Narrative Review of COVID-19 Impact on Obsessive-Compulsive Disorder in Child, Adolescent and Adult Clinical Populations

Abstract

Background: The COVID-19 pandemic and quarantine had a significant impact on mental health which resulted in an increase of anxiety and depression in adult, child and adolescent clinical populations. Less is known about the potential effect of pandemic on obsessive-compulsive disorder (OCD) so there is a lack of review work to illustrate the impact of the COVID-19 pandemic on OCD.Purpose: The main objective is to review all the empirical contributions published after March 2020 that dealt with the impact of the COVID-19 pandemic on OCD in adults, children and adolescents, investigating the state-of-the-art literature concerning the impact on OCD and detailing limitations.Methods: The literature search was conducted using PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, PubMed, and Google Scholar. This review analyzed all studies from January 2020 to 8 January 2021, focusing on clinical populations of children, adolescents, and adults with OCD.Results: A total of 102 articles were screened, resulting in the identification of 64 full-text articles to be further scrutinized. Upon closer examination, there was consensus that 39 articles met the study inclusion criteria and 14 of these were selected for study. Analysis of the results revealed that COVID-19 had an impact on OCD in both adults and young people and seems to have caused exacerbation of symptoms, especially of the contamination/washing subtypes. Eight studies in adult samples showed an increase in the severity of obsessive-compulsive symptoms; two studies underlined a minimal impact of COVID-19 on OCD patients and one study showed a slight improvement in symptoms. Two out of three studies on children and adolescents showed an exacerbation of OCD and a worsening even in the presence of an ongoing treatment.Conclusions: The studies reviewed are few. There are more studies on adult OCD than on children and adolescents. The results are controversial: few studies examined OCD subtypes; in most studies the typology of treatment was not clear and the samples covered a wide age range; a large number of studies did not use the same monitoring period or quantitative measures, both of which make it difficult to compare or rely on the results.

An Observational Study of OCD Patients Treated With Cognitive Behavioral Therapy During the COVID-19 Pandemic

“…Although the consequences of the COVID-19 pandemic for general mental health and the increase in anxiety and depression are clear, less is known about the potential effect of the pandemic on obsessive-compulsive disorder [OCD; (30,31)]. The increase in distress, concern, and fear has affected reactions to the present situation and exacerbated some existing psychiatric disorders (32,33).…”

“…It is interesting to reflect on how this condition of uncertainty and alarm due to the pandemic has influenced OCD patients and so how the pandemic and the lockdown period may have affected OCD patients. However, two reviews have investigated the impact of the COVID-19 pandemic on OCD (30,31) and the results are controversial.…”

“…However, it is impossible to generalize the results because the study refers only to the USA, China, India, and the UK. Another recent narrative review by Zaccari et al (31) highlighted the presence of a small number of studies with controversial results. The authors underline that few studies have specified OCD subtypes and that samples cover a wide age range.…”

“…Even if patients in some studies showed an increase in the severity and in the number of obsessions (51)(52)(53)(54), OCD patients in others have been only minimally impacted by the pandemic (23,55) or shown a slight decrease in symptoms (56). Moreover, regarding the typology of treatment, Zaccari et al (31) showed that OCD patients were given cognitive behavioral therapy (CBT) treatment with exposure and response prevention (ERP) during the monitoring period in only two studies (54,57).…”

“…Although CBT and ERP represent the elective treatment for OCD according to the National Institute for Health and Clinical Excellence guidelines (58), Zaccari et al (31) reported that only two studies used this protocol. Over the last 30 years, different studies have confirmed the beneficial effect of CBT with ERP for OCD patients (59)(60)(61)(62)100).…”