Between the Covid-19 pandemic and regular seasonal viruses, we’ve all received a lot of messaging about the importance of washing our hands. But, what does adequate handwashing look like? Even though washing your hands can be an important way to stay clean and healthy, it’s possible to overdo it.
If you’re spending long periods of time at the sink multiple times a day, or meticulously scrubbing your hands until they’re raw, you might be engaging in compulsive handwashing. It’s one of the most common compulsions for people with obsessive-compulsive disorder (OCD), especially if your obsessions center on dirt and germs. Keep reading to explore the signs of compulsive handwashing, understand its connection to OCD, and learn strategies for managing this behavior.
What is compulsive handwashing?
Compulsive handwashing is characterized by excessive washing in a repetitive and/or ritualistic manner. “It can involve washing hands a certain number of times, a certain length of time, or using a certain number of pumps of soap,” says Tracie Ibrahim, LMFT, CST, and Chief Compliance Officer at NOCD.
This behavior is usually driven by some form of health anxiety, or obsessive concerns about contamination. Often, these fears stem from obsessive-compulsive disorder (OCD), a complex mental health condition marked by two key symptoms: obsessions and compulsions. Obsessions are thoughts, sensations, images, feelings, or urges that are intrusive, unwanted, and lead to distress. In an effort to mitigate this distress, people with OCD perform repetitive behaviors or rituals known as compulsions.
Proper hygiene vs. compulsive handwashing
Washing your hands is important, but it’s key to find a balance between practicing proper hygiene and engaging in compulsive behaviors. The Centers for Disease Control and Prevention (CDC) recommend washing before and after prepping or eating food, caring for someone sick, treating a cut or wound, using the bathroom, touching an animal, handling garbage, or blowing your nose, coughing, or sneezing. They say you should wash your hands with soap and running water for at least twenty seconds.
If you’re trying to figure out whether your handwashing behaviors are compulsive, consider how often you’re washing and for how much time. It can also be helpful to look out for any rituals or patterns that may be developing around your handwashing routines. Do you find yourself counting to a certain number before you allow yourself to finish? Do you feel the need to wash your hands in a specific order?
Finally, consider whether washing your hands is interfering with your daily life. Is it taking time away from work, school, or social activities? Are you spending a lot of money on hand soap, sanitizer, wipes, or your water bill? Ibrahim says that compulsive handwashing can cause some people to avoid travel, or situations where “they fear they will not have access to their handwashing rituals, such as going camping.”
Physical impacts of excessive handwashing:
According to Ibrahim, while compulsive handwashing is often done in an attempt to prevent negative physical health outcomes, it can have the opposite effect: “Compulsive handwashing removes the layers of skin that are meant to protect people from getting sick [or from] harmful bacteria, so now they actually become more prone to those things.”
Common signs of compulsive handwashing include:
- Dry, red or irritated skin
- Eczema, blistering or scaling
- Frequent itching
- Frequent small cuts, which can get infected
- Changes in your skin’s pigmentation
Consult a physician if you think you have an infection, or if symptoms don’t resolve on their own.
Causes
Excessive handwashing can be caused by OCD, phobias, and illness anxiety disorders—mental health conditions characterized by an intense preoccupation with acquiring a serious illness. OCD, phobias and illness anxiety disorders often look similar; all involve anxiety, fear, obsessive thoughts, and time-consuming behaviors. The key difference is that OCD compulsions are performed in a more ritualistic manner.
If you have OCD, you might feel a need to wash your hands in exactly the same way every time, or feel that you have to count to a certain number before you can stop. If you have an illness anxiety disorder or phobia—like fear of germs—you’re more likely to wash whenever your health anxiety is activated, without paying special attention to patterns or rituals.
How compulsive handwashing shows up in OCD
Contamination OCD
Ibrahim says that compulsive handwashing is most often seen with contamination OCD, a subtype marked by intrusive thoughts about becoming contaminated by germs, accidentally infecting others, or becoming like someone or something you find disgusting. In addition to frequently and aggressively washing your hands, your compulsions might include using harsh chemicals to clean yourself. Or, you may feel compelled to wear plastic gloves in an effort to stay clean. You may find yourself excessively researching illnesses and pathogens, washing after having “impure” thoughts, or avoiding “dirty” places like public transportation.
