Got Anxiety? Triggers for compulsive washing (part 2 of 4)
Mary B. Barmann, MFT
This is the second in a 4-part series about obsessive hand-washing. Click here to read Part 1.
Approximately 3-5% of the population have a diagnosis of Obsessive-Compulsive Disorder (OCD), of which there are several subtypes such as compulsive checking, repeating, symmetry, scrupulosity, etc.
However, one of the most common involves obsessional fears related to contamination. These individuals have intrusive thoughts of becoming contaminated by germs, dirt, other people, pollutants, and a variety of other sources, thus resulting in compulsive washing rituals.
Let’s take a look at the primary triggers for this form of OCD.
THE OBSESSION-RITUAL CYCLE
With respect to contamination OCD, the obsession-ritual cycle is typically triggered by something a person observes in his or her external environment, which is considered to contain some type of contaminate.
Less often, the trigger is internal; that is, the person begins to experience intrusive thoughts (which appear to originate “out of the blue”) concerning the strong possibility of becoming contaminated by encountering direct contact with specific objects or other people.
Whether thoughts related to contamination are triggered by internal or external sources, the person begins to place a great deal of meaning on these intrusive thoughts, followed by a strong attempt to suppress them, due to the emotional discomfort (anxiety, disgust, and/or guilt) resulting from these thoughts or images.
The second part of this cycle involves engaging in some type of behavioral or mental ritual (compulsion), consisting of several self-imposed rules related to the perfectionistic manner in which the ritual must be executed.
The primary purpose of performing rituals is to lower levels of emotional discomfort. Due to this sensation of relief following the ritual, the probability of performing the same, or similar rituals, in the future has been reinforced.
Unfortunately, this feeling of relief is temporary. Obsessions related to specific fears will frequently reoccur throughout each day, followed by engaging in several additional rituals.
We often remind our patients that emotional relief resulting from rituals tends to enjoy a half-life of approximately 2 hours!
A secondary purpose for employing the use of rituals is to prevent some type of catastrophic harm from occurring to the person themselves, someone they know, or even a perfect stranger.
TRIGGERS FOR WASHING
Every form of OCD is associated with a catastrophic fear. In the case of contamination OCD, the obvious fear is becoming seriously ill, as the result of contagion.
Washing (and cleaning) rituals are performed for the purpose of preventing harm caused by the belief that one may have encountered some form of contamination, and thus feels the need to “decontaminate” by engaging in washing and/or cleaning rituals.
Exactly what triggers these obsessive fears will vary from person to person, but generally involves the following:
In most cases, these individuals have directly endured some type of trauma in their past, associated with contamination and/or illness.
For example, one of the patients currently being treated within our clinical practice for contamination OCD, reported that several years ago he was trapped in a building which was destroyed during an earthquake.
During this frightening experience, he was severely injured and spent several weeks in the intensive care unit of his local hospital.
While in the ICU, he was quarantined, and not allowed any visitors for fear that his immune system was quite weak, thus increasing the chances he might acquire a serious infection which could possibly lead to his death.
In contrast to those who had personally experienced a traumatic event related to injury, disease, etc., some people report that although they have never had such an experience themselves, they do recall one or more situations in their past when they observed someone who was the victim of a terrible accident which lead to contracting a serious illness as the result of contaminated substances.
In addition, there are also several instances consisting of those who never directly faced any form of trauma related to contamination and illness, nor did they ever observe another individual experience a situation of this nature.
However, they do report hearing or reading about someone with an illness or injury which was caused by factors related to contamination.
Clearly, there are several explanations which can trigger compulsive washing rituals for those who evidence a diagnosis of OCD.
However, whether through direct or indirect life events, it is evident that most of these individuals experienced a conditioned learning history involving contact with objects believed to contain contaminants of some nature, subsequently followed by the occurrence of a serious illness.
In Part 3 of this series, we’ll discuss an interesting, yet very complex form of contamination OCD — “Mental Pollution.”
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.
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Tahoe Forest Health System is pleased to announce that Lindsay Koppinger, MD, has joined their team at the Tahoe Forest MultiSpecialty Clinics – Pediatrics.