COVID-19 Related Stress Reactions in Patients with Obsessive - Compulsive Disorder

Background: With the outbreak of the COVID-19 pandemic, a large percentage of the world's population has been exposed to multiple burdens, including immediate hazards such as the risk of infection as well as social isolation, and economic insecurity. Based on the diathesis-stress model, which helps explain the development and maintenance of many mental disorders, these stresses may particularly affect people with preexisting mental disorders. In this study, we aimed to assess the effects of the COVID-19 pandemic on patients with OCD and healthy individuals. Results: According to OCSS, 23.9% of our participants were having mild OCD symptoms, 41.6% of them were having moderate symptoms, and severe symptoms presented in 34.5% of them. Our results revealed that there was a high statistically significant increase in total CSS scores in the OCD group compared to the control group. Conclusion: The results of the present study supported the notion that the increase in symptoms and general severity observed among those with OCD might primarily be due to stress induced by the current pandemic. [ FROM AUTHOR] Copyright of Arab Journal of Psychiatry is the property of Arab Federation of Psychiatrists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 anxiety and mental health among university students during the early phases of the U.S. pandemic.

OBJECTIVE: This study examined the impact of COVID-19 in the early stages of the pandemic on university students in the U.S. by: (1) characterizing COVID-19-related disruptions; (2) evaluating health anxiety, obsessive-compulsive (OC), depression, and stress symptoms; and (3) analyzing the unique role of COVID-19 anxiety on mental health outcomes, after accounting for relevant variables. PARTICIPANTS: Participants included 263 students (63.9% female). METHODS: Data were collected online between March 19, 2020 and May 1, 2020. RESULTS: Participants screened positive for health anxiety (6.5%), OC symptoms (48.7%), or depression (29.7%). COVID-19 anxiety was positively associated with mental health symptoms. After controlling for demographics and COVID-19 impact, COVID-19 anxiety accounted for significant variance in health anxiety, OC symptoms, and stress. CONCLUSIONS: Findings demonstrate the vast impact of COVID-19 on mental health among university students and provide guidance for identifying mental health priorities in the context of public health crises.

A bibliometric analysis of publications on obsessive-compulsive disorder using VOSviewer.

Background: Obsessive-compulsive disorder (OCD) is one of the top ten disabling diseases seriously affecting the health of population. Recently, studies on this disease significantly increased. However, only a few bibliometric analyses concerning this area have been reported. In this study, we used bibliometrics and visualization tools to examine the current state, hot topics and future trends in OCD research. Methods: Scientific publications regarding OCD were retrieved from the Web of Science Core Collection (WoSCC) database. The features of OCD research were further analyzed using VOSviewer. Results: A total of 24,552 publications and 65,296 authors in the field of OCD were retrieved from 2000 to 2022, showing an overall upward trend in publications over the past 22 years. One hundred and thirteen countries around the world had participated in the research. Among these countries, the developed countries such as the United States, England, and Canada were the crucial productive nations in this subject. As for institutions, the Harvard University, the University of London, and the University of California system were the leading institutions. Authors including Storch EA, Mataix-Cols D, and Stein DJ were the prolific authors. 1,949 journals are contributing to the OCD field, of which the top three are Biological Psychiatry (831 articles), European Neuropsychopharmacology (776 articles) and Psychiatric Research (648 articles). Research hotspots of OCD included pathogenesis, epidemiology, comorbidities, clinical features, and evaluation methods. COVID-19, mental health, functional connectivity, and genome-wide association were emerging trends in the field of OCD. Conclusion: This study integrates the bibliometric information on the current research status and emerging trends in OCD from a macro perspective. The findings can provide valuable insights into further research on OCD.

Acute eosinophilic pneumonia-like syndrome post-initiation of vortioxetine.

A man in his mid-30s presented to the emergency department with a 1-week history of fatigue, loss of appetite, fever and productive (yellow) cough. This progressed to requiring admission to intensive care needing a oxygen therapy via high-flow nasal cannula for acute hypoxaemic respiratory failure. He had recently started vortioxetine for major depressive disorder, and his acute symptoms correlated with an increase in the dose of vortioxetine. For more than 20 years, rare but consistent reports of serotonergic medications have been implicated in eosinophilic pulmonary conditions. During this same period, serotonergic medications have become a mainstay solution for a wide range of depressive symptoms and disorders. This is the first report of an eosinophilic pneumonia-like syndrome occurring while consuming the novel serotonergic medication vortioxetine.

