Covid-19 outbreak: A challenge calling for early intervention on contamination obsessive fears?

Donatella Marazziti, Federico Mucci, Armando Piccinni, Davide Dèttore, Andrea Pozza

Accepted August 31, 2019

First published August 31, 2019


The present Covid-19 outbreak is an international public health emergency that has imposed to people
strict mobility/activity restrictions and changes in the hygiene habits, essential to limit/delay virus diffusion. Early
identification of and intervention on contamination obsessive fear, a core symptom of obsessive-compulsive disorder
(OCD), are always of paramount importance, and in critical periods, such as the present one, should be imperative. OCD
is generally associated with a delay in the correct diagnosis and first professional management of several years after
symptom onset. A longer duration of untreated illness is in turn associated with a worst prognosis, higher treatment
resistance and other clinical complications, as well as increased societal costs. It seems to be crucial to promote
research efforts devoted to the early identification of subgroups at risk of developing clinically relevant contamination
symptoms, to understand more deeply the vulnerability and protective mechanisms involved in this pathophysiological
process in order to plan evidence-based early intervention strategies.

Covid-19 outbreak: A challenge calling for early intervention on contamination obsessive fears?


  • ABRAMOVITCH, A., PIZZAGALLI, D.A., GELLER, D.A.,REUMAN, L. & WILHELM, S. (2015). Cigarette smoking inobsessive-compulsive disorder and unaffected parents of OCDpatients. European Psychiatry, 30, 137-144.

  • ABRAMOWITZ, J.S., BAUCOM, D.H., BOEDING, S., WHEATON,M.G., PUKAY-MARTIN, N.D., FABRICANT, L.E. & FISCHER,M.S. (2013). Treating obsessive-compulsive disorder in intimaterelationships: A pilot study of couple-based cognitive-behaviortherapy. Behavior Therapy, 44, 395-407.

  • ABRAMOWITZ, J.S., KHANDKER, M., NELSON, C.A., DEACON,B.J. & RYGWALL, R. (2006). The role of cognitive factors in thepathogenesis of obsessive-compulsive symptoms: A prospectivestudy. Behaviour Research and Therapy, 44, 1361-1374.

  • BELUS, J.M., BAUCOM, D.H. & ABRAMOWITZ, J.S. (2014). Theeffect of a couple-based treatment for OCD on intimate partners.Journal of Behavior Therapy and Experimental Psychiatry, 45,484-488.

  • BESHARAT, M.A., ATARI, M. & MIRJALILI, R.S. (2019).Transdiagnostic processes in generalized anxiety disorder andobsessive-compulsive disorder: Worry, cognitive avoidance,intolerance of uncertainty, and metacognitive beliefs. Practice inClinical Psychology, 7, 281-290.

  • BLAKEY,S.M.&ABRAMOWITZ,J.S.(2018).Interoceptiveexposure:An overlooked modality in the cognitive-behavioral treatment ofOCD. Cognitive and Behavioral Practice, 25, 145-155.

  • BLAKEY,S.M.,ABRAMOWITZ,J.S.,LEONARD,R.C.&RIEMANN,B.C. (2019). Does exposure and response prevention behaviorallyactivate patients with obsessive-compulsive disorder? APreliminary Test. Behavior Therapy, 50, 214-224.

  • BLOCH, M.H., LANDEROS WEISENBERGER, A., ROSÁRIO, M.C.,PITTENGE, C. & LECKMAN, J.F. (2008). Meta-analysis of thesymptom structure of obsessive-compulsive disorder. AmericanJournal of Psychiatry, 165, 1532-1542.

  • BRAKOULIAS, V., PERKES, I.E. & TSALAMANIOS, E. (2018). A callfor prevention and early intervention in obsessive‐compulsivedisorder. Early Intervention in Psychiatry, 12, 572-577.

