Your daughter's obsession with handwashing likely stems from Obsessive-Compulsive Disorder (OCD), an anxiety disorder where unwanted intrusive thoughts (obsessions) about germs or contamination trigger repetitive behaviors (compulsions like handwashing) to temporarily relieve intense anxiety, making her feel safe or "just right," even if she can't explain why, which often requires professional evaluation for diagnosis and treatment.
Key points about OCD in children
The child uses compulsive rituals, such as handwashing, to control the fears. These rituals may feel rational or irrational to the person doing them. The child may not understand why they do these rituals. They may feel embarrassed that the behaviors occur and can't be controlled.
Excessive hand washing may be the most common observable symptom of OCD, and is probably the behavior most commonly associated with it. But how much is too much? Many people with OCD become quite comfortable washing their hands dozens of times per day.
OCD looks like overwhelming fears or thoughts and repeated actions or rituals that relieve anxiety. For instance, a child might worry constantly that things around them are dirty and will make them sick, so they wash their hands repeatedly as a way of dealing with that anxiety.
OCD often centers around certain themes, such as being overly fearful of getting contaminated by germs. To ease contamination fears, you may wash your hands over and over again until they're sore and chapped. If you have OCD , you may be ashamed, embarrassed and frustrated about the condition.
Compulsive hand–washing may result in the clinical features of both acute and chronic hand dermatitis. Acute hand dermatitis presents with erythema, oedema, blistering, and scaling. Chronic features of repetitive hand washing include lichenification, pigmentary changes, hyperkeratosis, and fissuring.
One of the key signs and symptoms of high functioning OCD is persistent, obsessive thoughts. These thoughts often revolve around fears of harm, making mistakes, or being imperfect. Unlike general anxiety, these thoughts are more than just worries—they are persistent, intrusive, and difficult to control.
Symptoms of OCD. Each child may experience symptoms of OCD differently, but common symptoms of the obsessive portion of the illness include: An extreme preoccupation with dirt, germs or contamination. Repeated, intrusive doubts and worries (obsessing over “what if” scenarios)
Response prevention happens when children agree ahead of time, that if they touch something they will try to avoid the typical response of hand washing. Although this causes anxiety at first, the more often they avoid hand washing, the easier it becomes over time to stop hand washing (or other compulsions).
Someone with OCD might feel like they have to:
OCD can affect men, women and children. People can start having symptoms from as early as 6 years old, but it often begins around puberty and early adulthood. OCD can be distressing and significantly interfere with your life, but treatment can help you keep it under control.
Response prevention strategies may look like:
Symptoms of high-functioning OCD involve recurrent, intrusive thoughts that provoke considerable anxiety, alongside repetitive behaviors the person feels driven to carry out to reduce their distress.
Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on it and feel they need to do it "just in case". Common types of compulsive behaviour in people with OCD include: cleaning and hand washing.
The 15-Minute Rule for OCD is a Cognitive Behavioral Therapy (CBT) technique where you delay performing a compulsion for 15 minutes when an obsessive thought triggers anxiety, allowing the urge to lessen naturally as you practice exposure and response prevention (ERP). It teaches your brain that discomfort decreases without the ritual, building resilience and breaking the obsessive-compulsive cycle by gradually increasing tolerance for uncertainty and distressing feelings.
Scrupulosity is characterized by obsessional fears and compulsive rituals that have religious or moral content. Children may fear offending God or sinning (religiosity based), or dishonesty, wastefulness, and other forms of “ethical rightness or perfection” (morality based) (Peris & Rozenman, 2016, p.
However, there are plenty of theories surrounding the potential causes of OCD, involving one of or a combination of either; neurobiological, genetic, learned behaviours, pregnancy, environmental factors or specific events that trigger the disorder in a specific individual at a particular point in time.
An OCD episode looks like a distressing cycle of unwanted, intrusive thoughts (obsessions) causing intense anxiety, followed by repetitive actions or mental rituals (compulsions) performed to temporarily relieve that anxiety, only for the cycle to quickly restart, interfering significantly with daily life, and often involving physical signs like shaking or sweating. It's characterized by excessive worry about harm, contamination, order, or morality, leading to time-consuming checking, washing, counting, or seeking reassurance.
A common mysophobia treatment is exposure therapy. Working with your mental health provider, you explore the reasons behind your fear of germs. This is the first step in overcoming mysophobia. When you feel comfortable, your therapist gradually exposes you to situations where germs may be present.
Autism spectrum disorder (ASD) is a developmental condition while obsessive-compulsive disorder (OCD) is a mental health disorder. Both affect a person's behavior. Some people may question if they have OCD or autism as these conditions can have an overlap in symptoms. ASD and OCD can sometimes have similar symptoms.
An OCD attack can feel like a storm of intense emotions and physical sensations. The person may experience physical symptoms, such as sweating, shaking, and rapid heartbeat. These symptoms may be accompanied with obsessive thoughts, intrusive thoughts, and an urge to engage in compulsions.
Types Of OCD
Anything that causes stress, anxiety, or an intense emotional reaction has the potential to be a trigger. After someone with OCD is triggered, they may experience an increase in intrusive thoughts, which can then result in carrying out compulsions.
OCD symptoms involve intrusive, unwanted obsessions (fears like contamination, harm, or doubt) and repetitive compulsions (actions like excessive washing, checking, ordering, counting) performed to relieve the obsession's anxiety, often including needing perfect symmetry, hoarding, repeating rituals, seeking reassurance, or neutralizing bad thoughts, all significantly interfering with daily life.
There appear to be two peaks of incidence of Obsessive Compulsive Disorder (OCD), one with a pre-adolescent onset and another in early adulthood. As new cases are added, the cumulative prevalence of OCD increases, but the great majority of cases have an onset in youth.