Effects of strict COVID-19 lockdown on patients with obsessive-compulsive disorder compared to a clinical and a nonclinical sample

Abstract

Background Symptoms of obsessive-compulsive disorder (OCD) have been reported to increase during the COVID-19 lockdowns because of the hygiene requirements related to the pandemic. Patients with adjustment disorder (AD) may, in turn, represent a vulnerable population for identifiable stressors. In this study, we aimed at assessing potential symptoms changes in OCD patients during the lockdown in comparison with AD patients as well as versus healthy controls (HC). Methods During the COVID-related lockdown, we enrolled 65 patients and 29 HC. Participants were tested with four clinical rating scales (Yale–Brown obsessive-compulsive scale and Brown Assessment of Beliefs Scale for OCD patients; Beck Depression Inventory-II and State–Trait Anxiety Inventory-Y for each group) that had been also administered just before the Italian lockdown. Results Our results showed that during the lockdown: (i) the symptoms of depression and anxiety increased in all groups, but this increase was most pronounced in HC (p < 0.001); (ii) OCD symptoms severity did not increase, but the insight worsened (p = 0.028); (iii) the proportion of OCD patients showing hygiene-related symptoms increased (p = 0.031 for obsessions of contamination), whereas that of patients with checking-related symptoms decreased. Conclusions The lockdown-induced psychological distress apparently changed the characteristics and the pattern of OCD symptoms expression but not their overall severity. This evidence confirms the heterogeneity and changing nature of OCD symptoms, strongly depending on the environmental circumstances.

The anxiety response of patients with severe psychiatric disorders to the recent public health crisis

“…Although these findings are consistent with the findings of some studies [ 50 ], most previous studies have reported that psychiatric patients, especially those with SPDs, experienced more anxiety than the general population [ 31 – 33 ]. One explanation is that pre-existing symptoms exacerbated their anxiety in the face of the pandemic [ 51 ].…”

“…Stressful factors such as fear of death, fear of losing loved ones, loss of social connection, and loss of employment may even cause severe psychological problems in formerly healthy people [ 52 ]. Some studies reported that healthy individuals had higher levels of anxiety and depression than individuals with SPDs during COVID-19 health crisis [ 51 ]. What further strengthens this interpretation is that participants without psychiatric disorders performed more safety behaviors in response to the pandemic than patients with OCD, or did not differ in this respect from patients with SSD, BD, and MDD.…”

“…There was no significant difference in anxiety sensitivity, as a general trans-diagnostic factor of vulnerability to experience anxiety between them [ 23 ]. This overall increase in anxiety and depression responses to COVID-19, which causes worsening psychological reactions in the general population, can be an expression of the ceiling effect [ 51 , 53 ]. Such an effect may cause the previously apparent difference between the two populations to diminish and possibly disappear during periods of the public health crisis.…”

“…There are various reasons for the lower manifestation of COVID-19-related anxiety and safety behaviors in patients with SPDs. Some have suggested that the lives of patients with psychiatric disorders are already troubled by many challenges, and the outbreak of a global health crisis has had more adverse effects on the lives of non-disordered individuals [ 50 , 51 ]. In other words, the most significant anxiety, interference, and restrictions caused by the pandemic have been created for those who had a less troublesome life before [ 51 ].…”

“…Some have suggested that the lives of patients with psychiatric disorders are already troubled by many challenges, and the outbreak of a global health crisis has had more adverse effects on the lives of non-disordered individuals [ 50 , 51 ]. In other words, the most significant anxiety, interference, and restrictions caused by the pandemic have been created for those who had a less troublesome life before [ 51 ]. For example, many people with mental disorders may have previously experienced isolation and lack of a suitable social network, as a result, the “social distancing” recommended by the healthcare system and the resulting psychological consequences do not seem to be central problem for them [ 50 ].…”