Washing and Checking OCD

Obsessive Compulsive Disorder (OCD), despite its myriad of manifestations and nuances, is most commonly known for and portrayed as an elaborate ritual of washing and checking. Indeed, to the average therapist, much less the average person, OCD would likely be synonymous with the washing and checking routines seen on TV and movies. While Washing and Checking OCD mainly describes the common compulsions seen in this OCD subtype, the corresponding obsessions and feared thought can vary.

What is Washing and Checking OCD?

The naming of this subtype describes the most common symptom and observable behavior associated with this expression of OCD. In this case, someone suffering with washing and checking OCD experiences a series of unwanted, intrusive thoughts, feelings, images, sensations, or urges that result in tremendous anxiety and discomfort. The obsessive thought is often a feared story about what the individual will suffer, endure, cause, or feel unless they clean or check something. Washing and Checking sufferers then give into compulsory behavior in order to feel clean, safe, or otherwise get back to a sense of emotional normalcy. Unfortunately, once the sufferer achieves this temporary sense of security and cleanliness, their original obsessive thought is made stronger.

Washing and Checking Compulsions

Common washing compulsions can include:

• Washing hands repeatedly
• Using hand sanitizer excessively
• Washing clothes more often than needed
• Wiping off items without evidence they are dirty

Common checking compulsions can include:

• Checking that appliances are off or unplugged
• Reviewing files to ensure that they are organized correctly
• Opening and closing doors to ensure they are fully closed
• Waking up at night to inspect and ensure doors and windows are locked

Washing and Checking Obsessions

Washing and Checking OCD covers a wide range of fears. Unlike other anxiety and OCD subtypes that tend to focus on a very specific set of triggers, like Scrupulosity, HOCD, and phobias, Washing and Checking OCD can be connected to a number of different issues. For example, washing behaviors, like compulsive hand washing and showering, can follow from a fear of germs or virus contamination, a superstitious connection to keeping others safe, or simply the overwhelming feeling that something is not “right.”

Checking behaviors associated with this OCD subtype can also be rooted in a range of feared stories. For example, someone may check their trashcan repeatedly for evidence that they did or did not throw something away accidentally. A student may check that her homework is in her backpack over and over out of fear they forgot to do it or may have done it incorrectly. Still another person may have to memorize the exact space and word placement of a text or re-read previous sentences (perhaps even in this article) to make sure they fully understood the material, or else they will feel an overwhelming sense of doom.

Washing and Checking OCD Treatment

Effective treatment for washing and checking related OCD can be done with Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness based treatments, such as Acceptance and Commitment Therapy (ACT). Clients begin by working to develop a more balanced understanding of their obsessions. First, clients must understand the root of their obsessions by identifying the feared stories that contribute to their compulsions. Once their feared stories are identified, the client begins to reevaluate the grounds for their fear and consider more rational and likely alternative outcomes of their fear.

With this grounding in reality-based thinking, clients can begin addressing their fears head on by engaging in ERP exercises. These carefully crafted techniques help the client progressively face their fears while building confidence to resist their washing and checking routines. After repeated exposures and compulsion resistance, clients begin to notice a slow reduction of their anxiety, called habituation.

Mindfulness based treatments, such as ACT, help clients refocus on the present moment while disconnecting from the feared story. Clients often discover that their anxiety and fear is what they currently experience, not their feared story! What’s more important, is that their anxiety gradually reduces. ACT helps create a framework for clients to accept their thoughts and feelings while actively engaging in truly valued activities.

To learn more about washing and checking OCD, or to schedule an assessment, please contact me here.