How To Stop Compulsive Handwashing
1. Understand your contamination obsessions: Contamination obsession is a common symptom of obsessive-compulsive disorder (OCD).
2. De-Personalize the Symptoms: You are not the OCD. You are not defective.
3. Identify ‘What If” Thoughts: You will expose OCD’s unhelpful “What If” thoughts and change them to more helpful “If Then” thoughts.
4. Create Powerful “If Then” Thoughts: “If Then” thoughts and statements set behavioral intentions or goals with the power to create feelings of certainty. This will help reduce self-doubt.
5. Devalue the Obsessive Thoughts: Instead of focusing on the fearful content of the thought (“What if there are germs on my hand?”), label it as just a thought that produces self-doubt and anxiety. “That’s just an obsession.”
6. Use Imaginal Exposure: Mentally rehearse touching an object without immediately washing your hands. Repeat this until your level of anxiety decreases.
7. Delay washing your hands: Actual real-time exposure can be gradual. Set a timer for 5 minutes and then wash your hands only one time and rate your level of anxiety. Continue to delay until your level of anxiety is lower.
8. Choose not to wash your hands: After successfully delaying the compulsion to wash your hands, you are now ready to challenge yourself with not washing at all.
Overview
Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder and is considered a chronic condition. Effective treatment, however, can significantly reduce the symptoms and produce a full remission of the disorder.
Obsessions are unwanted intrusive thoughts, images, or impulses/urges that cause intense feelings of shame, guilt, and doubt. This can trigger uncomfortable levels of anxiety, including panic attacks (aka anxiety attacks).
Compulsions are behaviors or rituals that are used to decrease the intensity of the obsessions and anxiety. Compulsive behaviors can also be said to neutralize the feeling of anxiety caused by the obsessive thoughts and beliefs. But the compulsive behavior only provides short-term relief from anxiety.
When the compulsive behavior reduces a person’s anxiety, it also confirms that the obsessive thoughts are dangerous or somehow true. Because anxiety is reduced, the compulsive behavior or ritual is reinforced and is more likely to be repeated again in the future. This becomes a vicious cycle.
Symptoms
Obsessive Thoughts, Images, or Impulses
Obsessive thoughts and images may not be about real or actual events. These intrusive thoughts are repetitive and focus more on getting it “right” and involve the fear of something that has not happened yet, such as “What if I didn’t lock the door, someone can just walk in my home and take everything.” Or more disturbing, “What if I can’t control myself while using a knife and I stab everyone in the room.” These are not fantasies or actual urges. These are unwanted fearful thoughts that can cause feelings of shame and self-doubt.
Types of Obsessions
Contamination Obsessions
Fear of Germs
Fear of Chemicals
Fear of Bodily Fluids (urine, saliva, and blood)
Losing Control Obsessions
Fear of acting on impulse and saying inappropriate things
Fear of acting on an impulse to harm oneself
Fear of acting on an impulse to harm others
Fear of violent thoughts and images
Harm Obsessions
Fear of inadvertently causing another person’s harm (by thinking it or not being careful enough)
Moral Obsessions
Unwanted Sexually Explicit or Perverse Thoughts and/or Images
Over-concern with right and wrong judgements
Over-concern with sin or angering God
Self-Doubt Obsessions
Fear of losing or forgetting important information when throwing something out
Fear of making mistakes or doing something wrong
Perfectionistic Obsessions
Over-concern about things being exact and precise
Over-concern with a need to know something or to remember something
Compulsions
Compulsive behaviors only temporarily reduce obsessive thoughts and the resulting anxiety. These behaviors attempt to get things rights, remove doubt, and to avoid some future calamity. Compulsions are time consuming and often interfere with important obligations such as getting to school or work on time.