  • BROOKS, S.K., WEBSTER, R.K., SMITH, L.E., WOODLAND, L.,WESSELY, S., GREENBERG, N. & RUBIN, G.J. (2020). Thepsychological impact of quarantine and how to reduce it: Rapidreview of the evidence. The Lancet, 395, 912-920

  • CHACON, P., BERNARDES, E., FAGGIAN, L., BATISTUZZO,M., MORIYAMA, T., MIGUEL, E.C. & POLANCZYK, G.V.(2018). Obsessive-compulsive symptoms in children with firstdegree relatives diagnosed with obsessive-compulsive disorder.Brazilian Journal of Psychiatry, 40, 388-393.

  • COLES, M.E. & RAVID, A. (2016). Clinical presentation of not-just right experiences (NJREs) in individuals with OCD:Characteristics and response to treatment. Behaviour Researchand Therapy, 87, 182-187.

  • COLLARDEAU, F., CORBYN, B., ABRAMOWITZ, J.S., JANSSEN,P.A., WOODY, S. & FAIRBROTHER, N. (2019). Maternalunwanted and intrusive thoughts of infant-related harm,obsessive-compulsive disorder and depression in the perinatalperiod: study protocol. BMC Psychiatry, 19, 94.

  • COX, R.C., TUCK, B. & OLATUNJI, B.O. (2018). The role ofeveningness in obsessive-compulsive symptoms: Cross-sectionaland prospective approaches. Journal of Affective Disorders, 235,448-455.

  • DELL’OSSO, B., BENATTI, B., RODRIGUEZ, C.I., ARICI, C.,PALAZZO, C., ALTAMURA, A.C., … & LANZAGORTA, N.(2017). Obsessive-compulsive disorder in the elderly: A reportfrom the International College of Obsessive-CompulsiveSpectrum Disorders (ICOCS). European Psychiatry, 45, 36-40.

  • DEPOUX, A., MARTIN, S., KARAFILLAKIS, E., BSD, R.P.,WILDER-SMITH, A. & LARSON, H. (2020). The pandemic ofsocial media panic travels faster than the COVID-19 outbreak.Journal of Travel Medicine.

  • DÈTTORE, D. & O’CONNOR, K. (2013). OCD and cognitiveillusions. Cognitive Therapy and Research, 37, 109-121.

  • DÈTTORE, D., POZZA, A. & ANDERSSON, G. (2015). Efficacy oftechnology-delivered cognitive behavioural therapy for OCDversus control conditions, and in comparison with therapist-administered CBT: Meta-analysis of randomized controlledtrials. Cognitive Behaviour Therapy, 44, 190-211.

  • FINEBERG, N.A., DELL’OSSO, B., ALBERT, U., MAINA, G.,GELLER, D., CARMI, L., … & HOLLANDER, E. (2019). Earlyintervention for obsessive compulsive disorder: An expertconsensus statement. European Neuropsychopharmacology, 29,549-565.

  • FONTENELLE, L.F. & YÜCEL, M. (2019). A clinical staging modelfor obsessive-compulsive disorder: Is it ready for prime time?EClinicalMedicine, 7, 65-72.

  • FULLANA, M.A., TORTELLA-FELIU, M., DE LA CRUZ, L.F.,CHAMORRO, J., PÉREZ-VIGIL, A., IOANNIDIS, J.P. &RAMELLA-CRAVARO, V. (2019). Risk and protective factors foranxiety and obsessive-compulsive disorders: An umbrella reviewof systematic reviews and meta-analyses. Psychological Medicine,1-16.

  • GOODMAN, W., PRICE, L., RASMUSSEN, S., MAZURE, C.,FLEISCHMANN, R.L. & HILL, C.L. (1989). The Y-BOCS (1):Development, use and reliability. Archives of General Psychiatry,46, 1006-1011.

  • HABERKAMP, A., SCHMIDT, F., HANSMEIER, J. &GLOMBIEWSKI, J.A. (2019). Contamination-fear in subclinicalobsessive-compulsive disorder: A further proof for nopreferential processing of disorder-related stimuli. Journal ofObsessive-Compulsive and Related Disorders, 21, 26-36.

  • HJEMDAL, O., VOGEL, P.A., SOLEM, S., HAGEN, K. & STILES, T.C.(2011). The relationship between resilience and levels of anxiety,depression, and obsessive-compulsive symptoms in adolescents.Clinical Psychology & Psychotherapy, 18, 314-321.

