By Malika Noor Mehta
Artwork by Trisha Srivastava
I have bitten my nails ever since I was a child. A terrible habit by all accounts. My mother will often swat my hand away from my face, grimacing at the fact that her 32-year-old daughter still partakes in this unfortunate act. More often than not, I find myself trying to explain to my mother that when I am concerned about something, I inevitably (and mostly unintentionally) begin to bite my nails. Of course, that is no excuse – I must make a conscious effort to kick the habit (and believe me, I have been trying). Sometimes, however, I wonder whether this incessant nail biting is a symptom of something more serious – perhaps not just basic nervousness, but deep-seated anxiety that I need to address in a more structured and purposeful manner. In fact, I have often described the habit as more of a compulsion. Something I have very little control over unless I am paying active and immediate attention to it. Something that unconsciously occurs when I am feeling stressed or nervous.
In an effort to understand my own actions better, I began researching the word “compulsion” and slowly migrated my research to “OCD” or Obsessive Compulsive Disorder.
We use these terms rather flippantly in this day and age (I have occasionally called myself “OCD” for biting my nails with such unconscious force), but in fact, OCD is a complex and serious condition, one that requires deeper attention.
What is Obsessive-Compulsive Disorder or OCD?
Obsessive-Compulsive Disorder or OCD is a condition in which individuals have recurring, undesired thoughts (obsessions) that compel them to perform certain acts repetitively (compulsions). While OCD is a serious disorder, it does not necessarily disrupt a person’s daily life. A person living with OCD adjusts to the obsessions and compulsions they experience because ignoring the thoughts and not performing the behaviours causes distress and anxiety. Many people with OCD understand that their obsessions and compulsions are not realistic or required (for instance, washing your hands repetitively a certain number of times a day does not necessarily prevent you from exposure to germs). Despite this understanding, people with this condition cannot resolve OCD behaviours through rationalization and logical reasoning. They find it very tough to suppress the obsessive sensations or disengage from the compulsive behaviours.
Now, as I researched OCD in the context of my nail-biting habit, I realized that I do not, in fact, have this condition. There are certain parameters that need to be met in order to be diagnosed with OCD – all of which I did not meet. For instance, if the obsessions and/or compulsions are time-consuming and take up more than one hour per day, cause considerable anxiety if not performed, and possibly prevent a person from functioning well (in work or other social settings), then an OCD diagnosis is more likely.
Not all habits or rituals are compulsions. It is the lack of control over one’s thoughts and actions even when we understand their excessive nature that could indicate OCD. Our culture has normalized the usage of the term “OCD” as a part of mainstream lingo to describe individuals who perform certain tasks in a ritualistic manner. Yet, a person’s ability to disengage from the said task, or to remain calm if the task is not completed indicates mental wellbeing and stability. In those cases, OCD is an unlikely concern.
OCD and COVID-19
For those who do struggle with this condition, the most common obsessions involve themes of dirt, illness, contamination, fear of getting sick or transmitting a virus. The most common compulsions are known to be hand-washing, excessive cleaning, creating order within spaces, arranging things in a very particular manner, repeatedly checking on something (is the gas turned off? is the door locked?), or counting compulsively (think Sheldon Cooper in the Big Bang Theory compulsively knocking on his neighbour, Penny’s door exactly three times).
During the pandemic, there were certain measures put in place to reduce the spread of the COVID-19 virus. Hand washing, mask-wearing, and sanitizing our physical spaces are only some of the behaviours that have sprouted as a result of the pandemic. We have seen celebrities around the world promote these habits in order to prevent the spread of germs – all of which is very helpful advice in the battle against COVID-19. Yet, these practices have unfortunately had an unexpected externality – they have worsened the symptoms of OCD in people struggling with the condition.
In fact, studies have found that patients who were diagnosed with OCD before the pandemic saw a dramatic increase in symptoms during the pandemic, especially in times of lockdown and quarantine. This has been particularly true of people who struggle with contamination OCD where obsessions centre on themes of illness, and the resulting compulsions are acts of sanitization in various forms.
While the pandemic has had a significant impact on mental health in general – increasing rates of anxiety and depression – it has had a unique effect on those with OCD. A person suffering from this condition might have spent a lot of time working through their anxiety in therapy, and developing coping methods as they try to break their OCD rituals. Imagine, then, being thrown into a situation where one is not only encouraged to obsessively perform certain behaviours (sanitization) but is also subjected to anxiety-inducing situations consistently for over one year (lockdown, quarantine, job instability, health concerns, negative news cycles). The pandemic places an inordinate amount of pressure on individuals with OCD, forcing them to balance behaviours that they have naturally performed ritualistically.
Furthermore, the pandemic could also have caused the development of OCD in some individuals – so those who did not suffer from this condition before the emergence of COVID-19, now struggle with it because of the virus. This has occurred because OCD not only arises because of biological and genetic factors but also because of stressful life events. For instance, trauma may increase the risk of OCD because the event triggers intrusive and unwanted thoughts that the person cannot control or regulate. It subsequently leads to behaviours that are performed to quell the anxiety caused by these stressful thoughts.
Trauma, as a risk factor for OCD, has been significantly worsened due to the pandemic. There has been trauma at a mass scale, as well as individual strife in an unprecedented manner. Alongside the health crisis and the fear of losing loved ones, limited resources (oxygen, ICU beds, medication), and the lack of basic necessities due to job loss has caused trauma in ways this generation has never witnessed. This trauma has led to a myriad of mental health conditions, one of which is definitely OCD.
Acceptance
While OCD is complex, it is definitely manageable. The first step in truly managing the condition is accepting its existence. The second step is asking for help. And in order for individuals to feel comfortable asking for help, society must show them the respect they deserve. Unfortunately, individuals who struggle with OCD often confront bullying and teasing as a result of stigma. One of the ways in which to break down this stigma is to stand up and discuss our own mental health struggles as openly and publicly as we feel comfortable doing so. By encouraging conversations about subjects like OCD, we normalize these conditions and create space for those who are truly struggling to ask for help. In some way or another, we all face mental trials and tribulations – it is first acknowledgement, then acceptance and finally action (in the form of seeking help) that will help us manage our mental health better.
About the author
Malika Noor Mehta is a mental health entrepreneur. Before the pandemic, she was engaged in creating a fellowship program that placed mental health counsellors in low-cost schools in Mumbai. Her interest in mental health stems from her teaching experience at Teach for India and her time in Jordan and Greece, creating trauma-sensitive education programs for Syrian refugees. She holds a Master in Public Policy from the Harvard Kennedy School of Government. In her free time, she loves to write and take photographs.