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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.

    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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    "The object of response prevention therapy is to delay implementation of the ritual," says Guardino, whose expertise and advocacy grew out of her own 25-year battle with anxiety and depression. "The longer you delay it, you will get slowly over time a decrease in the anxiety to enact the ritual."

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    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."

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    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.

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    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.

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