Obsessive-compulsive disorder as practice for COVID-19

Originally published at: https://boingboing.net/2020/06/18/obsessive-compulsive-disorder.html

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Oh, wow! I’ve been saying this all COVID long… my OCD is the one bright star. It makes it worse in that I’m a germaphobe, but I can now walk around with a mask and I’m genuinely excited about that.

I’m constantly reminded of Douglas Adams’ Golgafrinchans, a race that had a portion of the population that had a compulsion to sanitize telephones (they expelled the group, and later succumbed to a virulent diseas contracted through telephone handsets). People with OCD (that have grown comfortable with it through training/coping techniques) will physically survive the pandemic quite well, thank you. Psychologically speaking, it IS harder… Anxiety is cranked to a 13 instead of 11, but I am grateful for the tricks I’ve learned.

She’s spot on with the coping techniques and non-stop anxiety. I explain to people it’s like worrying that you left the iron on when you go on a trip. Being absolutely positive you left the iron on, but simultaneously knowing that you probably didn’t. And finding solace in knowing there’s nothing to be done and finding ways to let that anxious thought go. It definitely applies to the concerns of potential infection vectors (or politics, financial security, etc).

Tackle that which you have control over, and find ways to accept that which you don’t.

At any rate, I can let the reins loose a bit and let my OCD have some “fun.” My decontamination protocols take 45 minutes:

Before leaving, I open the washing machine, oven door, open a window, and turn on the bathroom fan next to the primary entrance, set out the cleaning supplies, and make a new solution of bleach water spray. The goal is to maintain a negative pressure flow that evacuates incoming apartment-hallway air, and minimize surface touches while contaminated when I get back.

Upon returning, I set down the groceries in a dedicated spot (refrigeratables in their own bag, furthest from the door). I use 2" masking tape to tape off the borders of the door (recall the negative air pressure is active). In the bathroom I turn the shower on high, steam will help capture aerosols that may come off the clothes/hair when it’s disturbed by the next step. I take off shoes and clothes, placing clothes gently in the washing machine. I take off my watch, hair clip, and empty purse onto the bathroom counter. I scrub my hands for 60 seconds with soap, hot water, and a mushroom brush (especially for under the nails, this is a hotbed of infection vector). Moisturize hands to prevent irritation and maintain a healthy barrier.

I wish this part could wait until I was fully decontaminated (hair is still a potential contamination source), but I have to start slowly and gently working on the refrigerated/frozen goods. Sanitizing with Lysol wipes or 70% alcohol (currently made from diluted Everclear, as it’s impossible to source as grain alcohol, but ethanol is better anyways for permeable food containers). These are put away.

I then take the bleach spray to the kitchen, take off my mask slowly and gently, and place it in the oven (timed to 170 degrees for 30 minutes; alternatively I have a ‘contaminated’ bin for 5-day isolation), close the door, spray down oven and floor as I back away to the bathroom. Everything is touched with the washed hands, and subsequently sprayed down.

Taking off glasses, I spray them and other items with alcohol. I spray down the bathroom floor with bleach, surfaces, and I spray the alcohol bottle with bleach and the bleach bottle with alcohol.

I enter the shower, wash my hands again, and scrub my hair extremely hot water (coronavirus is a fatty shell unlike other viral forms) for several minutes, taking care overwash doesn’t enter the nose or mouth. After the hair, I scrub my face with anti-inflammation soap for a minute [I have an autoimmune disorder that causes interleukin-4 and -13 to be excessively activated and causes my skin to be extremely annoyed, which makes the cytokine storm a concerning COVID-19 outcome for me… one interesting side effect is that my fingertips slough off once or twice a year, resulting in a lack of fingerprints and the predilection of dropping smooth objects for a month as they grow back].

Finally, I’ll scrub down the entire body with soap and water. Exit the shower, dry off, and moisturize face and body (the skin is an important barrier, treat it well). By now the watch and phone are dry, I may decide to spray them again (the small nooks and crannies are hotbeds, just like nails).

Then it’s on to dealing with the remaining groceries and mail, or leaving them in isolation for 5 days. As well as turning off the fan and closing the window (order’s important!). At the start I had a fan sealed to the window to ensure positive airflow, but then the apartment below me had someone sick with their window open… so I’ve switch to a fully sealed apartment that’s opened up every now and then (or when it’s raining).

OCD is no joke. I was serious when I said this was a portion of what my OCD would have me do. As a kid, my hands bled from all the washing, and I fight that urge frequently even as I walk around my self-isolated apartment. This time would be debilitating if I didn’t have three decades of practice with it. :confused:

My non-germ tells are “fun” as well. One example: Throwing a light switch has to be done a prime number of times, preferably 3, but best is 7. My coping technique to avoid annoying everyone? Start counting at 6. :stuck_out_tongue: It’s crazy (haha) some of the tricks that work. The negative thought cycles are harder. I pick my battles.

I’ve come to accept that OCD is a part of me. Coupled with (mostly treated) ADHD, I am amazing at pattern recognition and systems interaction analysis in my field as a Sr. Data and Applied Scientist in the games industry… when I can maintain focus on the right problems.

