From Handwashing to Heightened Distress: OCD and OCS During COVID-19 – A Systematic Review

Abstract Background The COVID-19 pandemic has posed unique challenges for mental health, potentially exacerbating obsessive-compulsive symptoms (OCS) and clinical OCD across populations. Objective To synthesize the evidence on how the COVID-19 pandemic affected OCS and clinical OCD in patients with OCD, the general population, children/adolescents, and healthcare workers. Methods We reviewed recent systematic reviews, meta-analyses, and representative primary studies addressing changes in OCS/OCD during the pandemic. Key outcomes included symptom exacerbation, emergence of COVID-focused obsessions/compulsions, affected symptom dimensions (especially contamination/washing), and factors associated with worsening or resilience. Results Evidence consistently indicates a pandemic-related increase in OCS. Findings show: (1) symptom worsening in a substantial proportion of OCD patients, particularly with contamination/washing; (2) new contamination-related OCS in individuals without prior OCD; (3) heterogeneous prevalence estimates across populations and countries; and (4) risk/protective factors such as baseline severity, comorbid anxiety/depression, social support, and pandemic-related stressors. In youth, pre-existing OCD was associated with symptom worsening. Healthcare workers exhibited elevated pooled OCS prevalence in several meta-analyses. Conclusions The COVID-19 pandemic significantly impacted OCD symptoms, especially contamination/washing dimensions and vulnerable groups. Ensuring continued access to evidence-based treatments and targeted screening during public-health emergencies remains a clinical priority.