Contamination-related behaviors, obsessions, and compulsions during the COVID-19 pandemic in a United States population sample

Jack Samuels; Calliope Holingue; Paul S Nestadt; O Joseph Bienvenu; Phillip Phan; Gerald Nestadt

doi:10.1016/j.jpsychires.2021.03.064

Contamination-related behaviors, obsessions, and compulsions during the COVID-19 pandemic in a United States population sample

J Psychiatr Res. 2021 Jun:138:155-162. doi: 10.1016/j.jpsychires.2021.03.064. Epub 2021 Apr 1.

Authors

Jack Samuels¹, Calliope Holingue², Paul S Nestadt³, O Joseph Bienvenu³, Phillip Phan⁴, Gerald Nestadt³

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA. Electronic address: jacks@jhmi.edu.
² Department of Mental Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, 21201, USA.
³ Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
⁴ The Johns Hopkins University Carey Business School, Baltimore, MD, 21202, USA; Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.

Abstract

Background: Contamination-prevention behaviors such as mask wearing and physical distancing are crucial to reduce coronavirus transmission during the COVID-19 pandemic. We hypothesized that engagement in these behaviors could provoke obsessions and phobias in vulnerable individuals in the community.

Methods: A total of 2117 participants, systematically selected to represent the age, gender, and race distributions of the US population, completed an online survey that assessed demographic characteristics, clinical features, COVID-19 risks, and COVID-19 contamination-prevention behaviors. Logistic regression was used to estimate the magnitude of the relationships between the COVID-19 behavior score and clinically significant contamination obsessions, contamination compulsions, and pre-COVID-19 to current change in obsessive-compulsive symptom scores.

Results: The COVID-19 behavior score was significantly associated with contamination obsessions (odds ratio (OR) = 1.15, 95% CI = 1.12-1.16; p < 0.001) and contamination phobias (OR = 1.14, 95% CI = 1.12-1.16; p < 0.001). The COVID-19 behavior score also was associated with pre-pandemic to current increase in the overall obsessive-compulsive symptom score (OR = 1.16, 95% CI = 1.09-1.23; p < 0.001), as well as increase in obsessive-compulsive symptom score excluding washing items (OR = 1.13, 95% CI = 1.07-1.19; p < 0.001). The magnitude of these relationships did not appreciably change, after adjustment for other variables associated with the outcomes. Moreover, the relationship was significant in those with or without OCD, and in individuals with different levels of doubt and COVID-19 risk.

Conclusions: Contamination safety measures are critical for reducing the spread of COVID-19 in the community. However, they may be related to the development of contamination-related symptoms and OCD in vulnerable individuals, complicating the diagnosis and treatment of mental disorders during this period.

Keywords: COVID-19; Contamination; General population; Obsessive-compulsive disorder; Phobia.

MeSH terms

COVID-19*
Humans
Obsessive Behavior
Obsessive-Compulsive Disorder* / epidemiology
Pandemics
SARS-CoV-2
United States / epidemiology