Ablutomania (compulsive washing)
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You wash your hands and, for a moment, you feel better. Then the doubt creeps back. Maybe you did not do it properly, maybe you touched something, so you wash again. Some people end up washing many times an hour, taking very long showers or scrubbing until their skin is sore, and still never quite feel clean.
If this sounds familiar, you are not alone and you have nothing to be ashamed of.
What it is
Ablutomania is an old word for a strong, repeated urge to wash your hands, shower or bathe far more than you need to. Doctors rarely use the term today and it is not a diagnosis in its own right. Instead, they talk about washing compulsions, which are one of the best known forms of obsessive compulsive disorder (OCD).
In OCD, an unwanted thought or fear, such as being contaminated by germs or passing an illness on to someone you love, causes real distress. Washing brings brief relief, so the brain learns to wash again the next time the fear appears. Many people keep washing until they feel clean, rather than stopping when they can see they are clean.
How it differs from a phobia
A phobia is a fear that makes you avoid something. Ablutomania works the other way round: it is an urge that pulls you towards washing, again and again. The two often go together. Someone with a fear of germs (mysophobia) may avoid door handles and public toilets, then feel driven to wash after any contact they could not avoid.
Read more about manias and phobias
Common signs
- Washing your hands far more often than you need to
- Long showers or baths that follow strict rules
- Starting again if a washing routine is interrupted
- Never quite feeling clean, however long you wash
- Dry, cracked or sore skin on your hands
- Knowing it is too much but feeling unable to stop
When it tends to show up
- After touching door handles, money or shared surfaces
- After using a public toilet
- When you get home from being out
- Before preparing food or holding your children
- When someone near you coughs or sneezes
- During news about viruses or outbreaks
- At times of stress, tiredness or big change
- Before bed, when you want to feel fully clean
Symptoms
In your body
- Tension or restlessness when you cannot wash
- Dry, red or cracked skin on the hands and arms
- Stinging, itching or small cuts from soap and water
- Tiredness after long washing routines
- A short wave of relief straight after washing
In your mind
- A lingering feeling of being dirty or contaminated
- Worry about getting ill or making your family ill
- Doubt about whether you washed properly
- Shame, or a wish to hide how much you wash
- Trouble thinking of anything else until you wash
What you might do
- Wash in a fixed order or a set number of times
- Use large amounts of soap, gel or sanitiser
- Avoid touching certain objects, people or places
- Ask others to wash or not to touch certain things
- Ask again and again whether something is clean or safe
What causes it
Nobody knows exactly what causes washing compulsions. When they are part of OCD, several things may play a part together: family history, differences in how the brain works, stressful or traumatic life events, and personality traits such as a strong sense of responsibility.
Once it starts, the habit keeps itself going. Washing calms the worry for a moment, so your mind decides the washing was needed, and the next doubt asks for a longer wash. Avoiding things that feel dirty works the same way, because you never get the chance to learn that the danger was smaller than it felt. It is not a lack of willpower.
How it can affect your life
Washing routines can eat up hours, make you late for work or school and stop you going to places you used to enjoy. Your skin can suffer too, as frequent washing with soap and water can lead to contact dermatitis, cracks and soreness. At home there may be tension if family members are asked to follow washing rules or answer the same questions again and again. Because many people keep it secret, it can feel lonely and wear down your mood.
Treatment
In the UK, your GP is the usual first step, and in England you can also refer yourself to an NHS talking therapies service without seeing a GP first. If your washing is part of OCD, the main talking therapy is cognitive behavioural therapy (CBT) with exposure and response prevention (ERP). With a therapist, you face the things that trigger the urge in small, manageable steps and practise not washing, so the anxiety can fade on its own.
A doctor may also talk to you about medication, usually a type of antidepressant called an SSRI, especially if OCD is more severe. A pharmacist or GP can also advise on emollients for sore or cracked skin.
Things that can help day to day
- Note when the urge appears and what set it off
- Keep normal handwashing, such as before eating and after the toilet
- Use a gentle moisturiser or emollient after washing
- If it feels manageable, delay a wash by a few minutes and notice the worry ease
- Ask family to support you without joining in the routines or giving constant reassurance
- Protect your sleep, as tiredness can make urges stronger
When to get help
Talk to your GP if washing takes up a lot of your day, if your skin is cracked, bleeding or looks infected, or if fear of dirt is deciding where you go and who you see. OCD is unlikely to get better without the right support. OCD-UK and OCD Action offer information and support groups, and Mind can help you find local services.
If you are also feeling very low, talk to your GP or call Samaritans free on 116 123. If you ever feel you might harm yourself or someone else, call 999 or go to A and E. For urgent mental health advice, call NHS 111 and choose the mental health option.
See also: Fear of germs (mysophobia) · Compulsive cleaning
How I can help
When I work with someone who washes far more than they want to, over Zoom, I use hypnotherapy and NLP to help them spot the moments just before the urge and to calm the tension that drives it. Together we rehearse a different response and build up tolerance of that not quite clean feeling, a step at a time. If the washing is part of OCD, the main treatment is CBT with exposure and response prevention, and my work fits alongside it, never instead of it. Many clients find it easier to stick with their therapy when the background tension is lower.
Common questions
Is ablutomania the same as OCD?
Not exactly. Ablutomania is an old name for excessive washing, while OCD is a recognised condition. Repeated washing is one of the most common signs of OCD, but only a GP or mental health professional can say whether that is what is going on for you.
Is washing your hands a lot a sign of OCD?
Not always. Many people wash often because of their job, or because they care for someone. It is more likely to be OCD when the washing is driven by fear, takes up a lot of time, brings only brief relief and gets in the way of daily life.
What is the difference between ablutomania and mysophobia?
Mysophobia is an intense fear of germs and dirt, which mainly leads to avoidance. Ablutomania describes the repeated urge to wash. They often go together, because fear of germs drives the washing and the washing keeps the fear alive.
How can I help a family member who washes all the time?
Listen without judging or teasing, as many people feel deeply ashamed. Gently encourage them to see their GP and go at their pace. Joining in the rituals or repeating that everything is clean usually keeps the problem going, and OCD charities have advice for families.
Further reading: NHS: Obsessive compulsive disorder (OCD), symptoms · NHS: Obsessive compulsive disorder (OCD), treatment · Mayo Clinic: Obsessive-compulsive disorder (OCD), symptoms and causes · OCD-UK: Types of OCD · NHS: Contact dermatitis
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