Mairwen K. Jones
In perhaps the most cited literary example of obsessive-compulsive disorder (OCD), contamination obsessions and handwashing rituals were depicted in the seventeenth century by Shakespeare in the character of Lady Macbeth, her ‘mind diseased’ and more in need of the ‘divine than the physician’. The performance of frequent, repetitive cleaning/washing behaviours and excessive concerns about contamination are extremely common symptoms in OCD. This chapter will review what is currently known about the nature, prevalence, origin and treatment of OCD washing.
Washing and contamination concerns may occur quite early in the course of the disorder. It has been suggested that fear of contamination is one of the most common obsessions in childhood OCD, and washing and cleaning behaviours are one of the most prevalent compulsions in this group (March & Leonard, 1998); for example, Swedo et al. (1989b) identified washing rituals in more than 85% of a group of 70 childhood cases of OCD.
So common are these concerns across the age spectrum that it has been suggested that the majority of OCD patients have performed excessive, compulsive washing at some point in their illness (Levenkron, 1991; Rachman & Hodgson, 1980; Rapoport, 1989; de Silva & Rachman, 1992). Rasmussen & Eisen (1992) reported that over an 8-year period, 50% of the 560 subjects they saw had contamination obsessions. More recently, Summerfeldt et al. (1997) reported that of 182 patients with OCD, 105 (57.7%) had contamination obsessions and 116 (63.7%) had washing compulsions. Finally, according to DSM-IV (APA, 1994), ‘almost 50% of OCD patients are washers’ (p. 420). So typical are washing concerns in the
Obsessive-Compulsive Disorder: Theory, Research and Treatment.
Edited by Ross G. Menzies and Padmal de Silva. © 2003 John Wiley & Sons, Ltd.