Brushing my teeth is a struggle. I brush so hard, and for so long, that sometimes my gums bleed. I can’t spit until I’ve touched each tooth carefully with the tip of my tongue. I open and close the medicine cabinet repeatedly, pressing my palm into the pointy corner of the mirror, until it feels like enough. I can’t leave the bathroom until I’ve flipped the light switch on and off a dozen times. Some nights, the routine takes 30 minutes. Some nights, I lean over the sink and cry.
My obsessive-compulsive disorder manifests in rituals: small, repeated behaviors that my anxious little brain demands. If you do not do this thing, my brain explains, something terrible will happen to someone you love. Fear of contracting a deadly virus, combined with the total disruption of my work and social life, has multiplied my compulsions, which now require much more of my time. The same is true for others living with OCD, many of whom are preoccupied by germs or illness. Society may be eagerly preparing for the summer to end all summers, but people with anxiety and an intolerance for uncertainty are not entirely optimistic. “The majority of people who don’t have OCD—their life will go back to normal,” Elizabeth McIngvale, the director of the McLean OCD Institute in Houston, told me. For many people with OCD, returning to “normalcy” isn’t as simple as eating indoors at restaurants again. It means recalibrating their brain.
One of my earliest memories of my OCD is from July 2007, when the last Harry Potter book came out. I was about to start high school, my family was moving to a new house, and I was a sweaty bundle of nerves. To cope, I immersed myself in the world of house elves and horcruxes, and made a compromise with my brain: Everything will be okay if I read every sentence three times. I finished the 784-page book long after my friends had spoiled the ending.
I wasn’t officially diagnosed with OCD until 10 years later; for most of that decade, I just thought I was weird. But the disorder is fairly common. Roughly 1.3 percent of Americans have symptoms that would warrant an OCD diagnosis—one in every 80 people—according to Chris Pittenger, a psychiatry professor and the director of the Yale OCD Research Clinic. The disorder can be broken into a few broad categories, but they tend to bleed into one another. Some people with OCD have obsessions and compulsions, such as hand-washing, related to cleaning and contamination. Others have a desire for symmetry or an urge to organize or do things according to a specific number. And some have uncomfortable thoughts they can’t escape, such as visualizations of death or illness or injury. I’ve always thought of OCD as the state of being biologically superstitious. The children’s sidewalk rhyme goes, “Step on a crack or you’ll break your mother’s back.” But a person with OCD may have to step on seven consecutive sidewalk cracks, three times in a row, and if she doesn’t, her mother will develop terminal cancer.
Stress, illness, and major life transitions can make OCD worse, which is why the pandemic exacerbated many people’s symptoms. “Every therapist has a waitlist; everyone is looking for more help,” Jeff Szymanski, the executive director of the International OCD Foundation, told me. “People can’t find enough OCD specialists to hire.”
For some people with OCD, the pandemic has affected their symptoms in a more general way, Pittenger said: More stress means more obsessive thoughts and compulsions, but not necessarily thoughts and compulsions related to the virus. That’s certainly been the case for me. Over the past 12 months, I’ve developed intricate new rituals for closing Ziploc bags and washing dishes. I have to read the entire label on the waist of my sweatpants before I can put them on. I even have a strange new tic: vigorous nodding. At certain points throughout the day, I feel the urge to bob my head back and forth until it hurts. I have to do it, or something bad will happen: Maybe I’ll contract COVID-19, or maybe my parents will get into a car accident. Sometimes I nod while I walk through the park next to my house, and people give me funny looks. At home when I nod, my boyfriend politely ignores me.
I am aware that my new rituals are not the worst outcome of this pandemic. People have lost their lives and their livelihoods. But the pandemic’s less visible consequences have been pernicious too, serving up months of mental anguish for people who, on the surface, might appear just fine.
OCD can feel utterly enormous, so I found it comforting to talk with others who have it for this story. Jeff Whitmire, who is 44 years old and lives in Lititz, Pennsylvania, has had OCD since he was a child. For him, it often manifests as overanalysis of events and interactions. Years ago, when Whitmire hit a stick on the road while driving his car, he couldn’t stop thinking about the fact that he hadn’t actually seen the stick. Which meant, he thought, that there was a chance that stick could have been a person. Whitmire drove 30 miles in distress before deciding to turn the car back around to check.
Whitmire’s compulsions calmed significantly when he entered his 40s: He was able to go off his medication and stop attending therapy. But when the pandemic hit, his anxiety shot up, and the compulsions came flooding back. “It was like going back to square one,” he told me. For a while, he was too anxious to call his best friend on the phone, because he didn’t want to spend the rest of the day overthinking their conversation.
For some people with contamination OCD, the pandemic has complicated their fears about germs and viruses—and many of them have become overwhelmed, Pittenger said. Chelsea Ridener, a 24-year-old pediatric nurse in Tulsa, Oklahoma, had mild contamination OCD before the pandemic. When the world grew fixated on a highly contagious virus, her compulsions became almost debilitating. Ridener now wipes down her grocery cart for 10 or 15 minutes before shopping and scrubs her hands with sanitizer after touching anything in a public space. (Scientists have concluded that the coronavirus is much more likely to be transmitted through the air than on surfaces.) At Walmart recently, Ridener’s 2-year-old son touched something in the bathroom and then immediately grabbed her hand. Picturing the germs spreading from his body to hers sent Ridener into a panic attack. She sat in a back hallway of the store, shaking and crying for nearly an hour.
Surprisingly, although the past year has been terrible for some people with contamination OCD, others have not experienced an increase in contamination-related thoughts and behaviors, Pittenger and Szymanski told me. People like me, who don’t have compulsions related to health, have been more likely to report exacerbated OCD symptoms, at least according to preliminary research, they said. This could be because people with contamination OCD actually found a strange relief in the pandemic: They were exceptionally well prepared to live through a global health crisis.
“My therapist said, ‘You’ve been prepping for this your whole life,’” says Dotty Dart, a 30-year-old who lives in Detroit and who has rituals associated with germs and a fear of vomiting. “It was weirdly comforting,” she told me, to know that other people finally understood the daily panic she’d always felt. Seeing people take public health seriously, wear masks, and wash their hands more often made her feel less anxious. But when Dart thinks about the world opening up again—people crowding restaurants and bars and stores, coughing and sneezing and touching things—that relief disappears. “It makes me a little nervous, thinking about people just going back to being gross adults.”
The pandemic will eventually retreat, but anxiety is a much stickier thing. Like some people with OCD across the country, I’m worried that I’m stuck with these new compulsions for the foreseeable future—that this time next year, I’ll still be struggling to put on sweatpants and walking around the park nodding at no one in particular. My OCD is still manageable. It does not tend to seriously disrupt my life. But sometimes I ask myself: What if my symptoms only get worse from here on out? What if 2020 was the year my brain broke?
I explained those fears to Pittenger, and he offered an alternative future: “As the world gets less stressful, the symptoms should calm down” at least a little, he told me. I’ll have to work on it, though, and employ common treatments for stress: good sleep, exercise, meditation, and mindfulness. But he and other experts are still concerned that some people with contamination OCD “will continue to struggle with these triggers” long after the pandemic ends. Ridener told me she already knows she’ll never be able to ditch her face mask: “I’ll be the person that is always wearing one, for the rest of my life,” she said.