Please remember, this column is designed to help the consumer seeking behavioral-health information, and not intended to be any form of psychotherapy or a replacement for professional, individualized services. Opinions expressed in the column are those of the columnist and do not represent the position of other SelfhelpMagazine.com staff.

Question

My boyfriend has been diagnosed with obsessive-compulsive disorder. He washes his hands too often, in my opinion, maybe seven or eight times each day. Although he talks about other symptoms of this disorder, he doesn't think washing his hands that often is a problem. His behavior bothers me, and it is affecting our relationship. What can I do?

Answer

Your question deserves a two-fold reply, it seems to me. I will respond to your personal dilemma by writing briefly about Obsessive-Compulsive Disorder (OCD), and appropriate treatments. But first, I want to discuss the issue of diagnosis and the challenge of living with, or with someone, where an anxiety or depressive disorder is suspected.

Anxiety and depression are inevitable in life. Loss, trauma, worry and failure come to us all. Most of this painful emotional experience can be handled through the support of family and friends, personal reflection, and time.

Also, in reaction to the stresses of worry and depressive thinking, most of us can think some fairly odd thoughts. Wishing something away, avoiding dealing with stressful situations, blaming someone else for our troubles--these are all common, normal, but unrealistic attempts to cope with worry and perceptions of failure.

I write about this because of concern that accurate diagnosis of any mental disorder is a prerequisite to effective treatment. Now, this may seem too obvious for comment. But I do feel a concern that we are overdiagnosing, or *pathologizing* each other these days. I believe that this is partly due to the prevalence of medications intended for use in major depression, anxiety disorders, and other disorders which can also be prescribed for emotional consequences of adjustment challenges or situational crises.

Some useful guidelines for any of us in knowing whether professional assistance versus interpersonal support is required are time, intensity, and reason. Transitions in response to losses or worries are relatively brief compared to the emotional symptoms of mental disorders. How much time? Sorry, but it is hard to say. Intensity is related to suffering. Even a day of the suffering commonly found with major depression, or severe anxiety is too much. And finally, a realistic reason for worry or sadness may indicate that support and time will return one to a satisfying emotional state. But the interaction between each of these three criteria can be helpful in knowing when professional help is needed.

Getting back to your concern, I wonder how your boyfriend received his diagnosis of OCD? The guidelines for diagnosis are quite clear, but especially for treatment planning, I hope he has seen a qualified practitioner.

Handwashing is a common compulsive ritual in OCD. But the ritual is, by definition, consuming so much time that it interferes with the life of the sufferer. Your boyfriend may have other behaviors that you don't mention,but the extent of handwashing you describe would not, by itself, indicate a problem. Many times a handwasher's hands will be red and raw from the excessive washing.

Treatment today usually consists of behavioral techniques, medication, or a combination of the two. Behavioral treatment is designed to provide exposure to objects or situations which provoke obsessional thinking, and response prevention to assist the client in resisting the accompanying compulsive behaviors (which often include thoughts, by the way). Medications are usually those used to treat depression; especially the newer serotonin re-uptake inhibitors such as Paxil, Zoloft, or Prozac.

In my opinion, choosing a behavioral specialist who consults with a medical provider is the best option for treatment of OCD. Behavioral treatments provide as good or better help in overcoming the symptoms of OCD, and are far superior in preventing relapse.

Best wishes in the future for you in your relationship.

02/21/98

Dr. Kenneth Dutro is a licensed psychologist in California. He is a member of the faculty at Humboldt State University, Arcata, California. He has been faculty member of a medical school, and worked for years as a psychologist in university-affiliated teaching hospitals.