17. October 2022
Do you disinfect a door handle before you touch it? Do you change your clothes several times a day? Do you wash your hands 60 times a day or more because you feel you are contaminated? If you answered YES to all of these questions, you probably suffer from a washing compulsion…or are at least on the way to it. And you wouldn’t be alone in that. About a million Germans are plagued by thoughts of contamination every day and feel compelled to take action against it.
A washing compulsion is one of the most common manifestations of an obsessive-compulsive disorder. Those affected suffer from an immense fear of bacteria, pollution and infection with diseases. Contact with various objects or people is avoided as much as possible and requires repeated and ritualized washing of the hands, the entire body or even the clothes after contact. If such a ritual is not strictly observed, the whole compulsive action often has to be started all over again. The following case example illustrates the extent of the impairment:Ms. S. is 36 years old and works as a teacher at an elementary school. Since childhood, she suffered from great fear of contracting diseases and maintained careful hygiene. In 2020, there was one of the first corona cases with severe course at her workplace. Since then, her symptoms have massively increased. “In the beginning, I still went to work with an extreme disgust and queasy feeling. I washed my hands for five minutes between every class, then ten minutes, and finally for the entire break.” Within a few months, the situation came to a head: Ms. S. could hardly ride the train for fear of germs, could no longer touch anything, avoided close contact with students as well as colleagues, finally did not go to work at all and washed her entire body for several hours every day. Her thoughts turned only to a possible infection and she panicked when washing was not possible. Ms. S. was well aware that her fears and actions were exaggerated, but she withdrew further and further from her social environment out of shame .
The transition between careful hygiene and a compulsion to wash usually occurs insidiously. However, a clinical compulsion to wash is distinguished by the following characteristics:
As with many mental illnesses, the causes of a compulsion to wash are very diverse:Traumaticexperiences Traumatic experiences represent the most common trigger for a compulsion to wash. Particularly when sufferers receive no support in coping with the experience, the psyche is often overwhelmed. The response to this is the development of a compulsion or associated rituals that give the sufferer support and security again.Education If a child does not feel loved by his caregivers or is treated badly, an obsessive-compulsive disorder, such as a washing compulsion, can develop. Again, the goal is to gain security. Growing up in a dirty or clean household does not have to have any influence on this.Formative experiencesSuch an experience can have a direct connection with an illness, as in the case of Mrs. S. above, or it can also be an extraordinary burden caused by the death of a relative or an act of violence. Especially people who already suffer from self-esteem problems and many insecurities often try to regain control over the situation they have to cope with through their obsessive-compulsive symptoms. In the case of Mrs. S., there is also the threat of a new type of virus, which cannot be assessed at the beginning.Neurobiological factorsPeople affected by compulsions have overactivity in certain areas of the brain, which leads to faulty communication between the frontal brain and the deeper brain structures. In addition, a deficiency of the neurotransmitter serotonin has been shown in patients with a washing compulsion. GeneticsVarious studies have shown a cumulative occurrence of obsessive-compulsive disorders in related individuals. Children of obsessive-compulsive parents and twins are particularly affected. In this aspect, however, model learning of compulsions certainly also plays a major role, which in turn points to the point of upbringing in equal measure.
Since Corona came into existence, frequent hand washing and disinfection have become the norm. More than two years after the onset of the pandemic, a wide variety of studies now exist looking at the effects on obsessive-compulsive disorders, such as compulsive washing. First of all it is important to mention that such a pandemic does not necessarily have to lead to a washing compulsion, however, an already existing one can strengthen! The results underline this statement: more than one third of the study participants reported a worsening of their compulsions, and the worsening was particularly severe in persons with a washing compulsion.
As mentioned earlier, a washing compulsion is often accompanied by isolation due to shame and fear of infection. In addition, the washing rituals also take up a lot of time, which enormously restricts the quality of life. Likewise, it is often very difficult for those affected to accept help. All these factors often lead to loneliness and depression. Basically, the disease has a high comorbidity with the following other disorders:
Apart from the aforementioned psychological burdens, compulsive washing also carries some long-term physical consequences. It is very important for the immune system to come into contact with bacteria on a regular basis in order to keep it active. Sufferers of compulsive washing are usually exposed to virtually no germs at all, which means that their bodies are completely overwhelmed when they come into contact with harmless germs. In addition, frequent washing attacks the skin. Affected people not only have enormously dry skin, but also often have bloody and inflamed cracks in it, which in turn allows pathogens to enter the body. At this point, the vicious circle of washing becomes clear.
In case of washing compulsions, especially in a more advanced stage and with strong isolation, it is of great importance to seek professional help. This is usually already a huge hurdle for those affected, but by their own efforts this disease can rarely be defeated. Frequently, the above-mentioned frequent and diverse comorbidities also make an inpatient stay necessary. The therapy method of choice is usually behavioral therapy. The goal is to find the trigger for the washing compulsion and to work on it. In this process, the patient is confronted with his fears and should learn that despite contact with bacteria, an illness does not automatically follow. In the course of this, it is possible to start small by touching various objects without washing one’s hands afterwards and to endure the fear together with the therapist. As soon as a confrontation exercise has been successfully mastered, the intensity can be increased step by step and the patient can also practice leaving the house again and thus return to everyday life. In parallel, it is important that the patient learns alternative strategies to deal with his unfulfilled need for security, so that the obsessive thoughts and actions can be let go.