OCD appears in a limited variety of guises. One of these is generally known as contamination fear/washing compulsion. For brevity’s sake often simply ‘contamination’ or ‘washing’ is used. Perhaps it is the form of OCD that can be hidden from the outside world only in the most difficult of ways. I will present a fictitious case here.
Iris is a woman aged 24. She is an ambitious student of medicine. In the past few years, her friends and fellow students noticed something. Iris made the impression of being anxious about something, but initially it was impossible to know what that was. Her relationship with her parents and siblings was good; no one saw anything wrong there. She had no boyfriend. Sometimes she was on the late side arriving in college and in practical work, she came across as being very rushed. Particularly at patients’ beds, she always tended to stay in the back of the group of students being taught by a doctor or professor.
Her ‘problem’ seemed to become more grave when she began to avoid parties, and visits to the cinema, two of her favourite pastimes. Also, she ended her hockey and swimming hobbies, for no obvious reason.
One day, a girlfriend noted something strange: her hands were all red and dry, the skin was more wrinkly than it should be. It looked like an infection or something, or an allergy, eczema. The girlfriend was apprehensive and did not want to inquire. But that problem did not go away. Her skin condition even got worse.
Finally that girlfriend found the courage to ask Iris about it. Iris got all confused, frightened even. She mumbled something about itching skin, about pain sometimes, but stayed very evasive. She did promise to go to a doctor, to find out what was troubling her. But she did not go. Then, her girlfriend confronted her about it, and asked roundly why Iris did not visit a medical professional. Finally, Iris gave in, on one condition: that her girlfriend would accompany her.
This turned out to be the first step towards a proper diagnosis, and also towards clarifying why Iris was so frightful about telling others what troubled her so much.
The doctor that got consulted first seemed to have formed a diagnosis quickly, yet he put a number of questions to Iris that were phrased very sensitively, so as not to make her shy or even run away from his office. Iris really had a hard time answering these still, she paused, hyperventilated a bit, stuttered – and then she was able to admit that she washed herself, especially her hands, longer than others did. She felt ashamed, she blushed. Asked how much ‘longer’ that ‘longer’ actually was, it turned out to be really longer in excess: sometimes she showered for hours on end in the middle of the night, and she could devote half an hour, or even longer, to washing and rubbing her hands with lots and lots of hand soap, and also with more aggressive detergents.
Iris’ girlfriend breathed a sigh of relief when she heard all this, and that was because she had a distant relative who had struggled with the same problems for decades, until that relative opened up about her affliction, and could get proper treatment.
The doctor referred Iris to a psychiatrist in the academic hospital where she was studying. He was all for keeping the various connections as short as possible, so as to hold bureaucratic procedures within acceptable boundaries.
The story of Iris is fictitious, but it is not unusual or esoteric. In my example, I also show how patients can be lucky or very unlucky in the way they get to encounter proper treatment. The distant relative of Iris’ girlfriend suffered for decades before she entered the fitting medical routes to a more healthy life – and it is good to mention here that the average time between first onset of OCD symptoms and the start of adequate treatment is no less than 17 years.
Iris, on the other hand, was lucky. During a few years she withdrew more and more from activities, and even in her study she, as a motivated and intelligent person, was thought by her teachers to be some kind of an underachiever, for her avoidance behaviour in all situations where there were mental associations with bacteriae and viruses. But in her situation, considerable ‘repair’ could be organized, and her career did not come into serious jeopardy.