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Trauma, Stress, and the Isolation of COVID Can Trigger and Worsen OCD in Children and Teens


Less Sun, More OCD: Get Your Kids Outside for Natural Light Therapy

The coronavirus pandemic turned our lives upside down.

It’s been a year now. Although the vaccines are here, we’re not quite out of the woods yet. But we are very close.

The cumulative stress of the pandemic affects us all.

However, it has had a disproportionate impact on people with pre-existing mental health disorders. Mental health experts warned the general public at the beginning of pandemic that many of the mitigation strategies – though absolutely necessary to combat the spread of the virus – would increase risk of relapse and exacerbate the symptoms of people with:

The mitigation strategies they refer to, of course, are:

  • Shelter-in-place orders
  • Virtual school
  • Social distancing
  • Restrictions on the size of public gatherings
  • Recommendations on the size of private gatherings

The downstream effects of these mitigation strategies meant that for millions of people, their go-to stress relievers, their favorite pastimes, their favorite social activities, and their preferred choices for entertainment – i.e. movies, concerts, sporting events – were suddenly off-limits. People found themselves isolated, under stress, and without their typical releases, outlets, or comforting rituals and activities.

Mental health-wise, it looked like a recipe for disaster.

However, early on in the pandemic, we published the following article – The Impact of COVID-19 on Teens with Obsessive-Compulsive Disorder – in which one of our therapists made an interesting observation: teens diagnosed with and who had received treatment for OCD may actually have been better prepared to handle some aspects of the pandemic than most.

She included teens who received treatment at adolescent inpatient or outpatient treatment centers, adolescent psychiatric programs, residential programs for teens, and teens who received evidence-based treatment at teenage behavioral treatment centers, among others.

A Year Later: Data from the Journal of Obsessive-Compulsive and Related Disorders

As it turns out, many mental health experts and people diagnosed with OCD around the country agreed, as confirmed by this article in Scientific American. At the same time, though, a peer-reviewed journal article released this month – The Impact of The Coronavirus Pandemic on Specific Symptom Dimensions and Severity in OCD: A Comparison Before and During COVID-19 in the Context of Stress Responses – shows that whether they were more prepared or not, the coronavirus had a significant negative impact on symptoms of OCD for people previously diagnosed with OCD.

The study is both relevant and valuable because researchers assessed the severity of the following four OCD symptom dimensions before and during the pandemic:

1. Contamination

This symptom refers to excessive and disruptive worry about germs and illness, the excessive avoidance of things that may result in contamination. It also includes the cleaning and/or washing rituals employed to avoid contamination.

2. Responsibility

This symptom refers to the condition wherein people with OCD feel they are responsible for – either through action or inaction – harm or misfortune befalling themselves or others. It also includes rituals involving checking and reassurance.

3. Unwanted Thoughts

This symptom refers to recurring, stressful, disturbing, and persistent thoughts related to an object or subject of obsession.

4. Symmetry

This symptom refers to the drive to correct things that are not exactly right and make perfect things that are not exactly perfect. This can include counting, arranging, and repeating rituals, among other things.

Here’s what they found.

Among 270 participants previously diagnosed with OCD, the stress related to the COVID pandemic increased:

  • Overall OCD intensity and severity
  • Symptoms related to contamination
  • Symptoms related to responsibility
  • Frequency and intensity of unwanted thoughts
  • Symptoms related to symmetry

These results are more confirmation than surprise.

And for the people who’ve already received treatment for OCD and have a robust set of coping skills, there’s more news about a simple technique that can help. But we’ll get to that in a moment. For now, we’ll offer a quick primer on OCD for people who don’t know much about it, or for those among you who know a little, but are curious about the details.

The Facts About Obsessive-Compulsive Disorder

The go-to manual mental health professionals consult when diagnosing mental and behavioral health disorders, the DSM-V, defines Obsessive-Compulsive Disorder as a neurological disorder characterized by obsessions and compulsions that take up at least an hour a day and cause a significant amount of psychological and emotional distress.

We’ll explain what those two operative words – obsession and compulsion – mean in real terms.

Obsessions are repeated thoughts, thought patterns, or mental images that cause significant worry, stress, or anxiety.

Common obsessions for children or teens with OCD include excessive fear of:

  • Germs or dirt
  • Harm or danger befalling themselves or a loved one
  • Loss of an important or favorite object
  • Lack of order and symmetry among common objects at school, work, or home
  • Not being perfect at everything
  • Occupation with special numbers or words

Compulsions are repetitive behaviors performed by an individual in response to obsessive thoughts.

