Abstract
Background
There is little research on cognitive factors that characterize the initiation of compulsive washing in obsessive–compulsive disorder (OCD). The present study seeks to contribute to a better understanding of the goals that are salient at the start of compulsive hand washing.
Methods
Thirty-eight individuals diagnosed with OCD with predominantly hand-washing compulsions and two comparison groups, one with 41 individuals diagnosed with OCD without washing compulsions and one with 43 nonclinical individuals, were interviewed about a situation when they needed to wash their hands. Participants’ goals for the wash and step-by-step descriptions of the wash were categorized and compared between groups.
Results
Findings indicate that some factors involved in the maintenance and termination of a compulsive wash might already be established at the outset of the wash, such as goals being characterized by higher levels of abstractness and importance for participants with predominantly hand-washing compulsions compared to controls. Number of goals was associated with number of repetitions of the compulsive wash.
Conclusions
Individuals with hand-washing compulsions might have goals in mind right from the start of the wash that are very difficult to reach. If our findings are confirmed in future studies, therapeutic implications could include exploring the adaptiveness of having abstract goals and their exaggerated importance.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Coding sheets are available on request from the first author.
Due to a technical problem and unfortunate loss of data, symptom severity and years of education could not be added as a covariate in the logistic regressions.
References
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Cooperation.
Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.
Bucarelli, B., & Purdon, C. (2015). A diary study of the phenomenology and persistence of compulsions. Journal of Behaviour Therapy and Experimental Psychiatry, 49, 209–215.
Cougle, J. R., Goetz, A. R., Fitch, K. E., & Hawkins, K. A. (2011). Termination of washing compulsions: A problem of internal reference criteria or 'not just right' experience? Journal of Anxiety Disorders, 25(6), 801–805. https://doi.org/10.1016/j.janxdis.2011.03.019.
Dar, R., & Katz, H. (2005). Action identification in obsessive-compulsive washers. Cognitive Therapy and Research, 29(3), 333–341. https://doi.org/10.1007/s10608-005-4266-5.
Dar, R., Lazarov, A., & Liberman, N. (2016). How can I know what I'm feeling? Obsessive-compulsive tendencies and induced doubt are related to reduced access to emotional states. Journal of Behavior Therapy and Experimental Psychiatry, 52, 128–137. https://doi.org/10.1016/j.jbtep.2016.04.004.
Deacon, B., & Olatunji, B. O. (2007). Specificity of disgust sensitivity in the prediction of behavioral avoidance in contamination fear. Behaviour Research and Therapy, 45(9), 2110–2120. https://doi.org/10.1016/j.brat.2007.03.008.
Field, A. (2009). Discovering statistics using SPSS (Vol. 3). London, England: SAGE.
First, M. B., Spitzer, R. L., Gibbon, M., Williams, J. B. W., Davies, M., Borus, J., … Rounsaville, B. (1995). The structured clinical interview for DSM-III-R personality disorders (SCID-II): II. Multi-site test-retest reliability study. Journal of Personality Disorders, 9(2), 92–104.
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychological Assessment, 10(3), 206–214.
Fontenelle, L. F., Mendlowicz, M. V., Marques, C., & Versiani, M. (2004). Trans-cultural aspects of obsessive-compulsive disorder: A description of a Brazilian sample and a systematic review of international clinical studies. Journal of Psychiatric Research, 38(4), 403–411. https://doi.org/10.1016/j.jpsychires.2003.12.004.
Giles, T. R. (1982). Cognitive restructuring and exposure with a compulsive washer—A test of reciprocal inhibition. Journal of Behavior Therapy and Experimental Psychiatry, 13(3), 221–224. https://doi.org/10.1016/0005-7916(82)90009-X.
Hinds, A. L., Woody, E. Z., Van Ameringen, M., Schmidt, L. A., & Szechtman, H. (2012). When too much is not enough: Obsessive-compulsive disorder as a pathology of stop**, rather than starting. PLoS ONE, 7, 1–9. https://doi.org/10.1371/journal.pone.0030586.
Hodgson, R. J., & Rachman, S. (1972). The effects of contamination and washing in obsessional patients. Behaviour Research and Therapy, 10(2), 111–117.
Joffe, H., & Yardley, L. (2004). Content and thematic analysis. In D. F. Marks & L. Yardley (Eds.), Research methods for clinical and health psychology (pp. 56–68). London, England: SAGE.
Kawahara, T., Ueda, Y., & Mitsuyama, Y. (2000). A case report of refractory obsessive-compulsive disorder improved by risperidone augmentation of clomipramine treatment. Psychiatry and Clinical Neurosciences, 54(5), 599–601. https://doi.org/10.1046/j.1440-1819.2000.00760.x.
Lazarov, A., Liberman, N., Hermesh, H., & Dar, R. (2014). Seeking proxies for internal states in obsessive-compulsive disorder. Journal of Abnormal Psychology, 123(4), 695–704. https://doi.org/10.1037/abn0000004.