Types of Compulsions
Avoiding
Staying away from people, places, and things that trigger obsessive thoughts, images, and/or impulses
Checking
Checking to make certain that you did not make a mistake
Checking that you did not harm others (calling them, calling hospitals)
Checking anything to remove feelings of doubt
Asking the same question over again or repetitively seeking reassurance
Cleaning and Washing
Cleaning and then re-cleaning
Excessively washing hands
Excessively showering (too many times or too long)
Mental Compulsions
Mentally counting to land on a specific number (ex. “Must be an even number”)
Praying or reciting
Repeating
Repeating a task (ex. locking the door 3 times)
Repeating body movements (tapping, blinking)
Other Symptoms
Tics
Tics are sudden, uncontrolled, and repetitive movements or vocal sounds that are common with OCD, Tourette’s, and ADHD. There are 2 kinds of Tics, motor and vocal.
Motor Tics
Simple motor tics include head twitching, eye blinking, nose twitching, facial grimacing, and shoulder shrugging.
More complex motor tics include skipping, jumping, kicking, and smelling hands or other objects.
Vocal Tics
Simple vocal tics include throat clearing, coughing, grunting, barking, and hissing.
More complex vocal tics include yelling, making animal sounds, and repeating words and/or phrases.
Risk Factors
It is estimated that 1 out of 200 kids and teens, and 1 out of 100 adults can be diagnosed with OCD.
It can begin as early as 8 years of age and typically develops between the ages of 15 and 44. OCD is the 4th most common mental illness after phobias and depression.
Risk factors for developing OCD include a family history of OCD, trauma, and chronic stress.
Causes
To this date there is no definitive cause for OCD.
Most theories suggest a possible genetic link, changes in brain chemistry and functions, and environmental factors such as infections (PANDAS).
Unhelpful reactions to intrusive thoughts or obsessions and poor coping skills can contribute to the development of OCD.
Exaggerated and catastrophic beliefs about the importance of the obsessive thoughts triggers anxiety and anxious behavior.
PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is a type of OCD that develops in children after being exposed to infection. The body reacts to the infection, causing sudden and severe symptoms of OCD.
Treatment
If you believe you could have Obsessive Compulsive Disorder (OCD) it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
Medication
Please consult with your primary care physician or a psychiatrist regarding the use of medication.
Anti-depressant medications are also effective at reducing symptoms of anxiety on a daily basis. This helps dampen the physical and emotional effects of anxiety and increases a person’s capacity to cope with stressful situations.
Commonly prescribed anti-depressants are:
Citalopram (Celexa)
Escitalopram (Lexapro)
Sertraline (Zoloft)
Paroxetine (Paxil)
Fluoxetine (Prozac)
Medication alone, however, is usually not enough for treating OCD. Certain medication can be more helpful when combined with psychotherapy.
Psychotherapy
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is a well-researched and highly effective form of talk therapy that focuses on learning more helpful ways of thinking and behaving. You learn different ways of responding to the symptoms of OCD and to your feelings of anxiety.
CBT helps challenge and change unhelpful beliefs that cause anxiety by restructuring automatic thinking and changing the way you behave in response to obsessive thoughts.
CBT sessions also provide education on the symptoms of OCD and how to manage the emotional and physical symptoms of anxiety.
Exposure and Response Prevention (ERP)
A form of Cognitive-Behavioral Therapy (CBT) known as Exposure and Response Prevention has been the most effective method for treating the symptoms of OCD.
With Exposure and Response Prevention, a mental health professional trained in CBT conducts a series of sessions to gradually expose the person to situations that trigger his or her obsessive thoughts and compulsive behaviors. Over time, the person learns to respond differently to these triggers, leading to a decrease in the frequency of compulsions and the intensity of obsessions.
As with most anxiety disorders, in order to learn how to overcome the symptoms of anxiety and to know that you can cope with anxiety and master the symptoms, you need to have the experience of successfully managing the symptoms. This often means exposing yourself to the thoughts, images, and impulses related to OCD and preventing from engaging in the compulsive behavior to reduce the anxiety.
