Pandemic increases need for mental health services

Anxiety among disorders to spike nationwide

Wash your hands for 20 seconds, stay 6 feet away from people, sanitize every surface and package.

This new routine has become a mantra for many as they navigate the dos and don'ts of life during the

COVID-19 pandemic.

But if some people feel some of their behaviors have crossed the line from precautious to obsessive, they are not alone.

Since coronavirus started to spread, health care providers have seen a spike in anxiety nationwide, caused by the fear among some people that they will encounter the invisible virus at any moment.

The Centers for Disease Control and Prevention (CDC) and the Anxiety and Depression Association of America (ADAA) anticipated this spike early on in the pandemic, warning that people with and without anxiety disorders would likely experience heightened anxiety.

The center predicted some people would experience fear and worry about their own health and that of loved ones, resulting in changes to sleeping or eating patterns, difficulty concentrating, worsening of chronic health problems and mental health conditions and increased substance use.

In southeastern Connecticut, health care providers say they have seen the impact on their patients' mental health and have been treating symptoms ranging from bouts of depression and vivid dreams to compulsive behaviors.

Providers say they have heard from many patients who are experiencing new, or increased, obsessive compulsive behaviors while self-quarantining. Whether it be compulsively cleaning their home, obsessively monitoring the media or scanning their bodies for symptoms, the stress

of the pandemic has resulted in behaviors that affect their everyday life.

“You can't be living right now without feeling some sort of anxiety. It's affecting all of us,” said Dr. Peter Morgan, chairman of the psychiatry department at Lawrence + Memorial Hospital. But that anxiety, he said, highlights things people fear and can give them an almost obsessive desire to avoid it.

One common reaction, he said, seems to be obsessive cleaning, sanitizing and organizing.

In general, obsessive-compulsive behaviors — behaviors that are part of more severe and chronic conditions like Obsessive Compulsive Disorder or Obsessive Compulsive Personality Disorder — can stem from needing a sense of control, and can manifest in acute, temporary changes in daily behavior.

“Our brain wants to find things to control to give us a little bit of strength to deal with the things we can't control,” said Morgan. “So you might think, ‘I can make my bed every day, nobody can stop me from making my bed every day' or ‘I can pull every single weed from my garden.' These are things you normally wouldn't need to do, but now you can do them just to have mastery over something,” he said.

Obsessive Compulsive Disorder — a diagnosis for someone who shows prolonged obsessive compulsive behaviors — affects 2.2 million adults in the U.S., according to the ADAA. But the number of people impacted by the disorder, or temporary obsessive compulsive behaviors, may be on the rise during quarantine.

“As we experience changes to our social and work environments, people are developing obsessive behaviors at home,” said Kristie Tapper, APRN at the Hartford Healthcare Medical Group in Old Lyme. “Obsession with staying clean and organized and neat, maybe that can be healthy in a way, but it can also be kind of disruptive.”

Everyone might have OCD tendencies, said Tapper, but what matters is how they affect a person's life, productivity and relationships with others.

Morgan said that being more intentional and conscious of cleanliness and sanitation during this time is, of course, normal and improves safety.

“But the problem is when the habits become anxiety-provoking themselves,” said Morgan.

Tapper and Morgan said they have both seen an increased number of patients coming to them with concerns about their mental health and specifically, obsessive behaviors.

Some are compulsively organizing, tearing up their closets to re-order their belongings; some are obsessively sanitizing their belongings, or maybe even their children and spouses; others are poring over medical journals, analyzing every sneeze and sniffle.

According to Morgan, extreme changes to a work environment — whether being laid off, furloughed or no longer going to school — can have a severe impact on a person's mental health. People who have had the structure of work and school taken away are probably struggling the most, said Morgan, while people who are retired and have adjusted to a slower pace of life may not be as strongly affected.

“The problem with being in a pandemic is a lot of people have had one of the main purposes in their life, work or school, taken away or changed dramatically, so they're left with the questions of ‘How do I spend my time? What do I focus on?'”

“A lot of people don't do well without having some purpose, and right now so many things are different, people need to organize their lives around something,” said Morgan. That's when new behaviors can form and can become obsessive.

OCD behaviors, said Tapper, tend to be related to daily behavior such as how clean we are, how much we eat or exercise or how much we organize.

Many of her patients, she said, are stuck inside their homes, repeating activities they previously didn't overthink such as organizing.

“We can't control the environment or what the government does or other people, and people may feel more depressed and anxious because of that, and strive to improve those feelings by decluttering and cleaning and finishing projects,” said Tapper.

For caretakers, mainly parents, there may be an obsessive sense to clean, or hoard cleaning supplies, to keep the family safe.

“Obsessively buying cleaning supplies, paper goods, and taking safety measures, I think, is kind of an innate response if you're the person who oversees the family,” said Tapper. “They don't have control over the virus infecting the family, or someone bringing the virus home, but they do have control of what things they can purchase in stores or online to keep things sanitized and to keep the virus from infecting the family.”

Morgan said that people who have spouses who are still working outside the home, many in health care or at Electric Boat, may be obsessing about cleanliness when their spouse comes home.

“They may be going through the process of sort of decontaminating the spouse when they get home and then wondering if they got everything, asking ‘Did I get the doorknob?' And checking and rechecking and cleaning and recleaning,” Morgan said.

For folks working from home, there may be a stronger desire to decorate, declutter and design.

Tapper said that in her research, she found that people dealing with obsessive behaviors can often get overwhelmed by a need for orderliness and symmetry within their visual space, “which can lead to a desire to ensure tidiness before diving into a day of work.”

At her practice, Tapper said she's seen a spike in anxiety and obsessive compulsiveness primarily from patients with preexisting mental health conditions and in those who work in education.

“There's mostly been a spike amongst my teacher population, my patients that are educators and have had to resort to technology and a different form of education have been severely anxious, she said.”

Tapper said that the majority of her patients who have come to her with obsessive behaviors have been experiencing hypervigilance about their health, or an obsession to get more knowledge about the virus itself.

“Initially it was this obsession of being tested and we couldn't always order the tests, so people were going to great lengths to figure out how to be tested,” said Tapper. Now, many patients are obsessing over testing for antibodies, even though it is not yet clear what exactly those tests reveal or how accurate they are.

For others, the obsession may come in the form of monitoring one's own symptoms, said Morgan. People may be having increased anxiety every time they wake up with a mild cough or scratchy throat and go directly to WebMD to compare their symptoms to signs of coronavirus, when in reality, the occasional cough, headache or congestion is normal, especially during allergy season.

Tapper said that in her practice, patients who previously took medications to ease anxiety are taking it much more frequently and that she is receiving more medication requests. People who have been in treatment for OCD, she said, may also experience setbacks.

In response, she said, she's trying to provide a lot of reassurance and support and is continuing to encourage overall wellness in her patients, recommending exercise, healthy eating habits and avoidance of abusive substances.

When necessary, she's encouraging patients to tap into the wealth of virtual options available for teletherapy, and to explore cognitive behavioral therapies and medication.

Morgan said that folks who may be considering asking for mental health help for the first time should remember that treatment doesn't have to be permanent as therapy or medication may just be needed temporarily. For some, he said, just the act of making the first call to their doctor might help immensely.

And, he said, “it's important to remember that it's OK to be stressed and it's OK to be doing things a little differently.”

Tapper agreed and encouraged people who are struggling with new or worsening mental health symptoms, including OCD, to remember that it's OK to be experiencing new problems during a pandemic and it's OK to need help.

“There's going to be a little bit of a void in our lives continuing to make us feel anxious, and we have to keep patting ourselves on the back and reminding ourselves that things are OK,” she said.