Health

January 13 2017

Getting to grips with germaphobia

Professor Michael Kyrios FAPS
By Australian National University expert in obsessive-compulsive spectrum disorders and behavioural addictions

Donald Trump has famously professed an aversion to germs. But when does distaste become a disorder?

What is germaphobia?

Germaphobia (sometimes spelt germophobia) is a term used by psychologists to describe a pathological fear of germs, bacteria, microbes, contamination and infection. It is known by a range of other terms including mysophobia (fear of uncleanliness), verminophobia, bacillophobia, bacteriophobia. Other terms which relate to an abnormal fear of dirt and filth include molysmophobia or molysomophobia, rhypophobia, and rupophobia.

Is there any relationship to obsessive-compulsive disorder?

The problems associated with germaphobia are closely related to obsessive-compulsive disorder (OCD). From studies in the US and other Western countries we known around one-quarter to one-third of people with OCD have contamination fears and associated decontamination rituals such as compulsive handwashing, washing and cleaning compulsions, and avoidance of potential contaminants. Studies from the Middle East reveal a higher prevalence of washing and cleaning rituals in OCD samples (between 50 per cent and 80 per cent), with females twice as likely to present with such difficulties.

While germaphobia is specifically related to fear of germs and infection, many people with OCD have concerns about a broader range of triggers, such as bodily fluids (sweat, saliva, mucus or tears), sticky or greasy substances, chemicals, radioactivity, broken glass, asbestos, newsprint and even moral impurity. Hence, prevalence rates for germaphobia specifically may be lower than those for contaminations fears and decontamination compulsions in OCD.

How does germaphobia manifest itself? 

Germaphobes will typically have washing and cleaning compulsions, and will avoid potential contaminants. Decontamination compulsions can consume the life of affected individuals. Excessive and time-consuming cleaning, ritualised showering and bathing to remove perceived dirt and germs, extreme tooth brushing, grooming or toilet routines, as well constantly focusing attention on assessing the threat of infection all take their toll on sufferers’ quality of life.  Persistent washing can result in red, dry, cracked or irritated skin, discomfort, wrinkles and even skin lesions which are then prone to bleeding and infection.

Avoidance can include the excessive use of hand sanitisers and antibacterial creams, avoiding  handshaking or specific aisles of the supermarket where chemicals are stored, using one’s sleeve or tissue to open a door, wearing gloves, shunning of social events in order to avoid people who might be ill, pushing the heel of one shoe down with the other so as not to touch their shoes, shopping online so as not to have to touch money, and evasion of hospitals, doctors or public toilets which can have an enormous detrimental effect on one’s health, social and work life.

Given germs can make us ill, is there a logical basis for the condition?  

There are “good” and “bad” germs which need to co-exist in order for our immune system to work effectively. We also need to be exposed to “bad germs” from our early years in order for us to develop a strong immune system. The human immune system is therefore resilient against germs. That said, there are reasonable steps we need to take to maintain good health personally and as a community. While there are clearly times and places when we need to be more attuned to maintaining healthy practices with respect to infection (such as when handling food, in a hospital, or during specific outbreaks such as flu season), it is a balancing act. We should not be alarmed or overly fearful, nor should we go overboard with preventative and reactive measures.

Has it increased in prevalence in recent years? 

It’s hard to know whether germaphobia has increased over the years. We know that it has peaked at various times, such as when there has been widespread reporting of AIDS, Bird Flu, Ebola and Zika virus outbreaks. Once these outbreaks subside, so does the reporting of germaphobia.

Are there common causes that can trigger it? 

A range of genetic and psychological factors, as well as life experiences, influence its onset. A predisposition to be sensitive to threat increases the chances of developing germaphobia. A family history of OCD or anxiety disorders or an upbringing overly focused on germs and washing/cleaning or with a history of health problems also increases the chances. Overestimating the probability of danger and the likely severity of dangerous outcomes eventuating, preserving the need for perfection and one’s intolerance for uncertainty, as well as having an overinflated sense of personal responsibility for preventing harm will all increase a person’s propensity for germaphobia.

Do you think the promotion of antibacterial products can exacerbate incidence of germaphobia?  

Yes. There are instances where antibacterial products are required such as in hospitals and food management and where their reasonable use can be advantageous. But scare campaigns that encourage the overuse of such products are of detriment to individuals and the community. For instance, the increased prevalence of allergies and asthma has been linked to widespread use of antibacterial products by parents.

Is it still possible to be a germaphobe and be filthy?   

With human nature, everything is possible. So, yes, it is possible to be germaphobic and live in unkempt surroundings, especially in cases where people are extremely avoidant.  I have seen a number of cases of people who live in squalid conditions, presenting with Hoarding Disorder and OCD characterised by contamination fears.

How can people overcome it? 

Germaphobia – like OCD  –  is treatable with psychological treatments such as cognitive behaviour therapy (CBT).  The basis of CBT is gradual exposure to feared situations and anxiety management strategies such as relaxation and breathing techniques.

More recently, mindfulness-based cognitive approaches, acceptance and commitment and narrative techniques have also been incorporated into more traditional CBT, although the evidence-base for such approaches is immature. CBT can be combined with psychotropic medications, usually serotonin reuptake inhibitors (SSRIs) in the treatment of OCD and germaphobia, but generally people with germaphobia benefit from psychological therapy to question their beliefs about the severity and likelihood of contamination and the possible outcomes of it.

Mike Kyrios recently spoke to The Washington Post about germaphobia.