Common compulsive behaviors for children or teens with OCD include:

  • Repetitive handwashing and cleaning, constant avoidance of things others have touched, constant avoidance of school cafeterias and other public places because they’re too dirty
  • Continuous, repetitive checking of locks on windows and doors, or making sure the kitchen stove is off
  • Refusing to get rid of or throw away items that have significance for them, but seem insignificant to parents, peers, and others
  • Continuous arranging and rearranging objects at home or school in a specific, precise, rigid manner
  • Constant, repetitive revising of homework or re-doing household chores and activities
  • Continuous, repetitive counting or performing activities or rituals the exact same number of times, every time

It’s important to point out here that everyone develops habits and rituals. We all have particular ways we like to do things. We all go back and double check things. It’s also important to note that some hobbies, interests, and pursuits overlap with OCD symptoms, but are not symptoms of OCD.

For example:

People collect coins, stamps, sports cards, books, or fan swag from television shows, movies, or cartoons. Sports fans talk endlessly about their favorite team or keep track of every statistic going back decades. Teenagers develop extreme pre-occupations with celebrities in music, film, and television. They cover their walls with posters, stickers, and everything to do with their favorite stars. They recite song lyrics or repeat a joke or line from a random pop culture source all day every day. But these preoccupations are not evidence of OCD: this is typical teen behavior – and so is the preoccupation with a favorite hobby or pastime.

So What’s the Difference?

The difference between harmless behaviors and OCD is that non-OCD preoccupations are things people love doing. They love to talk about or share their enthusiasm with others. On the other hand, people with OCD do not enjoy their repetitive thoughts and actions, nor do they like to talk about them. A person with OCD has extreme difficulty controlling symptomatic thoughts and behaviors even when they know they’re excessive. For people with OCD, obsessions and compulsions take up more than one hour per day and interfere with home or school activities.

The compulsions don’t make the individual feel good, but rather offer temporary relief from the anxiety caused by the associated obsessions – that’s what people without OCD need to understand about what’s happening with people who have OCD.

Before we talk about that new approach to therapy for OCD, we’ll offer the big picture prevalence statistics on OCD in the U.S.:

  • About 4% of the general adult population meet criteria for clinical OCD
    • That’s about 8.1 million adults
  • About 2% of children and adolescents meet criteria for clinical OCD
    • That’s over 500,000 children and adolescents
  • OCD typically first appears during two distinct periods of development:
    • Pre-adolescence (age 10-12)
    • Early adulthood (age 18-20)

That’s a lot of people.

There is encouraging news, though – treatment for OCD works. And one of the most recently recognized treatments is totally free and accessible to everyone.

Treatment for Obsessive-Compulsive Disorder

Traditional treatment for OCD involves a combination of therapy, medication, and complementary supports and/or lifestyle modifications.

Therapy for OCD includes:

  • Individual therapy
  • Group therapy
  • Family therapy

The most common therapeutic approach is cognitive behavioral therapy (CBT). Click here to learn more about CBT.

Medication for OCD may include:

  • Antidepressants such as selective serotonin reuptake inhibitors (SSRIs)
  • Other antidepressants, such as tricyclic antidepressants

Complementary supports and lifestyle modifications may include:

  • Mindfulness activities
    • Yoga, walking, meditation
  • Expressive therapies
    • Visual art
    • Drama
    • Writing
  • Exercise:
    • Surfing
    • Boxing
    • Hiking
    • General fitness

We’ve finally arrived at the approach to therapy that we teased in the title of this article and in the introduction. Researchers and therapists discovered this approach when they realized there may be a connection between seasonal affective disorder (SAD) and OCD.

Let the Sun Shine In

It’s called light therapy – and it’s exactly what you might think it is: it involves exposure to light as a way to reduce the symptoms of OCD. In one case study, a woman exposed to a full-spectrum light for two hours a day saw complete remission of her OCD symptoms after two weeks of treatment. When we combine this information with data that shows people who live in areas with less yearly sunlight experience higher rates of OCD than people who live in areas with more yearly sunlight, we realized that this is great news for people with OCD.

And it’s especially good news for children and teens who’ve been diagnosed with OCD, have received specialized treatment for teens with anxiety, and are tired of being cooped up all year under coronavirus guidelines.

The good news, specifically, is this: simply getting outside in the sunlight is therapeutic and can reduce symptoms of OCD.

There’s one more thing – and it changes this good news to great news:

Sunlight is free, available almost every day, and or receive the benefits,

all you have to do is go outside for an hour a day.

(But two hours would be better.)

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