The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder

Abstract

Background Obsessive compulsive disorder (OCD) is a distressing psychiatric disorder. Traumas may trigger or aggravate OCD symptoms. COVID-19 pandemic has coursed a global crisis and has been associated with onset of psychiatric disorders in adults. Little is known about children/adolescents with OCD. The present study aimed to examine how children/adolescents with OCD react towards COVID-19 crisis. Methods A questionnaire was distributed to two separate groups of children/adolescents. One group was a clinical group newly diagnosed at a specialized OCD clinic. All the children/adolescents had a current close contact to a therapist or doctor. The other group was a survey group identified through the Danish OCD Association. Most of these children/adolescents were diagnosed years ago, and their primary treatment was completed. For the clinical group, data from patient files was available. Results In both groups, but most pronounced in the survey group, participants experienced a worsening of their OCD, anxiety, and depressive symptoms. The aggravation of OCD correlated with the worsening of anxiety, depressive symptoms, and the extent of avoidance behavior. For both groups, OCD aggressive symptoms predicted a significant worsening. Poor baseline insight showed a trend to predict a symptom worsening. The worsening was most pronounced in children with early age of onset and a family history of attention deficit hyperactivity disorder. Conclusions To our knowledge, this is one of the first studies examining the effect of COVID-19 in children/adolescents with OCD. The effect was examined in two separate populations strengthening the findings. The study points towards an influence of the OCD phenotype, baseline insight suggesting a continued vulnerability, and a family history of psychiatric disorders. Trial registration The study is approved by the Danish Data Protection Agency (1–16–02-147-20) registered 1st of April 2020. Oral and written information was given to parents and patients and written consent from patients over 15 years and parents were received.

The impact of the coronavirus pandemic on specific symptom dimensions and severity in OCD: A comparison before and during COVID-19 in the context of stress responses

“…It is worth noting, however, that perceptions of threat and danger, including exaggerated danger-related stress responses to COVID-19, do not necessarily indicate a specific obsessional response, which has been suggested to depend on more specific perceived self-related vulnerabilities ( Aardema, 2020 ; Aardema & Wong, 2020 ). Nonetheless, results support that these danger-related stress reactions are associated with an increase in symptoms among those with OCD ( Ji et al, 2020 ; Nissen et al, 2020 ; Yassa et al, 2020 ), likely through similar mechanisms by which symptoms may be exacerbated in non-clinical and other clinical populations ( Song, 2020 ; Montano & Acebes, 2020 ; Taylor et al, 2020a ; Taylor et al, 2020c ).…”

“…COVID-19 has been previously been noted to have negative effects on mental health due to increased levels of uncertainty and unpredictability ( Tull et al, 2020 ; Wheaton et al, 2021 ; Zandifar & Badrfam, 2020 ), distress, fear, anxiety ( Elhai, Yang, McKay, & Asmundson, 2020 ; Mertens, Gerritsen, Duijndam, Salemink, & Engelhard, 2020 ), and health-related worries and concerns ( Jungmann & Witthöft, 2020 ; Taylor et al, 2020b ). Indeed, when OC symptoms emerge in community individuals due to the COVID-19 ( Zheng, Xiao, Xie, Wang, & Wang, 2020 ), it is not surprising to find an increase in symptoms across multiple dimensions in patients with OCD, especially in those with pre-existing OCD than those recently diagnosed with OCD ( Nissen et al, 2020 ). In particular, as outlined earlier, COVID-related stress and anxiety induced by the current pandemic may be an important underlying mechanism accounting for an exacerbation of symptoms, including those with OCD.…”

“…For example, excessive checking of news and events related to COVID-19 might result in increased concerns about responsibility for harm and checking behaviors ( Shafran et al, 2020 ). Similarly, anger and pessimistic attitudes towards the future and aggressive symptoms might result in an increase of symptoms revolving around immoral, sexual, suspicious, and violent themes or other OC symptoms during the COVID-19 pandemic in patients with OCD ( Nissen et al, 2020 ).…”

“…Some studies have primarily focused on treated or young patients with OCD (e.g., Davide et al, 2020 ; Matsunaga et al, 2020 ; Schwartz-Lifshitz et al, 2021 ; Tanir et al, 2020 ), while there is evidence that the effects of COVID-19 may be stronger in adults with pre-existing or untreated mental illnesses ( Asmundson et al, 2020 ; Sher, 2020 ; Ahmed et al, 2020 ; Pieh, Budimir, & Probst, 2020 ). Similarly, those with an untreated and/or current diagnosis of OCD may be especially likely to experience adverse effects ( Nissen, Højgaard, & Thomsen, 2020 ). Another important limitation is that a significant number of studies did not directly compare OC symptoms during the pandemic with scores from before the pandemic (e.g., Abba-Aji et al, 2020 ; Davide et al, 2020 ; Benatti et al, 2020 ; Jelinek et al, 2021 ).…”

“…Stressful life events, as well as distress in general, have previously been shown to be associated with the exacerbation of OC symptoms ( Adams et al, 2018 ; Imthon et al, 2020 ; Khosravani, Bastan, et al, 2020 ; Khosravani, Ardestani, et al, 2020 ; Rosso, Albert, Asinari, Bogetto, & Maina, 2012 ). COVID-19-related stress is significantly associated with OCD-like stress symptoms ( Taylor et al, 2020a ), intrusive thoughts ( Lee, 2020 ; Marroquín, Vine, & Morgan, 2020 ), reassurance-seeking ( Shafran, Coughtrey, & Whittal, 2020 ), intolerance of uncertainty, OCD symptoms, health anxiety ( Wheaton et al, 2021 ), anxiety symptoms, and avoidance behaviors ( McKay, Yang, Elhai, & Asmundson, 2020a ; Nissen et al, 2020 ; Seçer & Ulaş, 2020 ), especially in individuals with anxiety-related disorders ( Asmundson et al, 2020 ) and those with OCD ( Khosravani et al, 2021 ). Consequently, an increase in symptoms of OCD as the result of the current pandemic would be expected to be significantly predicted by what has recently been labeled as “COVID Stress Syndrome” ( Khosravani et al, 2021 ; Taylor et al, 2020c ).…”