Cleanliness Rules Germaphobes' Lives
Germaphobes are obsessed with sanitation and feel compelled to clean excessively, but they're really suffering from obsessive-compulsive disorder.
When Is Cleanliness a Problem? continued...
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."
"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
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
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."
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."