Common intrusive thoughts associated with contamination OCD include:
- “Someone sneezed near me; what if I get sick?”
- “I just showered, but I still feel dirty.”
- “If I use the public bathroom, I’ll never feel clean again.”
- “If I clean the bathroom, will germs contaminate my skin?”
- “I don’t care if I get sick, but I couldn’t live with myself if I got someone else sick.”
- “I just thought about cheating on my partner; I need to wash my hands to feel clean.”
Harm OCD
Harm OCD, a subtype that causes obsessions about harming oneself or others, can also contribute to excessive handwashing. People with harm OCD may obsess over accidentally infecting someone else. For example, you might worry: “What if I get someone sick, and they die?”
Responsibility and magical thinking OCD
Responsibility OCD can also play a role here. This subtype is characterized by the belief that you are responsible for negative outcomes, because you did (or did not) perform a specific action. These fears can feel enormous. For example, you might find yourself worrying about accidentally starting the spread of another pandemic, simply because you didn’t wash your hands enough.
In some cases, concerns like these can align with magical thinking OCD, a subtype that causes worries about bad outcomes occurring if you don’t perform compulsions. With magical thinking OCD, your fears may seem completely unrelated to compulsive handwashing, yet you still feel an urge to participate in this compulsion. For instance, you might be on a flight and think to yourself: “I must keep my hands exceptionally clean, otherwise this plane will crash.”
Scrupulosity OCD
Many spiritual practices include cleansing rituals. If you’re dealing with scrupulosity OCD—a subtype characterized by obsessions about violating a religious code, washing rituals can become compulsive. You might find yourself thinking: “My hands are still too dirty, therefore my prayers won’t count.”
Perfectionism OCD
With perfectionism OCD, you may feel a need to perform actions until you feel they have been “perfectly” executed. You may find yourself washing your hands over and over again in search of a perfect standard of cleanliness you can never truly achieve.
How to treat compulsive hand-washing
If compulsive handwashing is causing physical symptoms that aren’t clearing up quickly, it’s important to consult a physician. However, it will also be key to address the root cause of your behavior with a trained mental health professional.
ERP therapy for compulsive handwashing
Whether you’re dealing with an illness anxiety disorder, a specific phobia, or OCD, exposure and response prevention (ERP) therapy is the most effective treatment. In ERP therapy, you’ll be slowly exposed to situations that trigger your fears, and taught how to resist your compulsions.
This is a gradual process—meaning that you’ll begin with exposures that only elicit a small amount of discomfort, and work up from there. Ibrahim says that might include cutting down the number of times you wash per day, or reducing the amount of soap you use. “ERP can also include writing scripts about worst-case scenarios,” she explains. “That might mean exploring what it would be like if you contracted the disease you’re trying to avoid with compulsive handwashing.”
That might mean exploring what it would be like if you contracted the disease you’re trying to avoid with compulsive handwashing.
ERP therapy isn’t always easy, but it is highly effective, and you’ll have a specially trained therapist guiding you throughout your journey. In time, you’ll be able to manage your anxiety with more ease—instead of resorting to excessive handwashing.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Bottom line
It might feel like you’ll never be able to stop washing your hands, due to overwhelming worries about health, harm, contamination, or scrupulosity. But, with time—and the support of a trained ERP therapist—you can regain control over your fears, and return to a more manageable personal hygiene routine. Whenever you’re ready, know that there are trained therapists waiting to help you turn off the faucet, put down the soap, and get back to doing the things you love.
Key takeaways
- Compulsive handwashing is when someone repeatedly and excessively washes their hands, sometimes relying on ritualistic patterns.
- OCD, illness anxiety disorders, and phobias can all cause compulsive handwashing.
- For people with OCD, excessive handwashing may stem from fears about contamination, harm, scrupulosity, perfectionism, or responsibility for others.
- Compulsive handwashing can be effectively treated with ERP therapy, regardless of whether the cause is an illness anxiety disorder, phobia, or OCD.
