OCD Cleaning and Hand Washing: When is it Too Much?

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Obsessive Compulsive Disorder (OCD) is an anxiety disorder that is characterized by intrusive thoughts or ideas (obsessions) that lead to repetitive behaviors (compulsions).

These obsessions can manifest in several ways, including a strong fixation with dirt or germs, worry that something is incomplete, thoughts about violence or hurting someone, or extreme concern with order, symmetry, and precision etc.

A person with OCD will choose to cope with these thoughts through rituals or repetitive behaviors known as compulsions. These compulsions can include repeatedly checking locks, alarm systems, ovens, or light switches; excessively washing and cleaning; ordering or arranging things in a particular way; or excessively preferencing or avoiding certain numbers.

Compulsive cleaning with OCD

Washing and cleaning rituals are widely recognized symptoms of OCD. People with “cleaning OCD” can be characterized by their overwhelming desire to repeatedly clean themselves, their homes, their environment, their belongings, and sometimes even other people.

This goes beyond the simple need to maintain an orderly, hygienic home. People who experience compulsive cleaning need to clean or perform cleaning rituals to feel in control and manage their anxiety.

They may have obsessive thoughts that revolve around an extreme fear of contamination, dirt, toxins, and germs. They have a fear of being contaminated, and they even fear that they might make others sick.

This pervasive obsession with contamination and cleanliness is what manifests in cleaning compulsions and acts of decontamination. By compulsively cleaning themselves and their surroundings in a specific order or with a particular frequency, these people believe they can avoid contamination, infection, or illness.

Obsessive-compulsive cleaners can spend hours each day in ritualized cleaning activities, such as excessive hand washing, showering, bathing, or toothbrushing. They also might spend significant time cleaning household items and other inanimate objects, including their shoes, credit cards, and cell phones, that impact their daily functioning.

Cleaning is associated with hypothetical thinking, such as if they washed/cleaned sufficiently, a negative consequence or unwanted emotion can be avoided.

How does compulsive cleaning affect your daily life?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the handbook used by healthcare professionals worldwide to guide their diagnosis of mental disorders. The DSM-5 description of OCD emphasizes that compulsive acts can take up much time and space in one’s daily life.

Compulsive cleaning can cause disruptions in a person’s social, academic, and professional life as their cleaning rituals can end up occupying an entire day. For example, people with a hand-washing compulsion can spend multiple hours in a single day washing their hands, leaving their skin red, wounded, and irritated.

This can involve cleaning each finger under each fingernail individually and using hand sanitizers excessively between trips to the sink. These individuals may also use other measures to prevent contact with contaminants, such as wearing gloves or using a towel or napkin to open doors and touch objects.

This preoccupation with personal hygiene and cleaning can become a great source of stress and distraction.

Some people have trouble leaving their house because they feel they haven’t cleaned it sufficiently or they have a fear of being contaminated by the outside world. They might avoid “contaminated” spaces such as hospitals, public bathrooms, public transport, or even other peoples’ homes.

What causes cleaning OCD?

There are a number of risk factors, causes, and triggers of OCD. OCD usually develops around infancy or adolescence. It tends to appear at an earlier age in men, but by midlife, more women tend to display symptoms.

Genetics, differences in brain structures, and environmental factors can all be associated with a higher risk of developing OCD. There is promising evidence for the biological basis of OCD, and research has demonstrated that heredity plays an important role in the development of OCD.

Additionally, scientists in a 2017 study found greater connectivity and activity in parts of the brain associated with habit formation and in parts that process emotions (specifically fear), revealing that differences in brain structures can be a determining factor in whether someone develops OCD.

Environmental factors can also be associated with a higher risk of developing OCD. Individuals who have experienced traumatic events, family disruption, and/or prolonged periods of stress are particularly likely to experience symptoms of OCD. Sometimes, OCD can originate from growing up in an abusive, authoritarian household.

People who experience OCD typically feel guilty for things that happened in their past, which could cause them to become more involved in their routines to stabilize the present. Or, this sense of guilt can lead them to clean in order to symbolically cleanse themselves from their past mistakes.

Cleaning provides many people with a sense of control. As it has an immediate positive result, cleaning can help to relieve anxiety or even raise one’s self-esteem temporarily.

How do you know if you have “Cleaning OCD”?

Not everyone who is exceptionally clean has OCD. Knowing whether you have Cleaning OCD depends on whether your inclination to clean comes from obsessive thoughts and compulsions or simply a desire.

The key determining factor between someone with just a desire to clean and someone with OCD is whether the symptoms cause disruption and distress.

OCD symptoms include not only obsessions and compulsions, but also significant anxiety and unease.

