Psychologist shares checklist: how to distinguish a fear of contamination from 'normal' valuing hygiene

Maybe you recognize it in yourself or in someone else: you can't stand dirt or things that are unhygienic. At first glance, this may seem like a preference for hygiene and cleanliness, but sometimes there is more to it. With germaphobia, the aversion to potentially dirty things is so strong that it can really control your life.

When should you worry and is your cleaning obsession going too far? Metro calls psychologist-behavioral therapist Wendy de Pree of Leerpositiefdenken.be about this.

De Pree indicates that she has heard many people say that they have a fear of contamination. “90 percent of people indicate that they suffer from obsessive thoughts, but in reality they do not suffer from them. During the corona pandemic you often heard that statement. We knew little about the virus and where exactly it came from. People were afraid that bacteria were spread on packages or by the postman.” OCD (obsessive-compulsive disorder) actually occurs in about 1 percent of the population.

She continues: “In a sense, that wasn’t entirely unjustified, but it went too far sometimes. You can get stuck in thoughts like: ‘What if the doorknob is contaminated?’ Even in people without an OCD, that thought can come back, even though you knew somewhere that it was exaggerated. Yet you forgot about it afterwards. But if you really have a fear of contamination, that thought keeps coming back.”

“Fear of contamination is one of the most common obsessive-compulsive disorders. The fear or thought doesn’t go away on its own; it keeps compulsively circling around in your head. You attach meaning to it, even when you know it doesn’t really make sense. When you have obsessive-compulsive disorder, thoughts often pop into your head, like: ‘What if I step in front of a train or drop my baby?’ You don’t do it, but the idea is there,” says the psychologist.

De Pree lists the characteristics of germ phobia: “In short: it causes intense fear of contamination and pollution. To counteract this, you perform compulsive actions, such as cleaning or washing your hands. This gives you a feeling of control for a while, as if you are undoing something scary. But it only helps for a short while. You remain uncertain and you no longer trust your memory: was it really clean?”

But there is a clear difference with everyday things, the psychologist explains. “You can also get out of your car and suddenly wonder: ‘Did I lock the car?’ You go back to check. But if you do this ten times, that is compulsion. That is the difference between normal behavior and a disorder: you really suffer from it. People with a fear of contamination wash their hands extremely often, sometimes until they are open. They also avoid others, do not touch buttons in public transport, or avoid public transport altogether. Or they touch things in a specific way and clean everything continuously.”

“There is nothing wrong with being clean, as long as it doesn’t bother you,” says De Pree. “But on social media you increasingly see people who say they have a ‘germophobia’ or call themselves ‘ADHD’, without there actually being a disorder. It only becomes really bad when you suffer significantly from it. A clean house is fine, but if you are only allowed to sit in the kitchen and no one is allowed in the living room because you think others are dirty, that is a problem. Especially if you spend several hours a day on it, just because you are so afraid of it, while in the end it actually makes you more insecure.”

OCD and germ phobia are not talked about much, according to De Pree: “A client of mine is a 16-year-old boy. He always had to shower and put on clean clothes after school. He sat alone in his room, afraid of contamination from outside. When the housekeeper touched his phone, he completely panicked: 'That can't be right?', 'how could she do that?'. He thought it was inhuman, but no one knew that he was struggling with it. He was terribly ashamed, that is suffering.”

An obsessive-compulsive disorder such as germ phobia can often already be 'advanced'. "Many people only come to me when it has really gotten out of hand. Spending half an hour cleaning is manageable. But when you can no longer maintain social contact, for example, that's when it really becomes a problem.

There is nothing wrong with wanting to be neat, or taking a quick shower to feel fresh. But if you have to shower twice a day to be 'clean', you are already on a sliding scale and it quickly becomes three, or four, or five times. People want to have a grip on their fear, it creeps in quickly.”

De Pree emphasizes that fear of contamination is hereditary. “A lot of people don’t know that, because parents are also ashamed of it,” she explains. “It almost always comes up in periods of stress, as if it’s the only way people think they have control, and it becomes increasingly difficult to resist it.”

She continues: "I think we should talk about it more openly, if you notice it in someone. In a respectful way, so that someone doesn't feel attacked. Ask questions like: 'Does it bother you?' or say: 'I'm worried about you.' You can only discuss it from a position of proximity. But many people are left with it alone," the psychologist emphasizes.

According to De Pree, fear of contamination can affect your entire daily life: "You always use new towels, you don't dare to touch a garbage bag, tram button or toilet seat anymore or you can't go to a public toilet anymore. Some people don't even dare to go to the hospital for fear of getting infected or making someone else sick. It's deep inside. You find everything scary.

Instead of avoiding, you should practice. People with a fear of contamination often wear gloves, take tissues with them, use alcohol gel: anything to prevent them from touching something 'dirty'. But that only reinforces the problem. In therapy, you learn to tackle the behavior, but in small steps," De Pree offers as a solution.

De Pree explains her strategy: “A client of mine, for example, only walked around with his hands in his pockets, afraid of touching something dirty. The first exercise? Let one finger hang out of the pocket. Of course you don’t have to put your hands in a toilet, of course that’s not realistic, nobody asks you to do that. Often you don’t become completely free of compulsion, but it has to become liveable: that you just dare to go to the toilet. That’s what I’m aiming for.”

According to De Pree, many people with an obsessive-compulsive disorder are afraid of the therapy itself. "They know that they are dealing with their fear and it feels as if the therapist has the power. But that is not the case. A behavioral therapist can make your obsession more bearable. What is the worst that can happen? Without treatment, there is a chance that you will stay indoors your entire life, get stuck in a pattern of washing and cleaning and never leave your house again."

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