The perceived long-term impact of COVID-19 on OCD symptomology.

A pandemic outbreak can lead to excessive, maladaptive levels of anxiety, particularly among individuals who already suffer from obsessive-compulsive disorder (OCD). The Coronavirus Disease 2019 (COVID-19) provided a novel opportunity to examine the possibility that individuals with OCD, compared to those without OCD, might experience greater distress from this common stressor. The present study examined the lasting effects of COVID-19 in the year after the outbreak. Additionally, there is limited research regarding the stability of OCD dimensions; therefore, this study examined whether the COVID-19 pandemic impacted the stability of OCD dimensions. One hundred and forty-three adults who reported they had been diagnosed with OCD and ninety-eight adults without OCD, completed an online survey assessing the impact the COVID-19 pandemic had on symptoms of OCD in the year after the initial outbreak. The OCD group showed greater concern about the pandemic and greater concern about future pandemics compared to the comparison group. In addition, COVID-19 related distress differentially related to OCD symptoms dimensions, showing the strongest association with the contamination dimension. Lastly, results showed that many individuals reported that their OCD dimension shifted to obsessions about COVID-19 from their pre-existing OCD dimension.

The perceived impact of COVID-19 on OCD symptomology

Background: A pandemic outbreak can lead to excessive, maladaptive levels of anxiety, particularly among individuals who already suffer from debilitating anxiety disorders such as obsessive-compulsive disorder (OCD). The Coronavirus Disease 2019 (COVID-19) provided a novel opportunity to examine the possibility that individuals with OCD, compared to non-OCD individuals, might experience greater distress from this common stressor. The present study also examined how this highly contagious virus affected psychological symptom severity among individuals with OCD, many of whom were concerned about contagions and feared uncertainty. Finally, there is limited research regarding the stability of OCD subtypes;therefore, this study examined whether the stressfulness of the COVID-19 pandemic affected OCD subtype stability. Methods: One hundred and forty-three adults with a diagnosis of OCD and ninety-eight adults without OCD, completed an online survey assessing the impact the COVID-19 pandemic has had on symptoms of fear, general anxiety, and OCD. Results: The OCD group showed greater fear of the COVID-19 pandemic and greater fear of future pandemics compared to the comparison group. In addition, the level of distress from the COVID-19 pandemic differed amongst the different subtypes with contamination subtype showing the highest level of distress. Lastly, results showed that it was likely for one's OCD subtype to shift to obsessions about COVID-19 from their usual OCD obsessions. Conclusions: Individuals with a diagnosis of OCD are at increased risk for COVID-19 related distress underscoring the importance of therapeutic treatments and interventions during a stressful life event. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

An Investigation of the Effect of COVID-19 on OCD in Youth in the Context of Emotional Reactivity, Experiential Avoidance, Depression and Anxiety.

In addition to the serious physical and medical effects on individuals, the COVID-19 pandemic is likely to have short- and long-term psycho-social consequences, especially for young people. Nowadays, with psychological problems becoming more widely recognized in adolescents, it is possible that the fear and anxiety caused by the pandemic will trigger various anxiety disorders, OCD and similar negative outcomes. Considering that psychological qualities such as emotional reactivity and experiential avoidance observed in adolescents may increase the risk of such psycho-social disorders, in this study the relationship between fear of COVID-19 and OCD was investigated in a Turkish sample of 598 adolescents, and the mediating role of emotional reactivity, experiential avoidance and depression-anxiety in this relationship was examined. The data collection was performed online rather than in person because of the COVID-19 threat. A structural equation model was used to determine the direct and indirect predictive effects between variables in data analysis. The results of the study show that the effect of COVID-19 fear on OCD is mediated by emotional reactivity, experiential avoidance and depression-anxiety.

Year of Zoom in a Year of Doom: Lessons Learned Delivering ERP Remotely During the COVID-19 Pandemic.

