What is an Obsessive Cleaning Disorder?

In Shakespeare’s play Macbeth, Lady Macbeth kills herself because she is haunted by the fact that she was involved in the killing of the king.  She is seen night after night sleepwalking while obsessively cleaning her hands to rid them of the imagined blood stain.  Knowing will never be clean again,  she throws herself from the battlements  People with obsessive cleaning disorder don’t have the same cause of their obsession but the symptoms are as pervasive and as challenging of those thoughts and feelings of Lady Macbeth.

The term OCD has become another TLA – three letter acronym which is as overused as LOL and OMG. The way in which it is used often undermines the serious implications for the person with OCD and their families of a condition which can take over someone’s life and like Lady Macbeth, leaves them powerless to lead a normal life.

We often say someone is obsessive–compulsive when they are overly attentive and meticulous, with a tendency to repeat actions or if they are what we may consider to be a perfectionist. However the clinical diagnosis of obsessive compulsive disorder (OCD) covers a level of unwanted obsessions and compulsions that both impact significantly on the everyday function of people and often cause them significant distress.

It is believed that there are four sub types of OCD:

1. Checking: Involves constant and obtrusive checking of a state.  For example this can be where a person is unable to leave their home unless they have checked the doors and windows many times before they feel safe to leave.
2. Contamination / Mental Contamination: Mental contamination is a psychological feeling of dirtiness or violation.  In many cases it is linked to some event such as abuse or feeling out of control.  This means that one can feel contaminated without having touched a contaminant but this then affects behaviour toward a potential contaminant such as bodily fluids provokes a strong reaction, particularly cleaning behaviour.
3. Hoarding:  The most notable feature of this sub type of OCD is buying too much stuff and an inability to throw things away even when they are broken, useless or worn out.  They also have difficulty in organising their hoard.
4. Ruminations / Intrusive Thoughts: Ruminations are generally where a person with OCD spends too much time pondering unanswerable questions, where there can be no satisfactory conclusion, for example : “what happened after death” While ruminations are needlessly time consuming intrusive thoughts are more distressing and less under conscious control. Intrusive thoughts cause the person with OCD to think about unpleasant actions and events e.g. the potential to harm a loved one. These thoughts are not under conscious control and cause the person immense distress.

Obsessive cleaning disorder is generally considered as part of the contamination area of OCD. In contamination disorder the need to clean and wash is the compulsion, the obsessive fear is that something, an object, substance or the environment is contaminated. The fear is that this may cause an illness, or death, to the person who has the compulsion or someone they love. 

There is a standardised rating scale in the form of the Yale–Brown Obsessive Compulsive Scale which can be used to assess the severity of the symptoms in people with the disorder and it is listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association.

Causes of obsessive cleaning disorder

It is known that obsessive compulsive disorders occur in between 1 to 3 percent of the population and that It occurs equally in both male and female sexes. However in 80 percent of cases, the symptoms present before the age of 18. Despite the considerable research undertaken into obsessive compulsive behaviour, to date, there is not a definitive cause for a person developing the disorder.

It is believed that obsessive compulsive behaviours are likely to be the result of a combination of behavioural, faulty thinking patterns, environmental triggers, inherited, or neurobiological, factors that may trigger the disorder in a person a particular point in time.

Signs and symptoms

The UK-based charity OCD-UK lists a range of signs and symptoms that indicate a person may have contamination i.e. obsessive cleaning disorder:

• Using public toilets (fear of contracting germs from other people).
• Coming into contact with chemicals (fear of contamination).
• Shaking hands (fear of contracting germs from other people).
• Touching door knobs/handles (fear of contracting germs from other people).
• Using public telephones (fear of contracting germs from other people).
• Waiting in a GP’s surgery (fear of contracting germs from other people).
• Visiting hospitals (fear of contracting germs from other people).
• Eating in a cafe/restaurant   (fear of contracting germs from other people).
• Washing clothes in a launderette   (fear of contracting germs from other people).
• Touching bannisters on staircases (fear of contracting germs from other people).
• Touching poles  (fear of contracting germs from other people).
• Being in a crowd   (fear of contracting germs from other people).
• Avoiding red objects and stains (fear of contracting HIV/AIDS from blood like stains).
• Clothes (having to shake clothes to remove dead skin cells, fear of contamination).
• Excessive Tooth Brushing   (fear of leaving minute remains of mouth disease).
• Cleaning of Kitchen and Bathroom   (fear of germs being spread to family).

For many people the cleaning or washing is often carried out multiple times. It is often undertaken in a ritualised way, for example one finger at a time. This repetitive hand or body washing will continue until the person ‘feels’ she or he is clean. A person without obsessive cleaning disorder will wash or clean multiple times, or until they ‘see’ they are clean.

For many people the time taken to ‘feel clean’ can have a serious impact on their ability to engage in work or hold down relationships. In addition there is the secondary physical health problem of the constant scrubbing and cleaning on the skin, especially the hands often with abrasive items and frequently with harmful chemicals.  It is not uncommon for a person with an obsessive cleaning disorder to avoid entire places or buildings if they had experienced their contamination fears in that location before.

For people with obsessive cleaning disorder there are often significant costs derived from the constant use and purchase of cleaning products and items. In addition they may inadvertenly damage electrical items through excessive use of liquids to clean them.

Perhaps the most famous person to develop obsessive cleaning disorder was Howard Hughes. A brilliant man, designer, engineer, film mogul and record breaker he disappeared from public life at the age of 46 and spent the rest of his life in isolation from the world.  Phelan (1976) documents the lengths to which Howard Hughes went to avoid contamination.  Even having his hair cut was a three hour ordeal which involved operation style gowning for the barber and tools disinfected in alcohol.

Potential therapies and treatments

Treatments for obsessive cleaning disorders generally involve the use of behavioural therapies and sometimes the prescription of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants.

The behavioural therapies normally involve an increasing exposure to what causes the obsessive cleaning disorder while not allowing the cleaning to take place. Psychodynamic psychotherapy may help in managing some aspects of the disorder

Prognosis

Psychological interventions such as behavioural and cognitive behavioural therapy (CBT) in combination with appropriate drugs generally together, have good results in the reduction of obsessive cleaning disorder and other obsessive compulsive disorders. However it is uncommon for the person to be free of all the symptoms for the rest of their lives. They key appears to be, they may lean to manage themselves better.

References:

American Psychiatric Association (1994) DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders (Diagnostic & Statistical Manual of Mental Disorders) 

Ronald J. Comer: Abnormal Psychology 3^rd Edition,   Freeman Press, 1998

Phelan J  (1976) Howard Hughes the Hidden Years Random House, New York.

(Source: http://www.stlocd.org/handouts/YBOC-Symptom-Checklist.pdf)

(Source http://www.ocduk.org/types-ocd)