key: cord-0693137-vylc4to9 authors: Ornell, Felipe; Braga, Daniela Tusi; Bavaresco, Daniela Vicente; Francke, Ingrid Davila; Scherer, Juliana Nichterwitz; von Diemen, Lisia; Kessler, Felix Henrique Paim title: Obsessive-compulsive disorder reinforcement during the COVID-19 pandemic date: 2021-01-15 journal: Trends in psychiatry and psychotherapy DOI: 10.47626/2237-6089-2020-0054 sha: 98dc38f0eeea6dfef4e20e3a6b8d848e0fdc6148 doc_id: 693137 cord_uid: vylc4to9 The COVID-19 pandemic is unquestionably impacting on the mental health of the population worldwide. Fear of contamination can both increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing conditions, especially obsessive-compulsive disorder (OCD). During the COVID-19 pandemic, the imminent risk of contamination creates a logical need for self-surveillance and hygiene habits. However, this kind of information can have drastic implications for subjects with OCD, since cognitive distortions and compensatory strategies (cleansing rituals) are no longer irrational or oversized – rather, these ideas become legitimate and socially accepted, generating plausible validation for the intensification of compulsive cleaning rituals. Patients who presented remission of OCD symptoms would be more likely to have a relapse, and subclinical patients may scale up and ultimately be diagnosed with OCD due to the reinforcement of their habits, emotions and thoughts. The COVID-19 pandemic is unquestionably impacting on the mental health of the population. 1,2 Both fear of contamination and the socioeconomic effects of the pandemic can increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing disorders. 3, 4 It is important to note that a disproportionate level of anxiety, accompanied or not by harmful behaviors, is an essential component of the development of some psychiatric disorders 5, 6 especially obsessive-compulsive disorder (OCD). [7] [8] [9] [10] Moreover, in OCD, compulsive behaviors driven by fear are associated with worse long-term outcomes. 11 OCD can be found in about 4% of the general population. 12 The disorder is characterized by changes in thinking (obsessions), changes in behavior (compulsions), or both. Obsessions are recurring, persistent, unwanted ideas, images or impulses, usually involving thoughts of harm, risk or danger, which cause anxiety and are intrusive. Compulsions (also known as rituals) are certain mental actions or acts that the person feels compelled to do in trying to reduce or avoid the anxiety caused by obsessions. Obsessions or compulsions are time-consuming (e.g., they take more than an hour a day) and they cause suffering and impairment in social, professional and other important areas of an individual's life. In order to reduce the discomfort and suffering associated with these thoughts, patients can engage in maladaptive and exaggerated behaviors, also called compulsions or rituals. Among the most common OCD symptoms is the fear of contamination leading to excessive cleaning behaviors. 8, 13, 14 Other frequent compensatory behaviors in OCD are the compulsion to wash hands, avoidance behavior to touch objects considered contaminated, and cleansing rituals. Avoidance of situations that can be considered as presenting a high risk of contamination can also occur, such as walking, using public transportation, sitting on a public park bench, or going to a public bathroom. 8, 14 Briefly, the cognitive-behavioral model of OCD Taken together, the double burden on the illness of these patients and the concern about a possible increase in the incidence of OCD during and after the pandemic period stand out. In a recent study conducted in China during COVID-19, high levels of OCD were observed. 19 In addition, it is reasonable to predict that patients who presented remission of OCD symptoms would be more likely to have a relapse, and also that subclinical patients may scale up and ultimately be classified as having this disorder due to the reinforcement of their habits, emotions and thoughts. Finally, there is an increased chance of people developing other serious psychiatric disorders that can be disabling, such as mood and anxiety disorders. 16, 17, 25 It is important to note that the intensification of obsessions, hopelessness, depressive symptoms and anxiety are associated with high rates of suicide in individuals with OCD. 26 as well as the provision of remote assistance channels. It is also essential that health professionals and health services like hospitals are trained to assess, diagnose and treat this portion of the psychiatrically vulnerable population. Future investigations on the incidence and worsening of OCD during the pandemic and post-pandemic period are warranted, especially assessing the impact of this phenomenon on the quality of life of individuals, as well as on work and academic performance. 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