience suicidal ideation, increased Internet checking, sleep disturbances, avoidance behaviours and work difficulties.”
However, the school is not yet out about the impact of Covid-19 on OCD, according to Lochner.
“Comparison among studies is difficult due to methodological differences. Also, these studies mostly report on the short-term effects of the pandemic on OCD. Long-term, we may have to face an entirely different scenario.”
Lochner says there appears to be a connection between OCD symptoms and functioning in certain areas of the brain, but that connection is not clear. “Researchers have gained much insight into the cause of the disorder by comparing brains of people with OCD with those without the condition.
A global study which includes this South African study is collaborating to gain knowledge about the multiple brain networks playing a role in OCD, using standardized methods.
These methods include interviews, sophisticated neurocognitive testing and brain imaging. The long-term aim of this project is to streamline the treatment of the condition so that the brain networks involved in development and maintenance of OCD can be targeted more effectively.
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