Washing compulsions are the most common kind of obsessive-compulsive disorder (OCD). Sufferers wash their hands more often than the average person — sometimes up to 60 times a day or even more frequently.

In addition, their apartments are often kept fastidiously clean, and in very severe cases, they change their clothes several times a day. Before they touch a door handle, they disinfect it, and they often like to keep a good distance from other people.

With their actions, people with this kind of OCD  are trying to protect themselves from things like bacteria, viruses or dirt, whose dangers or omnipresence they exaggerate. These hygiene measures are rituals that often reduce anxiety and fear for a short while. But soon, the fears reemerge and everything starts all over again.

Before the COVID-19 pandemic, such behavior was often considered strange, abnormal or even crazy by others. But this has now changed.

From abnormal to normal

At the moment, we are all being urged to wash our hands as often as possible: if we have touched objects used by others, traveled on public transport or pushed a shopping cart, for example. What was considered unusual before the pandemic is now almost the norm. And this confuses some of the people who suffer from OCD, says Antonia Peters of theGerman Society for Obsessive-Compulsive Disorders (DGZ).

"It is incomprehensible to these people that almost everyone is suddenly walking around wearing gloves and a mask. Some people have thoughts like: 'That's used to be my special trademark. Now everybody's doing it,'" she says 

Back to square one

According to Peters, a number of people with washing compulsions have reported that their compulsion has become stronger due to the pandemic.

"They wash even more often and hardly dare to go outside. People who are already suffering from a compulsion for order or control have also been developing an additional washing compulsion," she says.

Treating OCD is a long process even at the best of times. Then came the COVID-19 pandemic.

"Patients who had already worked on themselves quite successfully in therapy now have the feeling that they have to start all over again and that everything they have learned in their therapy is for nothing," says Peters. It is very difficult for the patients to keep adapting their behavior patterns.

A paradox

For people who have been suffering from washing compulsions for years, the pandemic is not only dangerous but can also seem to pose a paradox. 

In the members' newsletter of the German Society of Compulsive Diseases, one young man wrote of his feeling that society had finally caught up with him and that people were finally realizing that what he had been doing was normal.

"All the techniques I used to use are being more or less copied — where are my patent royalties?" he asked.

Coronavirus study

Lena Jelinek from the Medical Center Hamburg-Eppendorf (UKE)  has carried out a study looking at the impact that the pandemic and the new fears and restrictions associated with it have been having on OCD sufferers.

The online survey of almost 400 people was designed to find out how people with OCD were faring during the coronavirus pandemic and whether their situation had got worse or better, she says.

The scientists conducting the study, which has yet to be published, were partly interested in whether there were differences between people with washing compulsions and people with other forms of OCD, such as obsessions with order or control.

"More than two-thirds of the respondents said that they noticed that their compulsive symptoms were getting worse," says Jelinek. "And among those with washing compulsions, the deterioration was even more severe."

In a first evaluation of the Hamburg study, the scientists found that compulsive symptoms had decreased in less than 7% of the participants. There is also a concern that the pandemic may cause many people to develop an OCD in the first place.

Not so rare

Some 2 million people in Germany suffer from one of the different forms of OCD, and the number of unreported cases is high. There are those who have a counting compulsion and thus count the steps every time they climb the stairs, those who have a compulsion to keep order, and those who hoard everything and can't throw anything away.

Whether such behavior is considered a mere quirk or as an illness depends more on quantity than quality, says Jelinek.

"It is partly a question of how much time I am spending on compulsive behavior each day, but also whether I feel anxiety or discomfort when I do not perform a particular action or perform it differently than usual," she says.

Switched off and locked?

OCD is a taboo subject. Many of those affected are ashamed of their illness and keep it a secret from others.

It does not matter what kinds of compulsive acts are involved. For example, people who suffer from a compulsion for control repeatedly check whether a stove is really switched off or that the front door is locked.

"There is no real danger," explains Jelinek. "People know in a purely rational sense that they have turned off the stove, but they often no longer trust their own perceptions. A patient may well come to me with his toaster in his backpack and say: 'I wasn't sure whether it was really turned off or not.'"

Always a little bit more ...

OCD develops insidiously, with many factors playing a role in its formation, including family predispositions. About a quarter of all cases of OCD arise in childhood.

Drastic experiences, an unusual situation or a difficult phase of life can also be the first trigger for an OCD.

"Perhaps parents have separated or a relative, close relative or close friend has died. A person's upbringing can also have an influence on whether an OCD develops," Peters says.

The feeling of being alone

Interestingly, some people who took part in the study felt that they were actually doing better at the moment despite the fact that most of them were experiencing a worsening of their compulsions.

"I feel like I'm finally being understood. I am finally being taken more seriously. Many people I know suddenly have fears. That is why I no longer feel so alone," is how Jelinek quotes some of the participants in the study.

"They describe it as 'Welcome to my world!' and say: 'What you are experiencing right now is what my life has been like for many, many years,'" she says.