  • JALAL, B., BRÜHL, A., O’CALLAGHAN, C., PIERCY, T.,CARDINAL, R.N., RAMACHANDRAN, V.S. & SAHAKIAN,B. J. (2018). Novel smartphone interventions improve cognitiveflexibility and obsessive-compulsive disorder symptoms inindividuals with contamination fears. Scientific Reports, 8, 1-11.

  • KARADAG, F., OGUZHANOGLU, N.K., ÖZDEL, O., ATESCI, F.Ç.& AMUK, T. (2006). OCD symptoms in a sample of Turkishpatients: A phenomenological picture. Depression and Anxiety,23, 145-152.

  • KIM, J.E., LEE, S.W. & LEE, S.J. (2014). Relationship between earlymaladaptive schemas and symptom dimensions in patientswith obsessive-compulsive disorder. Psychiatry Research, 215,134-140.

  • LAWRENCE, P.J., CRASKE, M.G., KEMPTON, C., STEWART, A. &STEIN, A. (2017). Intrusive thoughts and images of intentionalharm to infants in the context of maternal postnatal depression,anxiety,andOCD.BritishJournalofGeneralPractice,67,376-377.

  • LEEUWERIK, T., CAVANAGH, K. & STRAUSS, C. (2020). Theassociation of trait mindfulness and self-compassion withobsessive-compulsive disorder symptoms: Results from a largesurvey with treatment-seeking adults. Cognitive Therapy andResearch, 44, 120-135.

  • LI, Y., MARQUES, L., HINTON, D.E., WANG, Y. & XIAO, Z. (2009).Symptom dimensions in Chinese patients with obsessive‐compulsive disorder. CNS Neuroscience and Therapeutics, 15,276-282.

  • MAHGOUB, O.M. & ABDEL‐HAFIEZ, H.B. (1991). Pattern ofobsessive-compulsive disorder in eastern Saudi Arabia. BritishJournal of Psychiatry, 158, 840-842.

  • MALONEY, G., KOH, G., ROBERTS, S. & PITTENGER, C. (2019).Imagery rescripting as an adjunct clinical intervention forobsessive compulsive disorder. Journal of Anxiety Disorders, 66,102-110.

  • MANTZ, S.C. & ABBOTT, M.J. (2017). The relationship betweenresponsibility beliefs and symptoms and processes in obsessivecompulsive disorder: A systematic review. Journal of Obsessive-Compulsive and Related Disorders, 14, 13-26.

  • MARKARIAN, Y., LARSON, M.J., ALDEA, M.A., BALDWIN, S.A.,GOOD, D., BERKELJON, A., … & McKAY, D. (2010). Multiplepathways to functional impairment in obsessive-compulsivedisorder. Clinical Psychology Review, 30, 78-88.

  • MARSDEN, Z., LOVELL, K., BLORE, D., ALI, S. & DELGADILLO,J. (2018). A randomized controlled trial comparing EMDR andCBT for obsessive-compulsive disorder. Clinical Psychology &Psychotherapy, 25, e10-e18.

  • MATAIX-COLS, D., DE LA CRUZ, L.F., NORDSLETTEN, A.E.,LENHARD, F., ISOMURA, K. & SIMPSON, H.B. (2016).Towards an international expert consensus for definingtreatment response, remission, recovery and relapse in obsessive‐compulsive disorder. World Psychiatry, 15, 80-81.

  • MATHES, B.M., MORABITO, D.M. & SCHMIDT, N.B. (2019).Epidemiological and clinical gender differences in OCD. CurrentPsychiatry Reports, 21, 36.

  • McKAY, D. & CARP, S. (2017). Contamination fear and avoidance inadults. In J.S. Abramowitz, D. McKay & E.A. Storch (Eds.), TheWiley handbook of obsessive compulsive disorders. Hoboken, NJ:Wiley-Blackwell.

  • MELLI, G., CHIORRI, C., CARRARESI, C., STOPANI, E. & BULLI, F.(2015). The two dimensions of contamination fear in obsessive-compulsive disorder: Harm avoidance and disgust avoidance.Journal of Obsessive-Compulsive and Related Disorders, 6, 124-131.

