When You Can't Stop Washing or Cleaning: Contamination Fears in OCD

Obsessive-Compulsive Disorder Takes Many Forms

OCD Concerns about Germs and Dirt

Obsessive-compulsive disorder (OCD) consists of unwanted thoughts and repetitive behaviors intended to reduce the anxiety caused by the unwanted thoughts. Typical obsessions involve contamination, aggression, religious concerns, sexual concerns, and the need for exactness or symmetry. Over half of all OCD patients experience contamination fears that involve washing compulsions. OCD patients with washing compulsions worry about becoming contaminated and often describe contaminated objects as disgusting. They then engage in excessive washing to rid themselves of the feeling of being contaminated.

Differential Diagnosis

People with contamination obsessions and washing compulsions are sometimes called hypochondriacs. However, washing OCD and hypochondriasis are not the same thing. The person with OCD fears that he or she may become contaminated or contract an illness, while the hypochondriac fears that he or she is already ill.

Obsessive-Compulsive Disorder should not be confused with Obsessive-Compulsive Personality Disorder (OCPD), another disorder with a similar name. Although people with OCPD may also be obsessively concerned about cleanliness and order, the thoughts and behaviors do not cause them distress, thus OCPD is not considered an anxiety disorder. People with OCPD feel they do not have a problem, rather that everyone else should be as concerned about cleanliness and order as themselves.

How Clean is Too Clean?

People with contamination obsessions can never be too clean. One washing is never enough because of the worry that a critical spot may have been missed. Therefore a person with contamination OCD may wash their hands repeatedly until the soap is gone and their hands are chapped and bleeding (which may paradoxically make the person more prone to infection). It is no wonder then that dermatologists are often the first to diagnose OCD in patients such as this.

Washing behaviors are rarely confined to the hands. Such individuals may bathe and shower excessively. They may have rituals involving proper washing of clothing and utensils. They may clean their homes compulsively and insist that others observe the same extreme cleaning behaviors. Sometimes their pattern of behaviors is confusing to others because it may seem inconsistent. For example they may have a contamination concern about one specific thing such as not touching bruised fruits, but be unconcerned about other things that may seem more contaminated to others, such as gardening manure.

Washing Compulsions from an Evolutionary Perspective

OCD has been described as adaptive mechanism gone wrong. In other words, a behavior that is good and might help the species survive, has somehow become broken and taken to its extreme. For example, from an evolutionary perspective, it would be theoretically adaptive to avoid contact with disease-causing objects and other objects that had touched it. When taken to an extreme, this process may be called magical thinking or implausible beliefs about how contagions are spread. Examples may include an aversion toward sitting on a chair that someone else sat on, because that person had a stain on their clothing that "could have been blood." Contaminants that are perceived as changing or spreading may be sustained over a larger series of removals from the original object.

Treatment for Compulsive Washing & Cleaning

Contamination OCD responds well to cognitive-behavioral therapy and antidepressant medication. More about treatments for OCD...

Go to BrainPhysics OCD Page...

Disclaimer: This information should not be considered medical advice and should not substitute the judgment of a competent psychiatrist.

Credits: Article written by M. Williams, Ph.D. Source: Tolin, D.F.; Worhunsky, P.; Maltby, N. Sympathetic magic in contamination-related OCD. Journal of Behavior Therapy and Experimental Psychiatry, Vol 35(2), Jun 2004, pp. 193-205.