COVID-19 can worsen OCD in children and young people, study finds

Trauma and stress can trigger or worsen OCD. Researchers already know this. They have also shown us that COVID-19 may be associated with adults developing psychiatric disorders. But we do not know much about what the corona crisis means for children and young people.

A team of researchers from Aarhus University and the Centre for Child and Adolescent Psychiatry, Central Denmark Region, therefore decided to examine how children and young people with OCD experience the crisis. Professor, Department Chair Per Hove Thomsen led the research project.

Condition worsened

During the spring of 2020, the researchers sent a questionnaire to two groups of children and young people between the ages of seven and 21. One group had been diagnosed with OCD in a specialised OCD section at the Centre for Child and Adolescent Psychiatry -- and all had been in contact with a therapist at the hospital. The other group was identified through the Danish OCD Association. The majority of these children and young people had been diagnosed years ago. A total of 102 children responded to the questionnaire.

"Their experience was that their OCD, anxiety and depressive symptoms worsened during a crisis like COVID-19. This worsening was most pronounced for the group identified through the OCD Association," says Per Hove Thomsen.

Almost half of the children and young people who belonged to the first group reported that their symptoms had become worse, while a third of them replied that their anxiety had worsened and a third that their depressive symptoms had worsened. And of these, almost a fifth experienced that both symptoms had got worse. In the other group, 73 per cent reported that their condition had worsened, just over half that their anxiety had worsened, and 43 per cent answered that the depressive symptoms had increased.

Disinfect and wash hands

Judith Nissen, who is a consultant, was also one of the driving forces behind the study. She emphasises that it is no coincidence that the researchers have chosen to study OCD.

"The disorder is particularly interesting to study in relation to the COVID-19 pandemic, because OCD is a disorder with many different clinical expressions, including not least health anxiety, fear of bacteria and dirt, and excessive hand washing/use of disinfection. It's therefore important to examine how such a significant crisis can affect the expression, frequency and progression of the disorder," she explains.

The children and young people who in the questionnaire had described thoughts and anxiety over how something serious could happen, e.g. that they themselves could become ill or lose family members, experienced the most significant worsening of their OCD symptoms. In particular, children who had begun suffering from OCD at an early age experienced the most pronounced worsening.

"For children who are already anxious about loss, the daily descriptions in the media of illness and death and recommendations about isolation and focus on infection can exacerbate these anxious thoughts, perhaps also especially for the youngest children, who may have greater difficulty understanding the significance of the infection, but who are also very dependent on parents and grandparents and thus are most vulnerable to loss," says Judith Nissen.

On the other hand, there is no correlation with anxiety about infection and impulsive hand washing. The study thus indicates that children and young people with OCD may be vulnerable in relation to a crisis such as COVID-19, where anxiety about something serious happening -- including the loss of close relatives -- characterises a particularly vulnerable group.

"This may be related to both the direct threat of the infection and to the consequences of having to maintain social distancing, social isolation and the significant level of focus on hygiene. The crisis is not over yet, and it's therefore very important that we continue to focus on vulnerable children and young people in the future," says Judith Nissen.