  • MONAGHAN, S.C., CATTIE, J.E., MATHES, B.M., SHORSER-GENTILE, L.I., CROSBY, J.M. & ELIAS, J.A. (2015). Stagesof change and the treatment of OCD. Journal of Obsessive-Compulsive and Related Disorders, 5, 1-7.

  • MORITZ, S., FINK, J., MIEGEL, F., NITSCHE, K., KRAFT, V., TONN,P. & JELINEK, L. (2018). Obsessive-compulsive disorder ischaracterized by a lack of adaptive coping rather than an excess ofmaladaptive coping. Cognitive Therapy and Research, 42, 650-660.

  • OLATUNJI,B.O.(2010).Changesindisgustcorrespondwithchangesin symptoms of contamination-based OCD: A prospectiveexamination of specificity. Journal of Anxiety Disorders, 24,313-317.

  • ONG, C.W., CLYDE, J.W., BLUETT, E.J., LEVIN, M.E. & TWOHIG,M.P. (2016). Dropout rates in exposure with response preventionfor obsessive-compulsive disorder: What do the data really say?Journal of Anxiety Disorders, 40, 8-17.

  • OTTAVIANI, C., COLLAZZONI, A., D’OLIMPIO, F., MORETTA, T.& MANCINI, F. (2019). I obsessively clean because deontologicalguilt makes me feel physiologically disgusted! Journal ofObsessive-Compulsive and Related Disorders, 20, 21-29.

  • PALARDY, V., EL-BAALBAKI, G., FREDETTE, C., RIZKALLAH, E.& GUAY, S. (2018). Social support and symptom severity amongpatients with obsessive-compulsive disorder or panic disorderwith agoraphobia: A systematic review. Europe’s Journal ofPsychology, 14, 254-286.

  • PATERSON, J.L., REYNOLDS, A.C., FERGUSON, S.A. & DAWSON,D. (2013). Sleep and obsessive-compulsive disorder (OCD). SleepMedicine Reviews, 17, 465-474.

  • PEARCY, C.P., ANDERSON, R.A., EGAN, S.J. & REES, C.S. (2016).A systematic review and meta-analysis of self-help therapeuticinterventions for obsessive-compulsive disorder: Is therapeuticcontact key to overall improvement? Journal of Behavior Therapyand Experimental Psychiatry, 51, 74-83.

  • POZZA, A., ALBERT, U. & DÈTTORE, D. (2019). Perfectionism andintolerance of uncertainty are predictors of OCD symptoms inchildren and early adolescents: A prospective, cohort, one-year,follow-up study. Clinical Neuropsychiatry, 16, 53-61.

  • POZZA,A.&DÈTTORE,D.(2014).Areinflatedresponsibilitybeliefsspecific to OCD? Meta-analysis of the relations of responsibilityto OCD, anxiety disorders, and depression symptoms. ClinicalNeuropsychiatry, 11, 170-181.

  • PROUVOST, C., CALAMARI, J.E. & WOODARD, J.L. (2016).Does cognitive self-consciousness link older adults’ cognitivefunctioning to obsessive-compulsive symptoms? BehaviourResearch and Therapy, 85, 23-32.

  • RECTOR, N.A., CASSIN, S.E., RICHTER, M.A. & BURROUGHS,E. (2009). Obsessive beliefs in first-degree relatives of patientswith OCD: A test of the cognitive vulnerability model. Journal ofAnxiety Disorders, 23 (1), 145-149.

  • RUSCIO, A.M., STEIN, D.J., CHIU, W.T. & KESSLER, R.C. (2010).The epidemiology of obsessive-compulsive disorder in theNational Comorbidity Survey Replication. Molecular Psychiatry,15, 53-63.

  • SHERR, L., NAGRA, N., KULUBYA, G., CATALAN, J., CLUCAS, C.&HARDING,R.(2011).HIVinfectionassociatedpost-traumaticstress disorder and post-traumatic growth: A systematic review.Psychology, Health & Medicine, 16, 612-629.

