Many people openly admit to being a germaphobe. Although not an actual medical term, most people agree that a germaphobe is someone who is preoccupied or even obsessed with cleanliness, germs and infectious diseases. While being a germaphobe does not necessarily mean that you have OCD, an obsession with sanitation, cleanliness and germs along with compulsive behavior around washing or disinfection may signal a deeper problem. Let's explore when being a germaphobe may be an OCD symptom.
Worries About Germs are Common
Worries about contamination by germs and/or catching infectious diseases are common in our society -- you need not look further than the presence of hand sanitizer dispensers in public spaces or the barrage of advertisements for antibacterial products to realize that our society is, to some extent, preoccupied with germs.
That said, on a day-to-day basis, most people do not spend more than a few moments (if that) worrying about their hands being contaminated after touching the doorknob in an office building, pressing a button in an elevator or tying a loose shoelace after being in a public restroom. For most, if thoughts of contamination cross the mind, a common sense approach of washing or sanitizing their hands for a few moments sets the mind at ease and they get on with their day.
However, if you are a germaphobe, you know that these kinds of situations can be anxiety provoking and may even make you want to avoid places where you are likely to encounter contamination or germs. Importantly, an obsession with cleanliness, contamination and/or germs is also a common OCD symptom. However, when does a preoccupation with germs cross the line into an obsession? When does a personal hygiene routine or cleaning regimen become a compulsion? Let's try to answer these questions using two examples.
Tina and John: A Tale of Two Germaphobes
Case 1: Tina is a 38-year-old financial analyst. Tina readily describes herself as a germaphobe, and people who know her well have noticed her preoccupation with germs. Tina will often cover her hand with a paper towel when opening the door of a public restroom and prefers not to touch the seats on the subway which she rides every day. She cringes when she has to take out the garbage each week but does so without fail. Tina almost always thinks about germs for a moment or two when shaking someone's hand at a business meeting or in social settings, but this quickly leaves her mind after a few seconds. If she is really worried about her hands being dirty, a quick dab of hand sanitizer always does the trick. Importantly, Tina is not distressed by her preoccupation with germs; in fact, she feels that her vigilance allows her to avoid a number of colds each year and stay productive. Moreover, while her loft is usually spotless, she spends no more than three hours a week cleaning and often puts this off to head out for dinner with friends or to spend time with her partner.
Case 2: John is a 42-year-old part-time computer consultant. John also describes himself as a germaphobe, and his wife and children agree that this is the perfect label for him. John rarely allows eggs or chicken in the house as he is afraid that they will contaminate the house with salmonella bacteria. When his wife does cook with eggs he makes her wash her hands in very hot water for well over two minutes. Moreover, John has to wear thick rubber gloves when disposing of egg cartons and must wash his hands afterwords or else he feels extremely anxious. John refuses to go into public restrooms and has canceled numerous activities with friends over the years for fear of having to use the restroom in public. If John catches wind that someone at the office has come down with a stomach flu he will obsess for hours over whether he has come into contact with that person and will often take a shower because he feels "dirty". He knows this makes no sense and often feels he is going crazy. John spends up to 5 hours a day bleaching all of the surfaces in his home. His constant cleaning and preoccupation with contamination have put a significant strain on his relationship with his wife and children. Moreover, although he was initially able to cope with his obsessions while at work, his preoccupation with germs has started to affect his ability to perform the duties associated with this job.
The Analysis - Germaphobe, OCD or Both?
Both Tina and John describe themselves as "germaphobes"; however, it is clear that Tina's preoccupation with germs has only a small impact on her day-to-day functioning, while John's life is falling apart and dominated by obsessions with contamination (e.g., salmonella infection; catching a stomach flu; contracting germs from a bathroom) and ruled by compulsions that are designed to relieve his anxiety (e.g., hand washing, sanitizing).
In addition, while Tina is not distressed by her preoccupation with germs, John often feels he is going crazy, cannot tolerate the possibility of contamination and goes to great excess to ensure that all germs have been removed. Most importantly, while Tina has healthy personal and professional relationships, John's relationships at work and at home are being compromised by his obsession with contamination.
Thus, although they are both self-confessed "germaphobes", John's symptoms are very much consistent with OCD, whereas Tina is likely someone who simply has above-average concerns about germs. John would be very likely to benefit from consultation with his family doctor or a mental health professional to complete a clinical interview and medical history to make a definitive diagnosis of OCD and explore potential treatment options.
If you, a family member or someone else you know has a preoccupation with germs that is distressing, unwanted, uncontrollable and having an impact on day-to-day functioning, it may be time to consider speaking with a mental health professional -- the problem may run deeper than simply being a germaphobe. Effective psychological and medical treatment for OCD is available.
American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.