HealthLeader

An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Germaphobia

This irrational fear doesn't begin with the germs themselves

Germaphobia

You always admired the way your friend Jenny continually maintained the cleanest home on the block. The fact that she forever had a container of hand sanitizer at the ready just seemed like one of her endearing quirks.

But during a recent lunch date, you noticed she spent an inordinately long time in the restroom. You then noticed how dry and cracked her hands always appear to be, and there was no explaining away the cabinet in her kitchen stacked full with packages of antiseptic wipes. While you and Jenny share a desire to keep your homes and work spaces tidy and maintain good personal hygiene, she has apparently taken it to another level.

The truth is your friend may be one of the millions of Americans who has developed an unhealthy and potentially debilitating aversion to germs. Not just some germs; all germs. She is, you realize, a “germaphobe.”

In truth, germaphobia is not really about germs at all. Prevailing research indicates it is a form of obsessive compulsive disorder (OCD), an abnormality in the brain’s circuitry. While OCD can take many forms, the commonality of the disorder is that sufferers have a compulsion to repeat a behavior that will help them relieve the anxiety caused by an irrational, intrusive thought.

“People with OCD develop rituals to help them cope with the obsessive thoughts that come out of nowhere,” says Jair Soares, MD, professor and chair of the Department of Psychiatry and Behavioral Sciences at The University of Texas Health Science Center at Houston (UTHealth) Medical School. “But these rituals can ruin their life and take time away from other activities and prevent them from doing things they should be doing.”

While many of us enjoy a clean home, car or office and religiously wash our hands after using the restroom, a person suffering from germaphobia sees potentially harmful microorganisms lurking on every surface and believes contact with these surfaces or other people who they believe may be harboring germs can somehow harm them. So they resort to washing their hands or cleaning their kitchen counter tops over and over to the point that such actions begin to take control of their life.

Not only can the compulsive condition cause a disruption in the daily lives of the sufferers and those around them, the desire to rid their world of all germs can also predispose them to susceptibility to infection or illness by weakening their body’s immune system. While obsessively trying to keep clean, constant hand washing with antibacterial agents can leave skin dry and cracked, increasing the chance for harmful germs to gain entry to the body.

Most germs are harmless

“There are jillions of germs out there that are not pathogenic [harmful] at all. The germs in our bodies naturally comprise our normal flora, and we would have trouble existing without them,” says Charles D. Ericsson, MD, head of clinical infectious diseases in the Department of Internal Medicine at UTHealth Medical School. “The natural flora in symbiosis prevents pathogenic germs from getting a toe hold and causing infection.”

The assault against germs — bacteria, viruses and fungus — has intensified, at least in the U.S., over the last 20 to 30 years. In the 1980s, if you saw someone walking around with a bottle of hand sanitizer, you might assume that a member of a janitorial service was at work. But while having clean hands is certainly recommended to help stave off illness, a person with germaphobia takes it to the extreme and seeks to eradicate all germs from their life. But, as Ericsson explains, even if it were possible to achieve a germ-free world, it wouldn’t work out so well — for us.

“The theory that’s becoming more accepted is that failure to allow yourself some degree of germ exposure may prevent you from developing immunity to allergens and may make you prone to allergic reaction conditions,” Ericsson says.

According to Ericsson, there are three primary ways in which potentially harmful micro-organisms enter our bodies. They become “aerosolized” and spread around as tiny particles for long distances. Diseases like tuberculosis are spread in this manner. Second, the pathogen is spread via droplets projected into the air when someone coughs or sneezes. The third is by one’s own germy hands that then touch the nose, eyes, mouth or other opening in the skin or body, thereby allowing germs to gain entry.  

However, the person suffering from germaphobia is not concerned with logic or science; they are hounded by the irrational fear of germs nipping at their heels, so they wash and clean, clean and wash to relieve anxiety.

Our collective vigilance against germs began to accelerate after 19th century French chemist and microbiologist Louis Pasteur posited his “germ theory,” which stated that germs from the outside invade our bodies and cause illness, prompting the need to kill them before they enter. A variety of public health campaigns in the U.S. in the late 19th and early 20th centuries brought the importance of proper hygiene out in the open, but Ericsson maintains that as a society, we have been on an unrealistic trajectory toward ridding the world of bacteria for decades.