In response to the COVID-19 pandemic and consequential shutdown measures, many mental health professionals started providing therapy to patients exclusively via telehealth. Our research center, which specializes in studying and treating obsessive-compulsive disorder (OCD), historically has provided in-person exposure and response prevention (ERP) to adults with OCD, but shifted to telehealth during the pandemic. Unlike in other modes of talk therapy, ERP's emphasis on therapist-supervised exposures presented unique opportunities and challenges to delivering treatment entirely via a virtual platform. This paper provides case examples to illustrate lessons we learned delivering ERP exclusively via telehealth in New York from March 2020 through June 2021 and offers recommendations for future study and practice. Though we observed a number of drawbacks to fully remote ERP, we also discovered advantages to delivering ERP this way, meriting additional research attention.

COVID-19 Anxiety and Washing Obsessive-compulsive Symptoms: Stress Coping Styles as a Mediator

Background: The COVID-19 pandemic has significantly impacted people's psychological functioning, including how they cope with anxiety. This study aimed to assess the role of coping styles in the relationship between COVID-19 anxiety and Washing ObsessiveCompulsive Disorder (W-OCD) symptoms. Methods: A cross-sectional study was performed on 420 people living in Kashan city (Iran) from March to April, 2020. Participants were selected by the convenience sampling method due to the difficulties brought about by COVID-19 and completed the contamination subscale of the Padua Inventory, COVID-19 anxiety inventory, and coping strategies scale. Data were analyzed by structural equation modeling (SEM) using AMOS-22. Results: The results revealed that emotion-focused, somatization and social support coping strategies were significantly associated with W-OCD symptoms. Also, there was a significant correlation between COVID-19 anxiety and the W-OCD symptoms. SEM results revealed that emotion-focused and somatization coping strategies positively mediated the relationship between COVID-19 and W-OCD symptoms. Conclusion: Emotion-focused and somatization coping strategies increase W-OCD symptoms following COVID-19 anxiety. Psychoeducation interventions addressing COVID-19's physical and psychological impacts on health, discriminating the rational and adaptive behavior and obsessive and compulsive behaviors, and restricting the information gathering from numerous sources, which may lead to increased negative emotions, might be helpful. © 2023 Bentham Science Publishers.

Doomsday Prepping During the COVID-19 Pandemic.

"Doomsday prepping" is a phenomenon which involves preparing for feared societal collapse by stockpiling resources and readying for self-sufficiency. While doomsday prepping has traditionally been reported in the context of extremists, during the COVID-19 pandemic, excessive stockpiling leading to supply shortages has been reported globally. It is unclear what psychological or demographic factors are associated with this stockpiling. This study investigated doomsday prepping beliefs and behaviors in relation to COVID-19 proximity, demographics, coping strategies, psychopathology, intolerance of uncertainty (IU), and personality in 384 participants (249 female) in an online study. Participants completed a number of questionnaires including the Post-Apocalyptic and Doomsday Prepping Beliefs Scale and a scale designed for the current study to measure prepping in the context of COVID-19. These were analyzed using ANOVAs, correlational, and mediation analyses to examine relationships between psychometric variables and stockpiling. Prepping beliefs and behaviors were higher in males than females and positively associated with anxiety, obsessive-compulsive symptoms, IU, and traditional masculinity traits. Older age, male gender, obsessive-compulsive symptoms, and traditional masculinity predicted unique variance in prepping. The relationship between gender and stockpiling was mediated by social learning (witnessing other people panic buying) and the perceived threat of COVID-19 (doomsday interpretations) while proximity and personal vulnerability to COVID-19 were non-significant. Results indicate that panic buying was influenced more by witnessing others stockpiling, personality, and catastrophic thinking rather than by proximity to danger. Education could target these factors in ongoing waves of the pandemic or future catastrophes.

Obsessive Compulsive Disorders in the Primary Care Setting.

Mental health is a very important component of whole health because the body, mind, and spirit are woven together to create the fabric of a person's life. Many people in the United States and globally are living with mental health challenges, and it seems that much more attention has been given to anxiety-related mental health conditions in the past few years due to the coronavirus disease 2019 pandemic. The pandemic may certainly have accelerated the onset of mental health conditions for some who were already predisposed, whether it be to depression, anxiety, psychosis, or obsessive-compulsive disorder, to name a few.

The infected and the affected: A longitudinal study of the impact of the COVID-19 pandemic on schoolchildren in Florida.