Exposure and Response Prevention is an evidence-based treatment that interrupts the link between the anxiety produced by the obsessive thought and the compulsive behavior or ritual.
With the help of a mental health professional you are exposed to the obsession that triggers anxiety and then you are prevented from carrying out the compulsive ritual that usually decreases the anxiety.
For example some with an obsession about contamination, will touch something dirty. Their anxiety will increase and they will sit with the anxiety and not engage in their ritual of hand washing. The anxiety will reach a peak and then it will naturally decrease and return back to normal levels, all without engaging in the compulsive ritual.
This process will be repeated until touching the dirty object no longer produces anxiety.
The exposure is gradual at first and then the exposure becomes more prolonged overtime.
Cognitive Behavioral Therapies, such as ERP, can actually change the biochemistry in the brain that causes the symptoms of OCD.
Treating Intrusive Obsessional Thoughts without Compulsions
Most people experience intrusive thoughts. Intrusive thoughts by themselves are not the problem. It’s the reaction you have to the intrusive thought that’s the problem. If you react with the belief that the thoughts are dangerous by trying to stop the thoughts or use avoidance, then you will experience anxiety and fear. Your reaction causes the anxiety, not the intrusive thoughts.
To conquer intrusive thoughts see 7 Steps for Overcoming Intrusive Thoughts.
How to stop compulsive handwashing
1. Understand your contamination obsessions
Contamination obsession is a common symptom of obsessive-compulsive disorder (OCD), characterized by an overwhelming fear of germs, dirt, or harmful substances. Individuals with this obsession often experience intense anxiety about coming into contact with contaminants, leading to compulsive behaviors such as excessive handwashing, avoiding certain places or objects, and repeatedly disinfecting their surroundings. These fears may extend beyond physical germs to include environmental toxins, chemicals, or even perceived moral or spiritual contamination. Despite recognizing that their fears may be irrational, those affected struggle to control their intrusive thoughts and compulsions, which can significantly disrupt daily life and relationships. Therapy, particularly cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP), is often effective in helping individuals manage their contamination fears and regain a sense of control.
So learn to trust yourself and tell yourself "This is just OCD and it's lying to me."
2. De-Personalize the Symptoms of Obsessive Compulsive Disorder
You are not the OCD. You are not defective.
The first step in learning to trust yourself is to stop blaming yourself for the symptoms.
Detach your “Self” from the symptoms of obsessive compulsive disorder by telling yourself, “It’s the OCD, not me.”
These are symptoms of a medical disorder that can be successfully treated.
The symptoms of OCD are caused by biological imbalances in the brain. The feelings produced are a false alarm that have little or no basis in reality. They are false and misleading messages from parts your brain that contradict the logical part of your brain that says “But I did lock the door.”
Start trusting your knowledge about the symptoms, causes, and treatment of Obsessive Compulsive Disorder (OCD).
3. Identify ‘What If” Thoughts
You will expose OCD’s unhelpful “What If” thoughts and change them to more helpful “If Then” thoughts.
Your subconscious mind and your sympathetic nervous system will respond to the “What If” thoughts of your conscious mind by increasing the level of adrenaline and other stress hormones in your blood stream.
If your “What If” thought is focused on fear and anxiety, then you will experience more fear and anxiety. If your “What If” thought is focused on a desired positive outcome or what you want, then you will feel less anxious.
Identify the fear or what is going to happen if you don’t compulsively wash your hands.
Example: “What if my hands are contaminated and I don't wash them? I will get sick or something bad will happen!”
These “What If” thoughts trigger more self-doubt, anxiety, and more compulsive urges to hand wash.
4. Create Powerful “If Then” Thoughts
“If Then” thoughts and statements set behavioral intentions or goals with the power to create feelings of certainty. This will help reduce self-doubt.
These are logical statements that the human brain is very good at encoding.
This is the language of your brain. Your brain is more capable of processing, “If X happens, then Y will happen.” It’s very simple, specific, and not at all vague.
