“The ultimate exposure”: a qualitative exploration of the impact of COVID-19 on adults in treatment for obsessive-compulsive disorder with contamination fears

Abstract

ABSTRACT Objectives Risk of infection and emphasis on hygiene practices during the COVID-19 pandemic had the potential to exacerbate cognitive distortions and decontaminating rituals for people with obsessive-compulsive disorder (OCD), especially those with the contamination/cleaning subtype of OCD. Existing literature has been mostly quantitative, involving mixed OCD samples, with minimal specific focus on contamination symptoms. This qualitative study aimed to explore the impact of the pandemic on the symptomatology and treatment of Australian adults undergoing treatment primarily for contamination obsessions and washing and cleaning compulsions. Method Twelve adult clients diagnosed with OCD with contamination obsessions and washing compulsions completed semi-structured interviews. Transcribed interviews were analysed using thematic analysis. Results Participants’ intrapersonal and interpersonal experiences were captured by four overarching themes and 12 subthemes: (1) Evolving Self-Concept, (2) Changing Symptomatology, (3) The Family and Home, and (4) The Pandemic Environment. Interactions with the pandemic environment altered participants’ perception of themselves and their OCD, influencing the frequency and nature of subsequent engagement with the environment. Conclusions Clinical implications include: The importance of de-stigmatising OCD, tailoring psychological support during the pandemic context, and modifying exposure and response prevention to ensure that its principles are upheld in the event of another health crisis.