How many times have you heard that admonition? Your parents no doubt warned you to wash your hands frequently; hospitals post signs everywhere to promote regular hand washing; and notices in restaurant restrooms urge employees and patrons alike to wash their hands. Furthermore, almost everyone knows that washing hands regularly is one of the most useful things you can do to avoid spreading germs and diseases.
Perhaps it’s not surprising that worries about contamination represent one of the most common types of obsessive compulsive disorder (OCD). People with this problem dwell on the possibility of contacting germs and either becoming sick or even dying as a result. They often start washing their hands quite frequently to deal with this concern. Each time they wash, they feel better for a short while; then the obsession starts anew. Images of germs and contaminants flood their minds and the urge to wash increases. So they wash their hands again and again. Some people with this type of OCD spend many hours each day washing and rewashing their hands. And they point to the signs and warnings posted everywhere they turn as evidence that their behavior makes sense.
They problem of course is that hand washing conforms to the law of diminishing returns. Although a certain amount of washing makes great sense, the value of increased washing in terms of risk reduction quickly drops off at a certain point. Unfortunately, people with this kind of OCD don’t know where that point lies or how to find it.
As we’ve said in previous blogs, exposure and response prevention (ERP) is one of the best strategies for overcoming most types of OCD including contamination concerns. ERP involves having people touch or expose themselves to a wide variety dirt surfaces such as doorknobs, counters, greasy motor parts, tires, floors, shoes, or garbage cans while avoiding hand washing for as long as possible. Given what we’ve said about hand washing, you would be correct in surmising that ERP does involve a small degree of risk. Taking such risks actually helps immensely in overcoming a disorder that commands the mind to avoid all risks at all times (a command that’s of course impossible to carry out no matter how hard you try).
But once ERP procedures are complete, how does someone with OCD know where to draw the line between appropriate, reasonable hand washing and hand washing that threatens to cross into OCD territory? We have a couple of thoughts about how and when to wash hands in ways that should keep you as safe as anyone needs to be without triggering OCD.
How to wash: Obviously, you want to use clean water (tap water is fine in most of the world) and soap. Rub your hands together for about 20 seconds. Someone noted that it takes about that long to sing Happy Birthday. Hand sanitizer can substitute for soap. Rinse your hands quickly and dry with a clean towel. That’s it.
When to wash: This one is tougher, but we recommend that you wash:
If you notice that you’re washing your hands every hour or more, you very well may be starting to escalate. Also, if you start taking more than 20 to 30 seconds, your hand washing could be teetering toward OCD. Of course, if you’re a surgeon, you have a stricter routine to follow for good reasons. Unfortunately, there are no hard and fast rules set in stone. But following these guidelines should help keep you out of trouble.
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Prof.Lakshman (July 20, 2009)
Last reviewed: 20 Jul 2009