New Delhi: The coronavirus pandemic, now underway for five months and counting, is believed to be worsening anxiety disorders in people, causing patients to relapse and also affecting those who may never have experienced them before.
Counsellors and psychiatrists from different Indian cities claim the number of patients approaching them with anxiety disorders, such as obsessive-compulsive (OCD) and panic disorders, has been on the rise since the pandemic kicked in.
While one pegged the rise at 20-25 per cent, a second said approximately six of every 10 consultations he offers are about heightened anxiety and OCD.
The trigger appears to be a fear of illness — of contracting a disease that has killed over 7.6 lakh people worldwide and doesn’t appear to be abating.
“Patients with obsessive compulsive disorder (OCD) have witnessed a relapse in their symptoms and are now coming back with more severe symptoms,” said Dr Kaustubh Joag, senior research fellow with the Pune-based Centre for Mental Health Law and Policy.
“The new normal is cleaning (since it’s a key Covid-prevention measure) but, with OCD patients, the cleaning is almost of a ritualistic nature. Where you may wash your hands once, they will wash hands 10-15 times,” he added.
Explaining OCD, he said, “The disorder is made of two words — obsessions, which are recurring thoughts, images or ideas that lead to fear or anxiety. Compulsions are behaviours that pacify this anxiety.
“So, these create a cycle for people with OCD, when the obsessive thoughts recur, the resulting action will help pacify these fears, so patients with this disorder keep repeating these behaviours to calm their fears.”
It qualifies as a disorder, he said, when the activities become pervasive enough to start affecting their daily life functions.
‘Mimicking disease you are worried about’
According to Joag, there has been a 20-25 per cent increase in the number of OCD patients he has been seeing since the pandemic began.
“On the anxiety spectrum, apart from OCD, cases of panic disorder have increased as well. Its psychological effects, as most people already know, are worrying thoughts, but its physical effects are more worrisome and usually mimic whatever disease patients are worried about,” he said.
“So, patients of anxiety, right now, are feeling shortness of breath, tightness in their chest, or complaining of a stuffy nose, they don’t realise it is an anxiety symptom and relate these symptoms to Covid. This leads to heightened anxiety.”
The increase in OCD symptoms amid the Covid-19 pandemic was first suggested by a study conducted in June in Italy.
Titled “Impact of the Covid-19 pandemic on patients with OCD: Effects of contamination symptoms and remission state before the quarantine in a preliminary naturalistic study”, the study found that 13 per cent of its 30 participants experienced a relapse owing to the pandemic and media reportage on the same.
The report read, “Overall, an increase in obsession and compulsion severity after the beginning of the pandemic emerged. Contamination symptoms were associated with a more elevated worsening. Perhaps, the continuous catastrophic news on TV, radio and social media combined with hygiene tips could have been a stressful situation for this vulnerable group, particularly for those with pre-existing contamination symptoms.”
Dr Milan Balkrishnan, a psychiatrist with Bombay Hospital, said 60 per cent of all patients who have approached him during the pandemic are “on the anxiety spectrum”, up from 50 per cent in the times before.
Balkrishnan said there are “two groups of OCD”.
“One is what we call obsessive compulsive personality disorder, where patients are preoccupied with obsessions without being distressed about it. Such people have a personality trait that pushes them towards such behaviour but do not have a debilitating fear which OCD patients with anxiety have,” he added.
Anxiety-related obsessive compulsive disorder, he said, is a condition where “we have now seen worsening of symptoms and break down of patients’ lives resulting from constant friction between them and their world outside (peers and family)”.
Susan Christy, a clinical psychologist at Dhiraj Hospital in Vadodara, said some patients from neighbouring Rajasthan and Madhya Pradesh had continued to visit her through the lockdown. “These were either patients whose conditions had relapsed or patients whose underlying anxiety-related disorders had been triggered due to the pandemic.”
However, she added that some of her patients only come to her after the symptoms have worsened to a high degree.
“Because of the large treatment gap, I am getting patients who are so far gone that I have to send them back with advice to the family to first put them on medication for a month. It is difficult to treat such patients,” she added.
Asked why the pandemic has resulted in a spurt of anxiety disorders, Christy said many people may have been “suffering from a mental illness at a sub-clinical level, that is they might not understand that their minor problems indicate an illness”.
“These problems might find a trigger in this pandemic. A fearful situation like now provides the perfect setting for such conditions to amplify and surface,” she added.
Another reason, experts say, is the fact that the prevention measure of isolation has taken away what might have been a source of distraction for patients, like meeting people. “This (pandemic) will bring more new cases to the clinical level,” said Christy.