Is It Germ Awareness, or OCD?
To protect ourselves against the COVID-19 coronavirus, health care and government authorities are telling us to wash our hands, thoroughly and often. We’re supposed to clean and sanitize our doorknobs, phones, light switches and grocery carts.
We have started wearing masks everywhere and keeping our distance from other people, all to ward off germs.
So how can we tell what level of caution is normal for these abnormal times? What are the signs that hand-washing, cleaning, sanitizing and other protective steps have become extreme, signs of obsessive-compulsive disorder (OCD)?
We asked for advice from David Greenspan, MD, Chair of the Department of Psychiatry at Einstein Medical Center Philadelphia, and Brian Gallagher, PsyD, Program Director of the Einstein Healthcare Network’s Department of Outpatient Behavioral Health and Psychiatry.
What is obsessive-compulsive disorder (OCD)?
Dr. Greenspan: Obsessive Compulsive Disorder (or OCD) is differentiated from a healthy respect for cleanliness when two things happen:
- The desire to clean or to be clean, or perform some other behavior, is so strong that the act of satisfying the desire gets in the way of everyday life and relationships.
- The second thing that happens is that the person generally is suffering in some fashion.
We are all worried about germs now and may be cleaning or washing hands more often. When is this a sign of OCD?
Dr. Gallagher: With OCD, individuals cannot stop their behavior. Right now we are all expected to clean our hands. But what if you are washing your hands 50 times a day around your house when you are not leaving and your family is not leaving? In that case, you are doing something to reduce anxiety, not keep you safe from COVID-19.
A good question is what you would feel if you were prevented from washing your hands or engaging in the compulsive behavior. If you would be really distressed, then probably the compulsive behavior is becoming tied more to anxiety than germs.
Dr. Greenspan: Showering or washing hands so much that there is too little time to enjoy time with a friend or study in school or reliably perform one’s work is clear evidence that it is no longer just a wish to be clean but a need driven by illness.
OCD also causes suffering. The most common ways to suffer are through:
- Direct harm that the symptom is causing, such as dry, brittle or bleeding skin from the excessive cleaning
- Emotional distress that commonly occurs as the person realizes that the need to wash is excessive but they cannot help but keep doing it.
When should someone see a professional about possible OCD symptoms?
Dr. Gallagher: Sometimes it is not clear to the individual, but they’ll be getting a lot of feedback from others that their behavior is becoming a problem. If others in your life are noticing a problem, it is usually a good sign that you may need to go get help.
Dr. Greenspan: If symptoms interfere with life or cause physical or emotional suffering, that is the right time to seek professional help. There are excellent treatments for OCD before the condition causes any serious and ongoing harm.
To evaluate your symptoms, you can take the Yale-Brown Obsessive Compulsive Scale (YBOCS) OCD assessment.
How can people access mental health care at Einstein now?
Dr. Gallagher: We are offering telehealth visits. Call 215-456-9850 for an appointment.