Objectives: To identify risk factors associated with symptoms of anxiety, depression, and obsessive-compulsive disorder (OCD) among children during the 1st year of the COVID-19 pandemic. Methods: A longitudinal study with three cross-sectional timepoints [April 2020 (n = 273), October 2020 (n = 180), and April 2021 (n = 116)] was conducted at a K-12 public school in Florida. Infection and sero-positivity for SARS-CoV-2 was determined by molecular and serologic approaches. Adjusted odds ratios using mixed effect logistic regression models for symptom-derived indicators of anxiety, depression, and OCD in children in April 2021 are presented; past infection and seropositivity were included in the models. Results: The prevalence of anxiety, depression, or OCD moved from 47.1, to 57.2, to 42.2% across the three timepoints during the study. By endline of the study, in April 2021, non-white children were at higher risk for depression and OCD. Risk for anxiety, depression, and OCD was associated with students who lost a family member due to COVID-19 and who were identified as at-risk in previous timepoints. Rates of SARS-CoV-2 infection and seropositivity were low and not statistically associated with assessed outcomes. Conclusions: In situations like the COVID-19 pandemic, targeted mental health interventions and screenings are needed in children and adolescents, especially among minority children.

Anxiety-Related Disorders in the Context of Racism.

PURPOSE OF REVIEW: The literature on racism and anxiety-related disorders, especially social anxiety, specific phobia, and generalized anxiety disorder, is notably lacking. This report aims to review recent evidence demonstrating the link between racial discrimination and various anxiety-related disorders. RECENT FINDINGS: Anxiety-related disorders were the most significant mediator for daily discrimination and suicidal thoughts, above both depression and substance use. Further, studies showed that racial discrimination promotes posttraumatic stress and racial trauma among people of color. Systemic racism puts people of color at a higher risk for anxiety disorders than White people. Clinical case examples provide lived evidence of diverse racial and ethnic individuals suffering from anxiety-related disorders, with the development and worsening of symptoms due to racism and microaggressions. There is a prominent need for recent research on anxiety-related disorders and racism. Recommendations for clinicians and future research directions are provided. These actions are required to address bias and mental health inequities and empower people of color.

Feasibility, acceptability and practicality of transcranial stimulation in obsessive compulsive symptoms (FEATSOCS): A randomised controlled crossover trial.

BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive form of neurostimulation with potential for development as a self-administered intervention. It has shown promise as a safe and effective treatment for obsessive compulsive disorder (OCD) in a small number of studies. The two most favourable stimulation targets appear to be the left orbitofrontal cortex (L-OFC) and the supplementary motor area (SMA). We report the first study to test these targets head-to-head within a randomised sham-controlled trial. Our aim was to inform the design of future clinical research studies, by focussing on the acceptability and safety of the intervention, feasibility of recruitment, adherence to and tolerability of tDCS, and the size of any treatment-effect. METHODS: FEATSOCS was a randomised, double-blind, sham-controlled, cross-over, multicentre study. Twenty adults with DSM-5-defined OCD were randomised to treatment, comprising three courses of clinic-based tDCS (SMA, L-OFC, Sham), randomly allocated and delivered in counterbalanced order. Each course comprised four 20-min 2 mA stimulations, delivered over two consecutive days, separated by a 'washout' period of at least four weeks. Assessments were carried out by raters who were blind to stimulation-type. Clinical outcomes were assessed before, during, and up to four weeks after stimulation. Patient representatives with lived experience of OCD were actively involved at all stages. RESULTS: Clinicians showed willingness to recruit participants and recruitment to target was achieved. Adherence to treatment and study interventions was generally good, with only two dropouts. There were no serious adverse events, and adverse effects which did occur were transient and mostly mild in intensity. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were numerically improved from baseline to 24 h after the final stimulation across all intervention groups but tended to worsen thereafter. The greatest effect size was seen in the L-OFC arm, (Cohen's d = -0.5 [95% CI -1.2 to 0.2] versus Sham), suggesting this stimulation site should be pursued in further studies. Additional significant sham referenced improvements in secondary outcomes occurred in the L-OFC arm, and to a lesser extent with SMA stimulation. CONCLUSIONS: tDCS was acceptable, practicable to apply, well-tolerated and appears a promising potential treatment for OCD. The L-OFC represents the most promising target based on clinical changes, though the effects on OCD symptoms were not statistically significant compared to sham. SMA stimulation showed lesser signs of promise. Further investigation of tDCS in OCD is warranted, to determine the optimal stimulation protocol (current, frequency, duration), longer-term effectiveness and brain-based mechanisms of effect. If efficacy is substantiated, consideration of home-based approaches represents a rational next step. TRIAL REGISTRATION: ISRCTN17937049. https://doi.org/10.1186/ISRCTN17937049.

