Understanding yourself
OCD: washing and contamination
“I wash until my hands bleed, and they still feel dirty.”
Fear of germs, dirt or disease that no amount of washing can settle. A common form of OCD, and a treatable one.
Afrin, a dental surgeon in Uttara, washes her hands forty times on a clinic day, which her colleagues put down to professionalism. At home it does not stop. After the bazaar she showers before touching her daughter. Her knuckles crack and bleed in winter. Since the pandemic, the rules have multiplied, and her family has started following them too.
An illustration drawn from common experience. The person is invented; the pattern is not.
Understanding contamination OCD
Contamination fear is one of the most common forms of obsessive compulsive disorder. The obsession is an intrusive fear of dirt, germs, illness, bodily fluids or chemicals, often with a sense of disgust or of something terrible happening to someone you love. The compulsion is washing, cleaning, avoiding, or asking others to clean, in set ways and for long periods. The relief lasts minutes; the fear returns, and the rituals grow.
How common is contamination OCD?
About 2.3% of American adults meet the criteria for OCD at some point in life, according to the US National Comorbidity Survey Replication.
Signs and symptoms of contamination OCD
- Washing or cleaning for hours a day, or until the skin is damaged
- Showering or changing clothes after going outside
- Avoiding shaking hands, public places, or certain rooms at home
- Family members drawn into cleaning rules and reassurance
Treatment for contamination OCD
UK national guidelines recommend exposure and response prevention, a form of cognitive behavioural therapy, and certain antidepressant medicines, alone or together depending on how severe the OCD is. In therapy, people touch what feels contaminated in small, planned steps and hold back from washing, until the fear fades on its own. Families learn how to support without joining the rituals.
What getting better can look like
Afrin’s sign might be coming home from the bazaar and lifting her daughter straight away, with the urge to wash still there, and fading.
Common questions about contamination OCD
How do I know if my handwashing is OCD?
Careful washing is ordinary, especially since the pandemic. In OCD, the washing is driven by an intrusive fear of dirt, germs or illness, it takes hours a day or damages the skin, and the relief lasts only minutes before the fear returns. Only an assessment can say for sure, but these signs are worth checking.
Can OCD be treated without medicine?
Exposure and response prevention, a form of CBT, is a first-line treatment for OCD in UK national guidelines, and certain antidepressant medicines are another; for severe OCD they are combined. Whether medicine is needed depends on how severe the OCD is, and it is decided with a psychiatrist. Anyone already taking medicine should discuss any change with their doctor first.
When to see a psychiatrist
If washing or cleaning is taking hours of your day or damaging your skin, OCD is treatable, and it helps to start early.
Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.
If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.
If some of this sounds familiar, a first conversation is a good place to start. You do not need the right words, or to be certain.
Dr. Tajreen is consulting in Uttar Badda now, until 8:00 pm. Call +880 1847-331010Every address and its hours
Sources
- Ruscio et al., Molecular Psychiatry, 2010 (PMID 18725912; NCS-R)
- NICE guideline CG31, Obsessive-compulsive disorder and body dysmorphic disorder, 2005
You do not need to have everything figured out before you begin.
