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.