Signs and Symptoms of Cleaning OCD might include:

Feeling disgust or fear over particular objects or substances, including dirt, illness, germs, body secretion, trash, chemicals, or toxins
Having a strong urge to wash your hands or shower frequently
Using particular processes or rituals for washing yourself and/or your surroundings
Changing your clothes several times per day
Avoiding places or people that you think may be infected
Conducting rigorous decontaminating rituals or routines
Refusing to allow others into your safe spaces
Damaging your skin and body through excessive cleaning
Experiencing extreme anxiety if certain things are not organized “just right”

The OCD Cycle with Cleaning

Obsessions → These involuntary and intrusive thoughts or sensations consume individuals with fears that a particular person, surface, or object is contaminated and must be either cleaned or avoided.
Anxiety → The obsessive thoughts thus lead to a build-up of insufferable anxiety.
Compulsive Behaviors → To alleviate the anxiety, the sufferer will resort to compulsive cleaning rituals. These compulsions can include a focus on handwashing and bathing or disinfecting door knobs, surfaces, and light switches.
Temporary Relief → Cleaning and washing might provide temporary relief from obsessive fears. However, this relief is short-lived because the obsessive thoughts of contamination typically return shortly, and the cycle then repeats itself. This cycle tends to repeat several times in a single day.

When to Seek Help

Too often, people with OCD suffer in silence and are unaware of the effective treatment options available to them. Many feel that their symptoms aren’t severe enough and are hesitant to seek help.

If you feel that your symptoms cause significant distress, take up excessive time, and/or disrupt your daily living, it is likely time to explore treatment options.

In the context of cleaning and washing, if you find that you are thinking about germs even after washing your hands, worry that you’re not cleaning well enough, or have irrational fears about the disease from the sink or door handle, this could be a sign that your hand-washing is compulsive.

Additionally, if you find that you are participating in elaborate hand washing routines, such as needing to scrub for a certain amount of time or washing under each individual nail, this is another warning sign.

If you spend hours a day cleaning and/or feel anxious and fearful from not cleaning, this could also be indication of OCD and a sign you should seek help.

The sooner you seek treatment for your OCD, the sooner you can start toward recovery. Early intervention is the best way to mitigate symptoms and help you regain control of your life.

How is OCD with compulsive cleaning or washing treated?

There are several treatments found to help manage symptoms of OCD and improve daily functioning. At least half of the patients who seek treatment for OCD will show symptomatic remission over the long term.

The best outcomes occur in individuals who are diagnosed early and start an intense treatment program right away.

Therapy

Cognitive Behavioral Therapy (CBT) is an effective treatment for individuals dealing with OCD. During CBT, your therapist will help you decrease your anxiety by identifying the thought patterns that are distorting your view of reality and leading to these obsessive thoughts. They will then help you restructure these thoughts in productive ways.

Exposure and Response Prevention (ERP), a type of CBT, is considered the first-line psychotherapy for OCD. In ERP, you will work with a therapist to identify both external and internal triggers that cause you stress and make you want to behave compulsively.

ERP is designed to gradually reduce the anxiety that feeds your obsessions and compulsions through a process called habituation. The goal of habituation is to help you become less provoked by triggering obsessions after being repeatedly and safely exposed to them.

Medication

A class of medications called selective serotonin reuptake inhibitors, or SSRIs, also help people manage their obsessions and compulsions. Some more common medications prescribed for OCD include Anafranil, Fluvoxamine, Paxil, Prozac, and Zoloft.

Deep Brain Stimulation (DBS)

Your doctor might recommend deep brain stimulation if more conservative treatment methods (i.e., psychotherapy and medication) are not working for you.

DBS is an advanced surgical treatment that uses electrical impulses to target the part of your brain that is causing your symptoms.

The goal is that these electrodes produce electrical pulses that will help change your thoughts and behaviors. The effects of DBS are long-term and have few side effects. DBS is effective for about 60 percent of patients.

FAQs

Does Being a “Neat Freak” Mean You Have OCD?

While some people with OCD are “neat freaks,” others are not. Being a perfectionist about cleaning does not necessarily mean you have OCD.

If you are a perfectionist about cleaning and experience persistent obsessive thoughts and compulsions to carry out certain ritualistic cleaning behaviors, this is likely a sign of OCD symptoms.

Typically, someone will only receive an OCD diagnosis if the symptoms are causing significant turmoil in their lives. So, if you just enjoy keeping a super-clean home, this does not necessarily mean you need treatment for OCD.

Is everyone with OCD obsessed with cleaning and washing?

No. For some people with OCD, obsessive thoughts do revolve around germs, and compulsions manifest as obsessive cleaning; however, some people with other subtypes of OCD will fixate on other things.

For example, they may obsess over safety and experience compulsions such as turning the stove on and off several times before feeling safe. Every case of OCD is unique. The symptoms are the obsessions and compulsions, not the cleaning itself.