What is cleanliness addiction?

Causes

Researchers do not understand the genetic mechanisms of obsessive compulsive disorder (OCD), though they suspect multiple genes are involved. Genetic links are being investigated. OCD often runs in families, and identical twins have a 70 percent chance of sharing the disorder (fraternal twins have a 50 percent chance of sharing the disorder). Later studies have shown that a streptococcal infection may trigger OCD in children; the infection is known as PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections).

Risk Factors

The onset of OCD is usually gradual. It most often begins in adolescence or early adulthood and is surprisingly common. Most people at some time in their lives exhibit some obsessive and compulsive symptoms.

A recent study suggests that fluctuating hormones may trigger OCD symptoms during pregnancy. The same study reports OCD in 30 percent of women observed. A woman may also sometimes develop OCD or see a mild condition worsen in the postpartum stage. Illness may intensify fears about health and cleanliness and increase the compulsive activities associated with those fears. Major life changes and problems at work or school may trigger worries, fears, and obsessions.

Symptoms

Those with contamination OCD have compulsions, intrusive thoughts, or rituals related to cleaning. Cleaning must be done in a certain order or frequency. Worry overwhelms the person, who might think, for example, that a critical spot may have been missed during cleaning. A person with contamination OCD may wash their hands repeatedly until their hands are chapped and even bleeding. This may expose the person to infection.

Washing behaviors are rarely confined to the hands and may include excessive bathing and showering. Rituals might also involve washing clothing and utensils, and house cleaning. Cleanliness addicts may also insist that others adopt the same extreme cleaning behaviors.

OCD can interfere with one’s ability to concentrate, and it is not uncommon for a person with OCD to avoid certain situations. For example, someone with cleanliness addiction may be unable to use public restrooms. That person also may have panic attacks when faced with certain situations; they may avoid shaking another person’s hand or may avoid public transportation.

People with OCD often miss work or appointments because of compulsions and may even become housebound. 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 fruit, but be unconcerned about other things (such as gardening manure) that may seem more of a contamination concern to many others.

Unlike adults, children with OCD do not realize that their obsessions and compulsions are excessive. Some experts believe that OCD that begins in childhood may be different from OCD that does not manifest until adulthood.

Screening and Diagnosis

A psychiatrist, psychologist, primary care physician, or nurse with mental health training will usually make a diagnosis of OCD. Many health care professionals use a tool called a structured clinical interview, which contains standardized questions about the nature, severity, and duration of various symptoms. For OCD to be diagnosed, the obsessions and compulsions must demand from the person a minimum of one hour every day or must interfere with normal routines, occupational functioning, social activities, or relationships.

People with contamination obsessions and washing compulsions are sometimes mistaken for hypochondriacs. However, a hypochondriac fears that he or she is already ill and a person with cleanliness addiction fears that he or she may become contaminated (and later, ill). Furthermore, OCD should not be confused with obsessive-compulsive personality disorder (OCPD), which involves, in the case of a cleanliness addict, obsessive concern with cleanliness but a concern that does not cause distress; thus, OCPD is not considered an anxiety disorder.

Dermatologists are often alerted to a cleanliness addiction because of chapped skin or other skin problems that excessive washing can cause. In many cases, family members and friends will urge a cleanliness addict to get help when they see the obsession interfering with the addict’s life and the lives of those around him or her.

Treatment

Recovery is a process, not a discrete event. There is no cure for this addiction, but cleanliness addiction can be managed. Cognitive-behavioral therapy and antidepressant medications are used to treat the disorder, usually in combination. Cognitive-behavioral therapy involves exposure with response prevention and cognitive therapy.

Exposure involves imagined or actual exposure to things (for example, touching a pet or taking off shoes) that triggers the obsessions and anxiety. Eventually, such exposure will cause little anxiety, if any. This process is called habituation. Response refers to the ritual behaviors that people with cleanliness addiction perform to reduce anxiety. Patients learn to resist the compulsive behaviors. Cognitive therapy focuses on how the person interprets the obsessions. A destructive belief will be objectively challenged and reinterpreted.

Some medication, such as selective serotonin reuptake inhibitors, can increase the levels of serotonin available to transmit messages in the brain, and they have been shown to alleviate the symptoms of 40 to 60 percent of persons with OCD. In cases extremely resistant to treatment, brain surgery may be considered.

Prevention

There is no known prevention for OCD. However, by adhering to therapy, it can be managed and relapse can be avoided.

Bibliography

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington: 2013. Print.

Grayson, Jonathan. Freedom from Obsessive Compulsive Disorder: A Personalized Recovery Program. New York: Penguin, 2004. Print.

March, John S., and Karen Mulle. OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual. New York: Guilford, 1998. Print.

Penzel, Fred. Obsessive Compulsive Contamination Fears. Boston: International OCD Foundation, 2010. PDF file.

"What Is OCD?" Beyond OCD. Beyond OCD, 2015. Web. 28 Oct. 2015.