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?
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
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.
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.