Cleanliness Rules Germaphobes' Lives (cont.)

What Causes the Compulsion to Wash?

OCD is believed to be caused by an abnormality in the brain's circuitry. Brain scans show brain activity is different in people with OCD. There's probably a genetic component as well, especially when OCD begins in childhood. One-third to one-half of adults with OCD say their illness started in childhood or adolescence.

Why someone with the disease is compelled to wash, as opposed to check or count or hoard, isn't known. What's true with all types of OCD is that a compulsion is acted out to relieve anxiety produced by an obsessive, intrusive thought. For example, a woman accidentally cuts herself, washes the wound, puts antibacterial ointment on it, and bandages it. That should be that, but an anxious feeling and thought intrude: what if microscopic germs remain? She knows it's irrational, but she's compelled to wash the cut again in order to relieve the anxiety. She may have to repeat the act over and over.

When Is Cleanliness a Problem?

Every office has its neat freak. Maybe it's the woman who cleans her cubicle every morning and keeps everything arranged just so. Is she just a perfectionist or is she driven by OCD? It can be hard to tell at first because OCD is a secretive illness, says Mary Guardino. She is the executive director of Freedom From Fear, the national mental illness advocacy organization she founded in Staten Island, N.Y., in 1984. "When you first meet her, you notice how nice and organized and clean everything is. But she may be hiding her rituals. If she heard a co-worker got the flu, she'd fear she might have touched something that person handled, so she'll sneak into the bathroom to wash."

Guardino says a clinician looks for these signs of OCD:

  • The obsession with contamination is gradually taking over the person's life and actions.
  • The individual engages in ritual cleaning or washing at least one hour a day.
  • Acting out the rituals is done to relieve anxiety.
  • The person knows the obsession with germs is foolish but feels compelled to wash or clean over and over.

"People who have OCD really don't want to be that way," Guardino tells WebMD. On the other hand, people who have obsessive-compulsive personality disorder (OCPD), which is less serious than OCD, pride themselves on being neat freaks. Felix Unger, of The Odd Couple, for example. "It didn't bother Felix that he ran around with a paper towel and Windex. It bothered Oscar. Also Felix probably didn't clean a surface over and over. He thought his behavior was appropriate because he needed to have things perfect. He didn't want to change."

Treatment With Medication and Therapy

The most effective treatment combines medication, usually one of several antidepressants, and a form of cognitive behavioral therapy called "response prevention" or "exposure and response therapy."

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