At any rate, OCD does allow me to feel a bit safer hiding out in isolation.

And Cognitive-Behavioral Therapy is amazing.

Best of luck, everyone out there.

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This is pretty much exactly what I needed to read right now. Is this what y’all are learning in therapy. I really need to get some therapy.

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Handy skills that one learns in DBT (Dialectical Behavioral Therapy) include: mindfulness, radical acceptance, fact-checking, living with ambiguity, effective communication, & ways to distract oneself from getting fixated on difficult thoughts. It’s like going to Buddhism class, with simple exercises as homework; exercises that turn out to have profound power. Highly recommended.

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Your decontamination routine is certainly very impressive and well thought-out for particulates, fomites, and other potential vectors. I will note, however, that what you’re doing is even more intense than what BSL2+ labs do, it’s more on the level of a BSL3 lab! There’s nothing wrong with that, it’s just a commendable level of dedication to detail and routine. I’ve wrestled with that irrational certainty that something isn’t right or is a threat in the past and it can be exhausting; I’m glad that you’re viewing it as a double-edged sword with commensurate advantages in your profession! I was dealing with present circumstances by having a “standard operating procedure” for things, but getting a puppy recently has thrown all of that off into complete chaos. Luckily the puppy is cute enough that the chaos is all welcome.

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Also, just a quick note: IL4 and IL13 aren’t showing up in COVID19 nearly as much as other cytokines. Still fair to be concerned, but the autoinflammatory loops that some patients are developing are driven by other arms of the immune system, so you probably don’t have to have any extra worry here.

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You’ll want to seek out someone who really does specialize in cognitive-behavioral therapy.

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Well! That’s… validating, thank you for bringing that up!

I figure it’s only a matter of time before we all contract it, my goal is to try to postpone until the later phases of COVID-19 are better understood and survivability improves. Or, heck, maybe last until a vaccine is available (but that’s going to be at least 2022 for the populace, IMHO).

And yeah. The strain in my life has approached levels unseen before. I was already dealing with two COVID-scale events in my life when 2020 happened (separated after 24 years, and transitioning genders). I picked a heck of a year-that-feels-like-a-decade-already to avoid drowning myself in booze. I had figured “You only go through puberty twice, might as well try it dry once!” :upside_down_face:
[But, genuinely, it’s good to face these hard emotions, though I do fear I’m close to the breaking point. Work is suffering. Sleep has become the new coping as divorce becomes certain and grief overwhelms. One day at a time.]

Ah well. At any rate, gotta find the positives somewhere! Regarding OCD, it was actually a diversity training video at work that highlighted a coworker with OCD: One person flippantly said “OMG, I have such OCD hahaha,” and the other person brought up how they had the diagnosed condition, and that it helped them in their day-to-day find patterns in accounting data.

A lightbulb went off, and I realized it’s one of several things that makes me different from my peers. I can glance at a proposed multi-tear service diagram that’s been whiteboarded and spot flaws that take me 30+ minutes to walk the others in the room through.

Good luck with your puppy! :slight_smile: Definitely couldn’t pull my routine off multiple times a day, every day, like that’d require. Instead I’ve discovered the joys of VR Chat. Turns out I have full-body phantom touch: I can feel when people hug me, or stroke my cheek. The oxytocin release is nuts and so very needed as I go through… what seems like everything at once.

Take care and stay safe!

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Oh yeah! I was stoked to see several studies are now popping up around Dupixent (dupilumab). My condition is severe enough that I was in the clinical trial to get this biologic fast-tracked by the FDA a few years ago (then… had to wait 6 months for my insurance to subsequently approve it, they appealed all the way up until the final panel). The drug clears my skin right up, except the face for me.

Anyways, turns out those on Dupixent may have a slight advantage, which makes sense as it was original developed to address inflammatory asthmas. I wasn’t sure which way it’d go, there are so many variables. Some anecdotal studies (n<3 for heaven’s sake) are promising, and then there was a recent study of 30 patients in a strongly-hit district in Italy that’s great news (expectation is that a one or two would need hospitalization, and it was 0, still a super small dataset).

I have greatly enjoyed our brief encounter. It’s been a joy to participate in a fact-based conversation. And I hope my experiences can help others in some small way. :slight_smile:

Take care!

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In UK there was a small study that showed those on adalumimab (is it called that in USA? - it looks like one of a similar group of drugs) also suffered less from the effects of C-19, once they have it, than those with the same condition (rheumatoid arthritis) but not on that drug.

This seems counter-intuitive, because it is an immunosuppressive (I am on it for a different condition). But in suppressing the immune system it is also anti-inflammatory and it may inhibit the cytokine storms C-19 can cause in the immune system once it gets hold.

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Yup, that’s my take. I was worried with (is the immunosuppressant going to weaken initial defenses and more rapid onset of the infection) and without (will my heightened immune system be more prone to a cytokine storm response).

Glad to papers are getting published about it and being made available for broader consumption… and that it’s leaning towards neutral/slightly-positive while remaining medicated.

I definitely wasn’t looking forward to a return of showers that caused blinding pain (off medication, I spent three decades covered 20-60% in weeping rash, and topical steroids only did so much).

It’s been an… interesting life.

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