Luka Buchanan has always been consumed by the fear of contamination and germs, washing their hands until they were raw, and terrified the food they ate would poison them. Diagnosed with obsessive compulsive disorder at age 19, Buchanan, who uses they/them pronouns, spent years in therapy telling themselves over and over that there was nothing to fear – that the chances of a global contagion were minuscule, and that they weren’t infected and dangerous to those around them. “I have to tell myself over and over there’s no justification for the levels of compulsions that I’m having about cleanliness,” Buchanan says. Then last March, Buchanan’s worst fears came true. “Suddenly, it’s like, ‘Oh fuck. Yeah, I was right’.” The Covid-19 pandemic has had a profound effect on those living with OCD. While large-scale studies are hard to come by, smaller data sets from Europe show between a third and half of those suffering from OCD had symptoms worsen during the pandemic. This can be especially problematic for people like Buchanan, whose OCD was already focused on cleanliness. “I could physically feel the germs on me … but then I kind of wasn’t really able to rationalise it, because at that point we didn’t know much about the virus,” the Perth native says. “OCD loves doubt and uncertainty, and because there was a lot of uncertainty it really did trigger me in a big way.” Dr James Collett, a psychologist at RMIT University in Melbourne, says although it was necessary from a public health standpoint, much of the government messaging around Covid-19 has been problematic for those with OCD. “The obsessions don’t occur at random, they’re connected to the person’s worries,” he says. “The Covid messaging is saying that ‘yeah there are germs out there’ and ‘yeah you might hurt someone severely by spreading germs without even knowing it’. People are really internalising this, even saying it’s cementing their OCD.” And for clinicians, these messages have been difficult to combat. “A client with OCD saying, ‘I was right all along,’ well, that’s actually pretty hard to argue with right now,” Collett says. “For clients that were previously experiencing washing-type symptoms … we’re seeing reduced social interaction and greater interpersonal conflict as well.” But this fear hasn’t been universal. For Buchanan’s friend Kai, the pandemic has had the opposite effect. “I’ve had OCD, pretty much my entire life, and as a result I’ve always felt a lot of shame about it because of my behaviour,” says Kai, who asked for his last name not to be included. Kai’s OCD is also focused on germs and cleanliness – he always carries hand sanitiser, he washes his hands before every meal, and whenever possible he likes to keep a safe distance between himself and other people and their possible germs. “Those are now just standard practice that everybody does,” he laughs. “It’s made it a lot easier to go out and have a social life because people don’t automatically notice that I have this mental illness … That takes a lot of the shame away.” Kai says in the first days of the pandemic, he was terrified that the global panic would make his anxiety and compulsions worse, but this never came to pass. “The world hasn’t felt any more scary than it did before. The level of anxiety that a lot of people who don’t have OCD are now feeling about getting sick, that’s just the way my brain works all the time,” he says. “A lot of us [in online OCD support groups] have been joking about how we have been preparing for this our whole lives.” But Collett says the increased awareness about cleanliness and staying at home may make it more difficult to identify people who are struggling with undiagnosed OCD. “Because of Covid, we may need to actually raise the threshold of the OCD diagnosis,” he says. “In the past, if someone was washing their hands every time they touched something in public or something like that, we might say ‘oh that’s a bit of a worry, may be vulnerable to OCD’. Now we might actually be saying, ‘oh yeah that’s normal understandable behaviour’. “We might actually find that where our ability to detect those OCD symptoms is actually a bit off in terms of just differentiating it from normal health behaviours now.” For both Kai and Buchanan, this newfound “permission” to take cleanliness seriously is a double-edged sword. Buchanan has worked for years to reduce the number of times they wash their hands each day. Now there is a sign in every shop reminding them to wash again. “I have to be really strict to only wash my hands for those 20 seconds,” they say. “If you could think of it like an addiction, there’s no such thing as having a little bit of it, because it just unlocks the gates. It feels so good to use those compulsions to quell the anxiety … I still struggle with what is actually too much.” Before the pandemic, one of Kai’s main goals was to press the pedestrian button on street corners with his hands. “As I was starting to get to a point where I could do that, the rules changed, and now the ones [in Perth] have stickers on them, saying ‘bump with your elbow’, which is what I was doing before,” he says. “I’m back to square one. The more years I have reinforced a behaviour, the harder it is to undo it. They become cemented in your brain.” Attention is now turning to how to help those with OCD transition out of the pandemic state of mind once vaccines become widespread. “There’s a real worry about people having difficulty, unlearning these behaviours that are appropriate during Covid,” Collett says. He says this easing period may be the most crucial in identifying people who may have been suffering from unnoticed dysfunctional behaviours throughout the pandemic. “I think the real message is we need to reach out to people who were perhaps seeming a bit more withdrawn, or they’re still really invested in things that are starting to look like ritual patterns of behaviour,” he says. Despite the increased anxiety, Buchanan has found a lot of comfort in society’s new obsession with hygiene. “I loved the fact that I would go into a restaurant and they would have Plexiglas things in front of the counter … Suddenly everyone sitting 1.5 metres apart in public transport. Oh god, that’s my dream.” But they know this won’t last forever. “I really hope this hygiene awareness just remains as like a post-Covid world,” they said. “But I’ll live with OCD for the rest of my life, so the world is going to keep changing, and I’ll just have to try and make it work, I guess.”