MANILA -- Sofia (not her real name) endured the painful sting on her hands as she repeatedly rubbed them with alcohol for an hour straight and scratched her arms until her skin wore off. Unlike most people, she does not know how to stop cleaning her hands when it is enough, and worse, does not know when it is enough.
She is part of the 2 percent worldwide estimate of people with a psychiatric condition called Obsessive Compulsive Disorder or OCD.
In the 2017 Global Health Estimates of the World Health Organization, there are more than 3 million people in the Philippines with anxiety disorder, where OCD is categorized.
Dr. April Lyn M. Peñaflorida-Vinoya, a psychiatrist from the National Center for Mental Health (NCMH), defined OCD as a “severe and debilitating” mental health issue characterized by “persistent, recurrent, and unwanted thoughts, images, or urges” or what is called as obsessions. These are accompanied by compulsions characterized by “repetitive actions or mental acts” which are often done by people with OCD to ease the anxiety that comes from their obsessions.
While Sofia has been living with OCD even before COVID-19 started, the pandemic surely brought additional burden as she battles with her obsession with germs and contamination.
She became afraid of groceries—not the expenses that come with it, but the actual physical boxes of milk, cans of pineapple juice, and other kitchen necessities.
During the onset of the pandemic, her family also started disinfecting their groceries one by one before stacking it in the pantry. This has been a normal practice for some people, but Sofia couldn’t do more than watch her mother do the disinfecting because of the overwhelming fear there are actual germs getting inside her.
“Dati, nangyari na ayokong hawakan yung grocery so I was watching my mom clean the groceries. Kunwari, napunasan niya na, diba. Huhugasan ko ulit… I’m afraid, so ang nangyayari, I don’t hold the [groceries] unless napunasan na siya,” she recalled.
But even after thorough disinfection, she would still be compelled to sanitize them all over again.
“Kasi parang baka may na-miss ka, or baka hindi enough. Tapos parang ang mahirap doon kasi, wala namang magsasabi sayo na enough na ‘yun.”
People have gotten more observant of COVID-19 protocols like the 20-second hand washing rule, but those with OCD do more than what is required because avoiding their compulsive hand washing or sanitation would consequently make them spiral into thoughts of death and the possibility of contaminating their loved ones.
“I am clean but it’s more than that. Kasi parang nai-imagine ko nga sila (germs) na pumapasok sa’kin. Like, there is this image in my mind. Pag ini-imagine mo, you can’t really hold them, you don’t know how to. So because of that there’s a compulsion to do it,” Sofia said.
Penaflorida clarifies that OCD is different from people who are just merely clean as they don’t experience “significant anxiety or distress” because of it and it is not “consuming” their time.
The real illness causes “poor quality of life,” and could spoil human relationships, she said.
“It can be really severe and debilitating to them kasi just imagine, having these obsessions [that are] constantly on your mind. Diba these obsessions are very intrusive. They are repeatedly coming even if you don’t want it. So just to ease the obsession, they must perform the compulsion to ease the stress,” Peñaflorida said.
“If you’re going to have these (obsessions) constantly going on in your mind and perform the compulsions, you won’t have really time to do other things that you would be productive [in]. And ma i-impair talaga ang functionality mo,” she added.
Rise in OCD symptoms
People without OCD have also started developing symptoms of the illness during the onset of the pandemic, said Dr. Rucelle Zuniega, a psychiatrist from In-touch, a non-profit organization that offers mental health services.
“Aside from the people with OCD experiencing exacerbation of their symptoms, many also experience emergence of new symptoms focused on COVID-19. So, health-related yung symptoms nila and particularly health related sa Covid,” she said.
This was affirmed by a March 2022 systematic review published by the Frontiers in Psychiatry where it was stated that “people both with and without diagnosed OCD prior to the pandemic generally experienced a worsened landscape of symptoms of OCD during the COVID-19 pandemic.”
Mental health condition
OCD is a serious mental health condition that 60 to 90 percent of those diagnosed with it have comorbidities like anxiety, depression, bipolar, substance-use disorder, and impulse control disorder, said Zuniega, who has handled OCD patients.
Peñaflorida also echoed this observation, saying that people with OCD “feel frustrated and powerless because they really can’t stop [their] obsessions and compulsions so they tend to get depressed and in turn, have suicidal thoughts.”
Some OCD patients, too, become “delusional” or “psychotic” in nature that they think they or their loved ones will die if they don’t perform their compulsions, Peñaflorida said.
Despite the pain and unwanted urges people with OCD have to go through every day, there is still a chance at a normal life.
People with OCD can get treated through medication, cognitive behavioral therapy, and exposure with response prevention therapy as the “combination of psychological and pharmacological treatment is considered to be superior compared to medication alone,” Zuniega said.
Through exposure therapy, Peñaflorida said that patients with OCD are exposed to their fears so they will be able to face them and eventually “not act upon the obsession” because they already know how to control their compulsions.
She said patients are encouraged to “deal with the situation that may cause less anxiety before moving to more severe exposure [as the] goal is to stop negative habits and have better ways to cope.”
Call for accessible health care
While awareness is important in breaking the stigma about mental health, Sofia says it is not enough until the government and health institution collaborate to provide accessible and affordable healthcare.
“My hope is cheaper medicines, cheaper health care, kung pwede free,” she added.
Zuniega also warned people against loosely using the term “OC” or “OCD” when referring to people who are clean and organized, saying this “minimizes” the “severity” of the illness as the grim reality of it is being overshadowed by the wrong use of the term.
Sofia also shared the same sentiment, saying “It’s not something that is quirky, it’s not something that is cute, it’s not something that you would want to have. It’s a very difficult disorder and it takes years of managing.
“It’s not something that people would wish to have if they knew how hard it is,” she added.