germaphobes - obsession with sanitation is actually a sign of obsessive-compulsive disorder on...

Source: http://www.medicinenet.com/script/main/art.asp?articlekey=46748

Cleanliness Rules Germaphobes' Lives

Germaphobes are obsessed with sanitation and feel compelled to cleanexcessively, but they're really suffering from obsessive-compulsivedisorder.

By Leanna SkarnulisWebMD Feature

Reviewed By Brunilda Nazario, MD

In the Monk TV series, gentle detective Adrian Monk works the grimy streets ofSan Francisco but is so driven by a fear of germs that he must scrub his handsafter shaking hands with someone. Monk has been called the "poster boy" forobsessive-compulsive disorder (OCD). In fact, in an informal survey conductedby the Obsessive-Compulsive Foundation, OCD patients said they liked thecharacter, who triumphs even when his condition interferes with his ability to dohis work.

Monk is a "germaphobe," the popular name for people who become obsessedwith germs and dirt and feel compelled to act out rituals of washing andcleaning. Real people with this condition include the late Howard Hughes andSaddam Hussein, who reportedly often ordered visitors to strip and wash withantibacterial soap.

True germaphobes have OCD, which can take various forms. For example, somepeople with OCD are "checkers." They're obsessed with a fear of losing controlof aggressive urges, and their anxiety can be relieved only by checkingsomething, such as whether a burner on the stove has been turned off.Hoarding, counting, and praying are some other manifestations of the disease.People often have multiple forms of OCD.

What Causes the Compulsion to Wash?

OCD is believed to be caused by an abnormality in the brain's circuitry. Brainscans show brain activity is different in people with OCD. There's probably agenetic component as well, especially when OCD begins in childhood. One-thirdto one-half of adults with OCD say their illness started in childhood oradolescence.

Why someone with the disease is compelled to wash, as opposed to check orcount or hoard, isn't known. What's true with all types of OCD is that acompulsion is acted out to relieve anxiety produced by an obsessive, intrusivethought. For example, a woman accidentally cuts herself, washes the wound,

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puts antibacterial ointment on it, and bandages it. That should be that, but ananxious feeling and thought intrude: what if microscopic germs remain? Sheknows it's irrational, but she's compelled to wash the cut again in order to relievethe 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 cubicleevery morning and keeps everything arranged just so. Is she just a perfectionistor is she driven by OCD? It can be hard to tell at first because OCD is a secretiveillness, 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 andclean everything is. But she may be hiding her rituals. If she heard a co-workergot 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 lifeand actions.The individual engages in ritual cleaning or washing at least one hour aday.Acting out the rituals is done to relieve anxiety.The person knows the obsession with germs is foolish but feels compelledto 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 ranaround with a paper towel and Windex. It bothered Oscar. Also Felix probablydidn't clean a surface over and over. He thought his behavior was appropriatebecause 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 severalantidepressants, and a form of cognitive behavioral therapy called "responseprevention" or "exposure and response therapy."

"The object of response prevention therapy is to delay implementation of theritual," says Guardino, whose expertise and advocacy grew out of her own25-year battle with anxiety and depression. "The longer you delay it, you will getslowly over time a decrease in the anxiety to enact the ritual."

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 oftime is increased until the patient can wash just once without feeling compelledto wash again. Successful treatment produces a change in brain activity and, formost 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 whosees his wife cleaning the house three or four hours a day may at first think he's


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got the world's greatest wife," says Guardino. "But over time he sees her energylevel 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 preventiontreatment prescribed by a therapist. "After dinner, the wife jumps up to clear thetable 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 throwingmy 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 anotherinfectious disease from a germaphobe. You'd probably be wrong. Guardino tellsWebMD germaphobes act on irrational fears, not on knowledge.

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

She adds that people who study germs obsessively typically have a form ofhypochondria, not OCD. "They spend all their time seeking information. Thewashers 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 toprevent catching an infectious disease, including colds, flu, hepatitis A,meningitis, and infectious diarrhea, according to the CDC. But that's not licenseto scrub hands raw. CDC guidelines recommend washing:

Before and after you prepare foodBefore you eatAfter you use the bathroomAfter handling animals or animal wasteAfter coughing or sneezingWhen your hands are dirtyMore 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 asoap dish that allows it to drain.Rub your hands together vigorously, scrubbing all surfaces for 15 to 20seconds. 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 orpaper towels.In the absence of soap and water, use alcohol-based disposable handwipes or gel sanitizers.

Resources

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


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Greist and James W. Jefferson.

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

Published July 12, 2004.

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

Last Editorial Review: 4/26/2005

© 2005-2015 WebMD, LLC. All rights reserved.Source article on WebMD

© 2015 MedicineNet, Inc. All rights reserved.MedicineNet does not provide medical advice, diagnosis or treatment.See additional information


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