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    Cleanliness Rules Germaphobes' Lives

    Germaphobes are obsessed with sanitation and feel compelled to clean excessively, but they're really suffering from obsessive-compulsive disorder.

    WebMD Feature

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

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

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    True germaphobes have OCD, which can take various forms. For example, some people with OCD are "checkers." They're obsessed with a fear of losing control of aggressive urges, and their anxiety can be relieved only by checking something, 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. 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.

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    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.

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