Example: “If I touch a door knob and don't wash my hands I will beat the OCD!” “If I don't wash my hands, then my feeling of anxiety and fear of contamination will eventually go away and I will feel proud of myself.”
You are telling your sympathetic nervous system that there is no danger. This will reduce the symptoms of anxiety.
You are instructing your sympathetic nervous system how to respond appropriately instead of reacting with anxiety.
5. Devalue the Obsessive Thoughts
Take the power away from the “What If” thoughts.
Instead of focusing on the fearful content of the thought (“What if my hands are contaminated?”), label it as just a thought that produces self-doubt and anxiety. “That’s just an obsession.”
This will move you away from the emotional content of the thought. Say, “This (what if) thought is just an anxiety provoking thought.”
They are just thoughts. They have no physical weight to them. No one can see them in your head. You can’t touch the thoughts. You can’t cut your finger with a thought.
Just because you have a thought, it does not mean that it is true or will come true.
6. Use mental rehearsal or Imaginal Exposure
Imaginal exposure is a cognitive-behavioral therapy (CBT) technique used to help individuals confront and process feared thoughts, images, or situations in a controlled way. It is particularly effective for anxiety disorders, including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and phobias. Instead of facing fears in real life, imaginal exposure involves vividly imagining distressing scenarios, often writing them down or listening to recordings, to reduce anxiety and desensitize the individual to the feared stimuli over time. This method is especially useful when real-life exposure is impractical or impossible, such as fears related to contamination, harming others, or intrusive thoughts. By repeatedly confronting these fears in a safe, structured manner, individuals learn that their anxiety decreases over time and that their feared outcomes are unlikely to occur, ultimately weakening the power of their obsessive thoughts.
Begin by using mental rehearsal (Imaginal exposure). Sit back, close your eyes, and visually imagine yourself touching a door knob and not washing your hands. Take some deep breaths and ride out any anxiety you feel in the moment. Continue doing this until you no longer experience any anxiety.
Then you can move to the next step which is real-time exposure (In vivo).
7. Delay washing your hands
Delay your compulsion to wash. This is called gradual exposure.
Allow yourself time to monitor your “What If” thoughts and to create a more powerful “If Then” thought.
Delay washing your hands while stating your “If Then” thought. You can use a timer on your phone to wait 2 minutes, 5 minutes etc. You can continue to delay for longer periods of time and eventually not wash at all.
Example: You experience fear and anxiety about contamination after touching the door to your home. After identifying your “What If” fear, create the intention of “If I touch the door knob and don't wash my hands right away, nothing bad will happen."
Set a timer for 5 minutes and then check you level of anxiety before washing your hands.
Each time you delay checking, try delaying for longer periods of time. This is how you gradually expose yourself to the anxiety. Using a timer can help you feel more in control and give you specific feedback about improvement. This can improve your level of confidence.
This is how you begin to take back control over something that you feel out of control with.
Identify your point of no return
Soon you will be able to delay washing your hands by driving away or finally falling asleep at night.
If you are leaving your home and going to work or school, there will be a place when turning back to wash your hands will be more difficult for you or unacceptable to do.
As a result you will tend to just keep on going to work or school without washing your hands.
Your goal is to get to this place of no return without washing your hands or using hand sanitizer.
Know that any anxiety you experience will subside as you begin to shift your focus to work, school, or other task that you are heading towards.
Be proud of yourself for reaching this point of no return and continuing on.
Resisting compulsions can actually change the biochemistry and functioning of your brain that is causing the symptoms of OCD.
8. Choose not to wash your hands
After successfully delaying the compulsion to immediately wash your hands, you will choose to wait even longer. Obviously, there will be a time when you will wash your hands such as after using the restroom, before cooking, and you know before doing that surgery.
“Resisting the urge to engage in the compulsion will change how my brain works and will decrease the symptoms of OCD.”
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