“In the medical field, we’ve known for a while how to avoid (bacterial) transmission, but for some reason this has carried over into the lay population as a worthy goal,” he says. “For many, this gets taken a quantum step forward beyond reasonableness. They might see the role models of cleanliness — doctors — washing their hands often and begin to think that’s something they should do on a regular basis.

“You see studies all the time where someone says they went to a local restaurant and cultured the iced tea and found bacteria,” Ericsson continues. “Well, so what? The world’s not sterile. It’s a matter of degree and what kind of bacteria you’re dealing with.”

We have enlisted a variety of drugs and chemical agents to assist in the anti-germ fight, including triclosan, the antibacterial and antifungal agent used in a host of products, including toothpaste, deodorants, mouth washes and cleaning supplies. While triclosan has been proven effective in destroying certain potentially harmful bacteria and viruses, research indicates its widespread use promotes the creation of resistant strains of pathogens.

It has even been linked to the formation of potentially toxic dioxins harmful to the human endocrine system. As a result, many are calling for triclosan to be banned. In 2009, the Canadian Medical Association asked the Canadian government to ban its use in household cleaning products.

Ericsson says the over prescription of antibiotics — the leaders in the antibacterial battle — to fight illness poses a health threat as well since their overuse can also lead to resistant strains of bacteria.

“Antibiotics are a double-edged sword. They have saved a tremendous number of lives and we wouldn’t want to live without them, but we have to be judicious and use them in a way that does not develop antibiotic resistance,” Ericsson says. “That may seem self-evident, but in one pediatric practice several years ago, patients were leaving with antibiotics in hand. And, in 34 percent of the cases, the pediatrician wrote on the chart, ‘viral syndrome’ and knew full well that the antibiotic [useless against viruses] won’t work, but the patient demanded it.”

Treatment options

The key to treating germaphobia, as with all OCD conditions, is to treat them for what they are: disorders in the brain’s circuitry. Soares says that while the cause of OCD is not known, there appears to be a hereditary connection.

“People with OCD have abnormalities in the part of the brain that controls our impulses and emotions,” Soares says. “We don’t know how this comes about, but there is a genetic component in that it often passes within families. But the specific genes have not been found.”

Soares says in the past, psychoanalysis was used to treat OCD and focused on finding psychological explanations for why people performed such ritual activities. The belief was that something bad happened earlier in life that made persons with germaphobia feel dirty, but he says the treatment strategy has changed.

“We know it is a disease of the brain, so we approach treatment from a clinical perspective. Treatment now includes a combination of medications to modulate serotonin in the brain, called selective serotonin re-uptake inhibitors, along with psychotherapy that utilizes cognitive behavioral therapy (CBT). These approaches focus on teaching techniques to control and conquer the undesired behavior,” Soares says.

Soares says CBT works by identifying the distorted thinking process behind OCD rituals and giving the patient tools to deal with the intrusive thoughts. The treatment frequently involves gradual exposure under supervised conditions to situations that make them uncomfortable.

“If someone has a need to keep washing their hands, for example, we develop a plan where they’re gradually not going to do that and give them tools to cope with their anxieties in other ways,” Soares says. “Many patients are able to achieve full remission through this technique and a sizeable group gets drastically better. The message is that it is a treatable condition.”

In addition to the medical and psychotherapy treatment plan, Soares says friends and family play a huge role in helping the germaphobic patient find other ways to deal with the overwhelming anxiety that marks the disorder.

“People with mental illness who do best are those with a good support system. People who live with a great deal of isolation may not be directed to the right resources they need to get better, and desperation may set in,” he says. “Sometimes the person is in denial and doesn’t recognize that washing their hands 30 times a day is problematic behavior. Friends and family can point out these behaviors and question the person’s resistance to getting treatment.”

Soares continues that friends and family can also make sure the patient follows up on the treatment plan that’s been put in place.

While the symptoms of germaphobia can cause physical problems, the emotional strain of such OCD conditions is often more debilitating. He says those close to the sufferer can help by reminding them that their condition is not indicative of a weakness in character or a moral failing.

“OCD can be demoralizing. Friends and family can help them understand what’s going on and make them aware of the tools available and what red flags to look for and triggers to avoid,” Soares says. “These people can work with them to achieve the best possible outcome by helping them connect with the right professionals.”