OCD: When Cleaning Is a Compulsion

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is an authoritative guide to psychological conditions. It describes OCD as a disorder that causes people to experience distressing thoughts and mental images that won’t go away.

In response to these unwanted thoughts, people with OCD may feel an intense urge to repeat certain actions. The actions may be physical behaviors (such as arranging objects in a particular order) or mental ones (like praying in a particular way).

Some people feel that completing these actions will neutralize a threat, make an obsessive thought stop, or relieve the anxiety that unwanted thoughts create.

DSM-5 emphasizes that compulsive acts can take up a lot of time. They can disrupt a person’s social, academic, or professional life. The need to precisely perform rituals and compulsive acts can cause serious anxiety.

OCD, then, is much more than a desire to work or live in a clean environment or a preference for neatness. It involves a sometimes debilitating and distressing need to clean and reclean specific areas or items.

Although DSM-5 doesn’t list subtypes of OCD, some researchers group obsessions and compulsions into “symptom dimensions.” These clusters of symptoms share similar anxieties and behavior patterns.

Here’s a brief look at the symptom dimensions as currently described in scientific literature:

Contamination and cleaning

Some people have an extreme fear of becoming contaminated by germs, bodily fluids, or other substances — including abstract contaminants like evil or bad luck. People may even fear that they’re contaminating others.

An obsession with contamination can lead to a cleaning compulsion. People may believe that by cleaning objects or spaces in a specific order or with a particular frequency, they can avoid or recover from contamination or infection.

Symmetry and ordering

Some people become preoccupied with arranging objects in a certain order, often because of a kind of magical thinking or magical ideation. For example, individuals with OCD may think, “If I don’t line up my toiletries exactly this far apart, someone is going to harm me today, or if I clean my sink five times this morning, my brother won’t get sick today.”

Researchers have found that people with symmetry obsession and an ordering compulsion often have trouble expressing anger in healthy ways and may have a personal history of trauma.

Doubt about harm and checking

Some people have intrusive thoughts and fears about harming others or being harmed themselves. An excessive dread of being responsible for harm can lead to compulsive checking behaviors — for example, repeatedly making sure you’ve turned off the stove or an iron.

People affected by checking compulsions describe a feeling of incompleteness unless they perform certain rituals or behaviors. Other common compulsions include repeating mantras, prayers, or safety words to ward off danger or reduce anxiety.

Similar to symmetry and order compulsions, checking compulsions have been associated with anger and trauma.

Unacceptable thoughts and mental rituals

Some people experience frequent intrusive thoughts about things that violate their own sense of morality and goodness. Often, these unwanted thoughts involve sex, violence, or religious images.

Although people with this symptom cluster generally have no history of violence, they spend a lot of time and energy trying to suppress or erase these thoughts. Trying to squelch the thoughts can lead to even more anxiety, which tends to produce more unwanted thoughts — resulting in an unhealthy cycle.

Two of these symptom dimensions have a clear link to cleaning tasks: contamination and cleaning as well as symmetry and ordering.

You can’t prevent OCD, though doctors say an early diagnosis and intervention may mean you spend less time dealing with the difficulties this disorder can present.

About 2 percent of the general population has OCD. The disorder tends to appear at an earlier age in males. By midlife, though, more women than men have symptoms of OCD.

Here’s what we know about the risk factors, causes, and triggers of this disorder.

Genetics

Researchers continue to explore the influence of genetics on whether someone develops OCD.

As of now, scientists know that if your parent or sibling has OCD, you’re more likely to develop the condition. Some studies have found that the symptom dimensions involving OCD cleaning and ordering are especially likely to run in families.

Brain structure

Researchers are finding differences in the brain structures of people with OCD, along with differences in how their brain functions.

For example, one 2017 study found that in people with OCD, there’s greater connectivity and activity in parts of the brain associated with habit formation and in parts that process emotions — especially fear.

Brain scans also reveal differences in estrogen receptors and in the amount of white and gray matter in the brains of people with the contamination and cleaning symptom dimensions.

Understanding differences in brain structures is important because it may point to new directions for treating the condition.

Environment

Behavioral researchers have long known that stress and trauma are associated with a higher risk of developing OCD.

