Cleanliness Rules Germaphobes' Lives (cont.)

For example, the therapist might tell a patient that after washing her hands once, she must wait 15 minutes before washing them again. Gradually the length of time is increased until the patient can wash just once without feeling compelled to wash again. Successful treatment produces a change in brain activity and, for most patients, at least partial remission of the disease.

The Role of Family Members

Families often make the mistake of enabling loved ones with OCD. "A man who sees his wife cleaning the house three or four hours a day may at first think he's got the world's greatest wife," says Guardino. "But over time he sees her energy level go down, she's irritable, and there's something bizarre about her cleaning. So he reads about OCD on WebMD and gets her into treatment."

Family members can play an important role in carrying out response prevention treatment prescribed by a therapist. "After dinner, the wife jumps up to clear the table and get the bleach, but the husband tells her, 'Sit down for half an hour, we're listening to Mozart,'" says Guardino. "In the morning he says, 'I'm throwing my pajamas on the floor and I want them there when I get home tonight."

Do Germaphobes Know Something Others Don't?

You might think you could get expert advice about SARS or flu or another infectious disease from a germaphobe. You'd probably be wrong. Guardino tells WebMD germaphobes act on irrational fears, not on knowledge.

In fact, cleaning rituals may increase their risk for infection. "They use a lot of bleach, and most spend at least half an hour in the shower, so their skin is dry and cracked," she says.

She adds that people who study germs obsessively typically have a form of hypochondria, not OCD. "They spend all their time seeking information. The washers are too busy acting out their rituals to seek information."

It's true that hand washing is the single most important thing you can do to prevent catching an infectious disease, including colds, flu, hepatitis A, meningitis, and infectious diarrhea, according to the CDC. But that's not license to scrub hands raw. CDC guidelines recommend washing:

  • Before and after you prepare food
  • Before you eat
  • After you use the bathroom
  • After handling animals or animal waste
  • After coughing or sneezing
  • When your hands are dirty
  • More frequently if someone in your home is sick

To wash properly:

  • Wet your hands and apply liquid or clean bar soap. Place bar soap on a soap dish that allows it to drain.
  • Rub your hands together vigorously, scrubbing all surfaces for 15 to 20 seconds. That's about how long it takes to hum "Happy Birthday" twice.
  • Rinse well and dry your hands. In a public restroom, use the air dryer or paper towels.
  • In the absence of soap and water, use alcohol-based disposable hand wipes or gel sanitizers.


Guardino recommends several self-help books: The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder, by Bruce M. Hyman, PhD; Stop Obsessing! How to Overcome Your Obsessions and Compulsions, by Edna B. Foa, PhD, and Reid Wilson, PhD; Everything In Its Place: My Trials and Triumphs With Obsessive Compulsive Disorder, by Marc Summers and Eric Hollander, MD; and OCD Casebook: Obsessive Compulsive Disorder, by John H. Greist and James W. Jefferson.

In addition, the Freedom From Fear web site has a directory of mental health professionals that can be searched by ZIP code. "We only list people who will give the first consultation free," says Guardino. "We know a free consultation will increase the probability that people will get into the mental health system."

Published July 12, 2004.

SOURCES: CDC. Mary Guardino, executive director, Freedom From Fear, Staten Island, N.Y. Obsessive-Compulsive Foundation.

Last Editorial Review: 4/26/2005

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