Lipton, M. G., Brewin, C. R., Linke, S., & Halperin, J. (2010). Distinguishing features of intrusive images in obsessive-compulsive disorder. Journal of Anxiety Disorders, 24(8), 816–822. https://doi.org/10.1016/j.janxdis.2010.06.003.
Rachman, S. (2004). Fear of contamination. Behaviour Research and Therapy, 42(11), 1227–1255. https://doi.org/10.1016/j.brat.2003.10.009.
Salkovskis, P. M. (1985). Obsessional-compulsive problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23(5), 571–583. https://doi.org/10.1016/0005-7967(85)90105-6.
Salkovskis, P. M., Millar, J., Gregory, J. D., & Wahl, K. (2017). The termination of checking and the role of just right feelings: A study of obsessional checkers compared with anxious and non-clinical controls. Behavioural and Cognitive Psychotherapy, 45(2), 139–155. https://doi.org/10.1017/S135246581600031x.
Sieg, J., & Scholz, O. B. (2001). Subjektives Gefühls- und Körpererleben bei Wasch- und Kontrollzwangshandlungen. Verhaltenstherapie, 11, 288–296.
Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory STAI (form Y). Palo Alto, CA: Consulting Psychologists Press.
Taylor, J., & Purdon, C. (2016). Responsibility and hand washing behaviour. Journal of Behavior Therapy and Experimental Psychiatry, 51, 43–50. https://doi.org/10.1016/j.jbtep.2015.12.005.
Vallacher, R. R., & Wegner, D. M. (1985). A theory of action identification. Hillsdale, NJ: Erlbaum.
Vallacher, R. R., & Wegner, D. M. (1987). What do people think they’re doing? Action identification and human behavior. Psychological Review, 94, 3–15.
Vickers, K., Ein, N., Koerner, N., Kusec, A., McCabe, R. E., Rowa, K., et al. (2017). Self-reported hygiene-related behaviors among individuals with contamination-related obsessive-compulsive disorder, individuals with anxiety disorders, and nonpsychiatric controls. Journal of Obsessive-Compulsive and Related Disorders, 14, 71–83. https://doi.org/10.1016/j.jocrd.2017.06.001.
Wahl, K., Salkovskis, P. M., & Cotter, I. (2008). 'I wash until it feels right'—The phenomenology of stop** criteria in obsessive-compulsive washing. Journal of Anxiety Disorders, 22(2), 143–161. https://doi.org/10.1016/j.janxdis.2007.02.009.
Zacks, J. M., & Tversky, B. (2001). Event structure in perception and conception. Psychological Bulletin, 127(1), 3–21. https://doi.org/10.1037//0033-2909.127.1.3.
Zor, R., Keren, H., Hermesh, H., Szechtman, H., Mort, J., & Eilam, D. (2009). Obsessive-compulsive disorder: A disorder of pessimal (non-functional) motor behavior. Acta Psychiatrica Scandinavica, 120(4), 288–298. https://doi.org/10.1111/j.1600-0447.2009.01370.x.
Acknowledgments
We would like to thank Carlotta Heinzel, Martin Mazanec, and Andrea Schumacher for their help with the coding of the interview data.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or nonprofit sectors.
Author information
Authors and Affiliations
Contributions
KW and PS conceptualized and designed the study. Data preparation and analysis was performed by FA, MM, AK, and KW. The first draft of the manuscript was written by KW, RL, and RD. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
Karina Wahl, Paul Salkovskis, Florence Allegro, Marcel Miché, Andreas Kordon, Roselind Lieb, Reuven Dar declare that they have no conflict of interest.
Ethics Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was covered by an ethics approval of the Institute of Psychiatry, King’s College London.
Animal Rights
No animal studies were carried out by the authors for this article.
Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (national and institutional). Informed consent was obtained from all individual subjects participating in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendices
Appendix 1
Examples of goals are provided to illustrate each category. All examples are quotes taken from washers.
-
1.
Cleanliness: “I wanted to get back to the baseline of cleanliness.”
-
2.
Prevention of contamination: “To get rid of any germs that I might have picked up from closing the door or flushing.”
-
3.
Decrease in anxiety or other negative feelings: “To get rid of anxious feeling.”
-
4.
Increase in positive feelings: “I want to feel as comfortable as I was before.”
-
5.
Other goals: “To keep thought at bay.”
Appendix 2
See Table 6.
Rights and permissions
About this article
Cite this article
Wahl, K., Salkovskis, P., Allegro, F. et al. Cognitive Motivations for the Initiation of Ritualistic Hand Washing in Obsessive–Compulsive Disorder. Cogn Ther Res 44, 943–953 (2020). https://doi.org/10.1007/s10608-020-10112-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-020-10112-5