For example, 2015 study involving 22,084 Swedish twins indicates that two kinds of childhood trauma are particularly likely to lead to symptoms of OCD: abuse and family disruption.

OCD symptoms include not only obsessions and compulsions, but significant anxiety as well. You may feel stressed in circumstances where you feel out of control or uncertain.

If you have OCD and contamination or cleaning are important to you, you may notice that you:

• feel disgust or fear over certain objects or substances, including dirt, illness, body secretions, trash, or chemicals
• believe you or others can be contaminated by magical or spiritual means — such as by saying certain names or numbers
• have a strong urge to wash your hands or shower frequently
• use a very specific process or ritual for washing yourself or your surroundings
• change clothes several times a day
• avoid places or people that may have been infected
• conduct precise decontaminating rituals
• refuse to allow others into your safe spaces
• damage your skin or body through excessive cleaning

If you have OCD and it’s important for you to keep things symmetrical or arranged in a precise order, you may notice that you:

• experience serious anxiety if certain things are not arranged “just right”
• feel an urge to repeat what happens to one side of your body on the other side of your body
• fear that if something is unbalanced or uneven, a catastrophe could happen
• perform touching or tapping rituals
• count things habitually

A doctor, psychologist, or psychiatrist can diagnose your condition by interviewing you about your thought and behavior patterns or by asking you about symptoms listed in DSM-5.

A physical examination could help your doctor determine whether an underlying health condition is causing your symptoms.

OCD is well researched. Doctors, psychiatrists, and psychologists have found a number of treatments that can decrease your symptoms and improve your daily functioning.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is an effective treatment for many people dealing with OCD.

In a CBT session, you meet with a therapist who can help you decrease your anxiety by identifying thought patterns that distort your view of reality and cause stress. Your therapist can then help you learn to restructure these thoughts in productive ways.

Studies have shown that CBT strengthens connections throughout your brain, especially in areas that deal with your ability to control your thinking and balance your emotions.

Exposure and response prevention

Exposure and response prevention (ERP) is another type of therapy known to be effective in treating OCD.

In ERP, you and your therapist work together to identify external and internal triggers that cause you stress and make you want to behave compulsively.

You also describe your obsessive thoughts and your compulsive behaviors to your therapist. You explain what you fear will happen if you don’t follow through with a behavior or rituals.

Your therapist then helps you practice gradually facing stressful situations — both in your imagination and in real life — without using your compulsions.

Medication

Your doctor may prescribe an antidepressant to reduce your OCD symptoms. Some of the more common medications prescribed for OCD are:

• Anafranil
• Fluvoxamine
• Paxil
• Prozac
• Zoloft

If you take one of these medications to treat OCD, it’s important to talk to your doctor before you change your dose.

You shouldn’t stop taking your medication suddenly, because in some cases it can cause:

• a relapse of your symptoms
• serious changes in your mood
• an increased risk of suicidal thoughts

Deep brain stimulation

Your doctor may recommend deep brain stimulation (DBS) if more conservative treatment methods aren’t working for you.

During DBS, doctors implant electrodes in targeted areas of your brain. The electrodes produce electrical pulses that may help change your thoughts and behaviors.

Transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) is another approach to consider if other treatments aren’t helping you.

During TMS, a doctor places an electromagnetic coil on your head. Magnetic fields interact with nerve cells in your brain in an attempt to lessen your OCD symptoms.

If you have OCD and a cleaning or ordering compulsion, your symptoms can be treated. There’s a good outlook for people who seek treatment for their OCD.

The best outcomes happen when people are diagnosed early and start a robust treatment program right away.

Sometimes OCD goes into remission on its own, especially if it initially appears during childhood. Other times people need long-term treatment to keep symptoms in check.

Being a perfectionist about cleaning doesn’t necessarily mean you have OCD. Individuals with OCD experience persistent intrusive thoughts and a compulsion to carry out certain ritualistic behaviors.

OCD produces serious anxiety. Compulsive cleaning is often related to fears of contamination, and compulsive arranging can be caused by a need for symmetry and balance.

This disorder can be treated with therapy, medications, and procedures that stimulate parts of your brain known to be affected by the disorder. If you are diagnosed early and you participate in a treatment program consistently, it’s possible you’ll be able have a good quality of life.