  • SIMPSON, H.B. & ZUCKOFF, A. (2011). Using motivationalinterviewing to enhance treatment outcome in people withobsessive-compulsive disorder. Cognitive and BehavioralPractice, 18, 28-37.

  • STAVROPOULOS, V., MOORE, K.A., LAZARATOU, H., DIKEOS,D. & GOMEZ, R. (2017). A multilevel longitudinal study ofobsessive-compulsive symptoms in adolescence: Male genderand emotional stability as protective factors. Annals of GeneralPsychiatry, 16, 42.

  • TEDESCHI, R.G. & CALHOUN, L.G. (2004). Posttraumatic growth:Conceptual foundations and empirical evidence. PsychologicalInquiry, 15, 1-18.

  • TIBI,L.,VANOPPEN,P.,VANBALKOM,A.J.L.M.,EIKELENBOOM,M., RICKELT, J., SCHRUERS, K.R.J. & ANHOLT, G.E. (2017).The long-term association of OCD and depression and itsmoderators: A four-year follow up study in a large clinicalsample. European Psychiatry, 44, 76-82.

  • VOGEL, P.A., HANSEN, B., STILES, T.C. & GÖTESTAM, K.G.(2006). Treatment motivation, treatment expectancy, andhelping alliance as predictors of outcome in cognitive behavioraltreatment of OCD. Journal of Behavior Therapy and ExperimentalPsychiatry, 37, 247-255.

  • WHEATON, M.G., MAHAFFEY, B., TIMPANO, K.R., BERMAN,N.C. & ABRAMOWITZ, J.S. (2012). The relationship betweenanxiety sensitivity and obsessive-compulsive symptomdimensions. Journal of Behavior Therapy and ExperimentalPsychiatry, 43, 891-896.

  • WILLIAMS, M.T., CHAPMAN, L.K., SIMMS, J.V. & TELLAWI, G.(2017). Cross-cultural phenomenology of obsessive-compulsivedisorder. In J.S. Abramowitz, D. McKay & E.A. Storch (Eds.), TheWiley handbook of obsessive-compulsive disorders. Hoboken, NJ:Wiley-Blackwell.

  • WILLIAMS, M.T., ELSTEIN, J., BUCKNER, E., ABELSON, J.M. &HIMLE, J.A. (2012). Symptom dimensions in two samples ofAfrican Americans with obsessive-compulsive disorder. Journalof Obsessive-Compulsive and Related Disorders, 1, 145-152.

  • WILLIAMS, M.T. & JAHN, M.E. (2017). Obsessive-compulsivedisorder in African American children and adolescents: Risks,resiliency, and barriers to treatment. American Journal ofOrthopsychiatry, 87, 291-303.

  • WU, M.S., McGUIRE, J.F., MARTINO, C., PHARES, V., SELLES,R.R. & STORCH, E.A. (2016). A meta-analysis of familyaccommodation and OCD symptom severity. Clinical PsychologyReview, 45, 34-44.

  • ZHANG, Z., WANG, M., MIAO, X., LI, Y., HITCHMAN, G. &YUAN, Z. (2017). Individuals with high obsessive-compulsivetendencies or undermined confidence rely more on externalproxies to access their internal states. Journal of Behavior Therapyand Experimental Psychiatry, 54, 263-269.


Related articles

Article info

Cite the article:

Author Surname Author Initial. Title. Publication Title. Year Published;Volume number(Issue number):Pages Used. doi:DOI Number.

Marazziti Donatella . Mucci Federico . Piccinni Armando . Dèttore Davide . Pozza Andrea . Covid-19 outbreak: A challenge calling for early intervention on contamination obsessive fears?. BPA Applied Psychology Bulletin. 2019;285(1):62-70. doi:10.26387/bpa.285.1.

Citation tool

How to cite this article

Author Surname Author Initial. Title. Publication Title. Year Published;Volume number(Issue number):Pages Used. doi:DOI Number.

Marazziti Donatella . Mucci Federico . Piccinni Armando . Dèttore Davide . Pozza Andrea . Covid-19 outbreak: A challenge calling for early intervention on contamination obsessive fears?. BPA Applied Psychology Bulletin. 2019;285(1):62-70. doi:10.26387/bpa.285.1.