Higher anxiety and perceived trauma among COVID-19 patients: a prospective comparative study.

BACKGROUND AND PURPOSE: Psychiatric disorders such as anxiety, depression, and traumatic stress are not rare during infectious outbreaks, as the COVID-19 pandemic has posed a great concern to the general population. In this study, we aimed to investigate whether experiencing psychiatric symptoms during COVID-19 is the result of the burden of carrying an illness or the COVID-19 itself. METHOD: Two hundred ten subjects and three different groups of participants (COVID-19 patients, university staff, and orthopedic patients) were recruited. They answered a demographic questionnaire, Yale-Brown Obsessive-Compulsive Scale (YBOCS) test for OCD symptoms, Impact of Event Scale-Revised (IES-R) for perceived trauma, Beck Anxiety Inventory (BAI) for anxiety, and Beck Depression Inventory (BDI) for depression assessments using phone or face-to-face interviews. RESULT: At least one OCD symptom was observed in 85.7% of the subjects. However, there was no significant difference between the 3 groups (p = 0.2194). Perceived trauma was significantly higher among COVID-19 patients followed by university staff and orthopedic patients (23.73, 16.21, 11.51 mean IES-R scores respectively, p = 8.449e-14). COVID-19 patients also showed higher anxiety (mean BAI score: 17.00) than the university staff and orthopedic patients' group (9.22 and 5.56 respectively) (p = 6.175e-08). BDI score did not show much variation for depression, the mean score was 9.66, 9.49, and 6.7 for the COVID-19 patients, university staff, and orthopedic patients respectively, (p = 0.2735). CONCLUSION: Perceived trauma and anxiety symptoms are significantly higher in COVID-19 patients and the symptoms of OCD and depression do not differ between COVID-19 and non-COVID-19 people, so the necessity of screening and following treatment of patients with COVID-19 should be kept in mind. TRIAL REGISTRATION: IR.IUMS.FMD.REC.1399.761.

Aggravation of Obsessive-Compulsive Disorder Due to Excessive Porn Consumption: A Case Report.

The past few decades have seen a significant rise in pornography consumption. This has brought into existence a new behavioral addiction, addiction to internet pornography, which impacts the psycho-somatic health of the individuals and people around them. The accessibility, affordability, and anonymity of online pornography have fed the growing popularity of online pornography. The International Classification of Diseases (ICD-11) has included pornography in Compulsive Sexual Behavior Disorder with it being categorized as an impulse control disorder and not necessarily an addictive disorder. However, the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) does not recognize a diagnosis of sexual addiction/compulsion (including internet pornography). Psychiatry remains an ever-evolving branch, and as the understanding evolves, the schools of thought change as well. The constantly evolving literature on behavioral addictions has helped the understanding that any source capable of stimulating the reward circuitry in an individual can become addictive. The stigma associated with behavioral addictions, particularly pornographic addiction, as well as a lack of awareness, contribute to under-reporting, making the reported cases just the tip of the iceberg. Addictions have been associated with various complications and other psychiatric phenomena. We describe a case of a 28-year-old male with mild features of obsessive-compulsive disorder (OCD) that took major shape with the advent of pornographic addiction. The patient was a known case of exam anxiety, panic attacks, auditory hallucinations, and mild obsessive and compulsive symptoms. However, with the death of his girlfriend's father, a breakup with his girlfriend, and coronavirus disease 2019 (COVID-19), he indulged in porn consumption which soon shifted to religious pornographic content leading to guilt with a fair insight. This later culminated in the aggravation of his OCD with repetitive cleaning activities. The patient was started on pharmacological and behavioral therapy and has responded well in follow-ups. In light of the special presentation of this case, we strongly recommend better reporting of such complications aiding in broadening the understanding of the spectrum of possible psychiatric impacts of pornographic consumption.

SARS-CoV-2/COVID-19 associated pediatric acute-onset neuropsychiatric syndrome a case report of female twin adolescents.

