Hand washing OCD
- Mitchell Howarth
- Jan 4
- 2 min read
Updated: Jan 7
Handwashing is common in Obsessive-Compulsive Disorder (OCD) - especially in the subtype of OCD where individuals experience intense fears of contamination. Unlike people who wash their hands for general hygiene, those with handwashing OCD feel compelled to wash excessively, even when this causes problems like wasted time and cracked, red and sore hands.
Sequence of Handwashing OCD
A person goes through a fairly predictable sequences of steps with their OCD. Their are certain triggers, that activate a person's core fears and anxieties, which in turn leads to them performing compulsions to cope.
Triggers:
Touching surfaces perceived as dirty, such as doorknobs, toilets, or communal items.
Shaking hands or physical contact with others.
Handling money, groceries, or shared objects.
Exposure to bodily fluids or chemicals.
Media reports about illnesses or outbreaks.
Core Fears:
Fear of death or illness caused by contamination, either for oneself or others.
Fear of unbearable suffering from germs or toxins entering the body.
Fear of being responsible for spreading illness or harm to others.
Fear of being a bad or careless person for not preventing contamination.
Compulsions / Safety Behaviours: Compulsions are actions people take to reduce anxiety or prevent perceived harm. These may include:
Excessive handwashing, sometimes to the point of skin damage, redness, or cracking.
Repeating handwashing rituals until they feel "just right."
Using excessive soap, disinfectants, or hot water.
Avoiding touching objects or people perceived as dirty.
Wearing gloves or using tissues to avoid direct contact with surfaces.
While these behaviors temporarily relieve distress, they reinforce the fear and keep the OCD cycle going.
What Causes Handwashing OCD?
The causes of OCD are complex and can include:
Genetics:Â Studies show OCD tends to run in families, suggesting a genetic component.
Biology:Â Differences in brain structure and function, particularly in areas related to decision-making and fear responses, may contribute.
Environment:Â Stressful or traumatic experiences, such as illness or loss, can trigger or worsen symptoms.
Learned Behavior:Â Growing up with caregivers who emphasize cleanliness or order may reinforce compulsive habits.
How Do You Treat Handwashing OCD?
The gold standard treatment for handwashing OCD is Cognitive Behavioural Therapy (CBT), particularly a method called Exposure and Response Prevention (ERP).
CBT helps individuals recognize and challenge the unhelpful thoughts which drive their excessive fear of contamination.
ERP gradually exposes individuals to feared situations, like touching a doorknob without washing hands, while resisting compulsions. Over time, this helps reduce anxiety and builds a person's tolerance for uncertainty.
For example:
An initial exposure task might involve touching a doorknob without immediately washing hands.
Later tasks might involve waiting longer before washing hands or using less soap, to eventully cutting down hand washing down to more managable levels.
Eventually, individuals learn to tolerate not washing their hands after perceived contamination.
Medication, such as selective serotonin reuptake inhibitors (SSRIs), may also be prescribed in combination with therapy to reduce symptoms.
Summary
People with handwashing OCD often fear contamination and use repetitive handwashing rituals to reduce anxiety or prevent harm. However, these compulsions keep the cycle going, as complete protection from germs is impossible. Effective treatments like CBT and ERP can help individuals learn to tolerate uncertainty and discomfort, breaking free from OCD and regaining control over their lives.