"Pediatric acute-onset neuropsychiatric syndrome", or PANS, is a rare syndrome characterized by an acute onset of obsessive-compulsive disorder (OCD), and/or severely restricted food intake accompanied by a variety of neuropsychiatric symptoms. To our knowledge, this is the first case report of twin adolescents with COVID-19-associated PANS. Dizygotic twin sisters in late teens, with abrupt and acute onset of severely restrictive food intake, weight loss, OCD, anxiety with intermittent auditory and visual hallucinations, depression, attention deficit, and sleep disturbances, simultaneously accompanied by milder neurologic symptoms such as hand tremor, tinnitus, dizziness, headache, and weakness of proximal muscles, were applied to child and adolescent psychiatry clinic. The only relevant agent underlying those neuropsychiatric and somatic complaints was COVID-19, and it was validated with laboratory testing, such as positive IgG titers of SARS-CoV-2 and negative biomarkers for other possible bacterial or viral agents. Generalized epileptic anomaly and a vermian/folial atrophy in the cerebellum were detected in further evaluations. Treatment options consisted of psychotropic agents, antibiotics, antiepileptic, and intravenous immunoglobulin transfusion finely treated the neuropsychiatric symptoms. Clinicians should consider SARS-CoV-2 as a potential agent, when a child presents with abrupt onset, dramatic neuropsychiatric symptoms also consisting of PANS, even in asymptomatic patients or with mild respiratory symptoms.

Obsessive-Compulsive Disorder (OCD) Types and Social Media: Are Social Media Important and Impactful for OCD People?

Social media (SM) are the new standard for social interaction and people with OCD use such platforms like everyone else. However, the research on these individuals provides limited, sporadic, and difficult-to-generalize data outside of social-media evidence for one specific context concerning how SM is experienced by people with OCD. Our cross-sectional study involved 660 participants (71.4% females, 28.6% males) with 22% of the sample surpassing the 90° percentile threshold to be identified as high-level OCD-symptomatic individuals. Our work highlighted that roughly all OCD types are affected by social media in terms of mood and that these individuals appeared to give SM more importance than non-OCD individuals. The evidence presented, although very narrow, can be conceived as the first building blocks to encourage future research considering how individuals with OCD experience social media, since they appear to be affected more by them compared to non-OCD individuals.

Perinatal patients with symptoms of anxiety

This chapter provides descriptions, typical clinical presentations, and case reviews of perinatal anxiety and perinatal obsessive-compulsive disorder. The discussed anxiety disorders include generalized anxiety disorder, panic disorder, and illness anxiety disorder as encountered in the perinatal period including pregnancy and 12 months' postpartum. Suggestions for provider advocacy during increased rates of intimate partner violence during COVID-19 are provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Delayed circadian rhythms and insomnia symptoms in obsessive-compulsive disorder.

BACKGROUND: Accumulating evidence implicates sleep and circadian rhythm disturbance in obsessive-compulsive disorder (OCD). However, a multimethod characterization of sleep and circadian rhythms in OCD, their association with symptom severity, and the functional relationship between these variables is lacking. METHODS: The present study measured multiple indicators of sleep and circadian rhythms in a sample of adults with OCD, adults without OCD, and healthy controls (n = 74). Participants completed measures of morningness-eveningness, delayed sleep-wake phase disorder (DSWPD), insomnia symptoms, and OCD symptoms, as well as one week of sleep monitoring via a sleep diary and actigraphy. RESULTS: Delayed circadian rhythms (higher eveningness, later mid-sleep timing, and higher rates of DSWPD) and higher insomnia symptoms were observed in those with OCD compared to healthy controls, as well as associations between delayed circadian rhythms and insomnia symptoms and OCD symptom severity across the full sample. Further, insomnia symptoms mediated the relationship between delayed circadian rhythms and OCD symptoms. In contrast, there were no links between total sleep time or sleep quality and OCD. LIMITATIONS: Data collection during COVID-19 pandemic, correlational data, no physiological measure of circadian rhythms. CONCLUSIONS: These findings highlight a robust association between delayed circadian rhythms and OCD and suggest insomnia symptoms may be one mechanism in this relationship. Sleep and circadian rhythm disturbance may be novel targets for OCD treatment.