Misophobia

An uncontrolled fear that arises as a mental reaction to a specific, completely safe object or situation is called a phobia. She subjugates a person for a while, it is impossible to resist. The body releases adrenaline and activates the self-preservation instinct - the reaction is inadequate in strength to the stimulus. Some people experience horror beyond their control from the thought of contamination. There are a lot of them. Such an obsessive state is called misophobia (from the Greek mysos - dirt, filth, as well as filth and vileness).

Basically, misophobes are people who often wash their hands, trying to avoid tactile contact with people and objects for fear of infection and subsequent illness. Initially, this term was introduced by the psychiatrist W.A. Hammond, who observed a patient who constantly washed his hands. He interpreted his behavior precisely as an immediate desire to wash his hands. Psychologist G.S. Sullivan added to the picture of an obsessive fear of becoming contaminated by the fact that it is based on the fear of contracting and getting sick. Such obsessions (obsessions) led to the development of rituals of purification - endless washing of hands, wiping surfaces with antiseptics, avoiding tactile contacts and others. Concrete cases of fear of microorganisms, and not just visually noticeable dirt, got quite definite names (verminophobia - from the English vermin, parasite; hermophobia - from the English germ, microbe; bacteriophobia, etc.).

In 1924, a study was published that examined the phenomenon of the so-called moral misophobia. The author, according to his observations, argued that the above rituals of purification are caused by obsessive thoughts of unacceptable content when a person feels morally defiled. [1]

One way or another, but this not healthy reaction can be a symptom of serious mental pathologies, including  obsessive-compulsive disorder  and even  schizophrenia .

Epidemiology

There is no statistics on phobias, however, studies have concluded that every tenth inhabitant of our planet has a phobia. How many people suffer from misophobia is unknown, but it is quite common in the civilized world. From the side of strangeness of behavior, you can not notice right away, because washing your hands is considered a completely ordinary action, the need for which is not regulated, but is determined by the desire of the person himself.

Causes of the misophobia

A stubborn, strongly expressed irrational fear of pollution and rituals associated with cleansing and avoiding getting dirty can be one of the manifestations of obsessive neurosis, anxiety-phobic or obsessive-compulsive disorder, schizoid psychopathy, schizophrenia. In such patients, misophobia will not be the only symptom.

Often there are phobias in people who are quite normal in all other respects and have certain personality traits — a predisposition to suggestion, increased sensitivity and sensitivity, suspiciousness, or, conversely, excessive self-esteem, a tendency to self-love (daffodils, perfectionists), for whom dirt is incompatible with their self-perception. Such qualities are usually inherited.

Risk factors

Risk factors for the development of misophobia include:

• family traditions, when personal hygiene was given hypertrophied attention, and almost every episode of non-compliance was accompanied by comments on the dangers of contracting terrible and deadly diseases;
• a negative event in the life of a misophobe or a person close to him, for example, associated with an infectious disease that entailed serious complications;
• an advertisement for antimicrobial hygiene products and household chemicals, which exaggerates the danger of contamination and germs lurking in the mud.

As a result of the action of traumatic factors on a susceptible personality, the pathogenesis of misophobia develops - a stubborn uncontrolled fear of getting dirty, touching the ubiquitous microbes appears, which is manifested by behavioral, physiological and emotional symptoms. The main motivator for such changes is anxiety.

Moral misophobia is a separate psychological phenomenon, when the desire to “wash off” and “cleanse” arises due to emotional reasons. Patients feel soiled with “moral filth”, but this causes them to appear symbolic cleansing rituals similar to washing real pollution (showers, baths, washing hands that touch a morally unclean object). This phenomenon remains to be explored. In order to conclude, not enough cases of moral misophobia have been described. However, the authors have already put forward several hypotheses about its origin. The most famous concept is that the basis of compulsive symbolic purification is an emotion of disgust caused by a sense of one's own wrong, guilt, and irresponsible behavior. Hypertrophic responsibility is called the main character trait of such people. Which, in general, is also considered a risk factor for the development of most types of obsessive-compulsive disorder.

Some authors consider the rejection of an immoral act (of their own or someone else's) as the basis of moral misophobia, with which the patient had to come into contact. Neuroimaging performed by the patient during studies of this phenomenon shows functional and structural disorders in the parts of the brain that form a feeling of disgust.

The ideas of moral misophobia, according to the researchers, so dominate the minds of patients that they resemble delusional ones, but the presence of compulsions (cleansing rituals) corresponds to their obsessive origin. The degree of maladaptation of the observed patients with moral misophobia, the formation of a noticeable intellectual deficiency in them, as well as treatment resistance allowed some authors to draw a parallel with schizophreniform disorders.

In studies on patients with OCD, mentions of moral misophobia are extremely rare.

Symptoms of the misophobia

Not every fear qualifies as a phobia. The level of anxiety corresponding to mental pathology leads to the fact that a person loses control over his fear and does everything to avoid a traumatic situation. And if meetings with heights, crowds, spiders and even dogs can be avoided, then germs and dirt are omnipresent. It is not at all necessary to get visible pollution, it is enough to drive in a minibus, give a hand for a greeting, count the money in your wallet. The objects that cause them to avoid and the desire to wash themselves, as a rule, are dust and dirt; blood, saliva, feces, urine, other body fluids, perceived as a source of infection; people and animals from which you can become infected; objects and places of common use; various chemicals used in everyday life.

Outwardly, the first signs look like behavioral deviations, eccentricities. Too often people wash their hands, endlessly rub their things with antiseptics, wash them unnecessarily, constantly do cleaning at home and in the workplace, try to avoid tactile contact. In advanced cases, the patient tries not to leave his sterile home and not invite anyone to him, during the period of the alleged epidemics puts a mask on his face and processes the nasal passages, if there is a need to go to a crowded place, etc.

Developed misophobia causes great inconvenience in everyday life. In addition, the need to go to work, ride in vehicles, and communicate with other people causes disturbances in mental stability and mood disorders. A person becomes restless, irritable and distracted. He does not sleep well, he is often haunted by disturbing thoughts, as a result, his mood tends to zero and a depressive disorder may develop.

Somatic manifestations aggravate the situation - tremor of the extremities, increased heart rate, arrhythmia, shortness of breath, hyperhidrosis, nausea, up to the development of gastric neurosis. In severe cases, if it is not possible to immediately clear the dirt or to avoid pollution, a panic attack may begin.

Moral misophobia manifests itself as a feeling of desecration, internal impurity, arising regardless of the presence of visual pollution. Such feelings appear after various events: accusations or reproaches thrown at the patient, abusive actions or phrases, they are associated with individual unpleasant memories that run counter to the religious, cultural or moral and ethical ideas of the patient. The appearance of obsessive thoughts and images causes a desire to wash oneself, to clean oneself from moral pollution or to cleanse objects and premises that were in contact with something “not clean”.

Complications and consequences

Frequent hand washing is not yet a phobia. Pathology is a condition that prevents a person from performing everyday functions and even just leaving the house. It is these dangers that await misophobes with an advanced stage of the disease.

In addition to the moral suffering experienced by the misophobic, his hypertrophic addiction to cleanliness becomes noticeable to others and begins to annoy them. Such people have difficulties with socialization, in society they are considered at least harmless eccentrics. It is difficult for them to create a family and preserve the one that already exists. A rare partner is ready to endure constant accusations of uncleanliness and fulfill ridiculous requirements for sanitary conditions - sterile cleanliness in the house, gloves and shoe covers, endless processing of things and objects with antiseptics. In addition, the tactics of avoiding the disturbing situation, which people with phobias resort to, lead to the fact that they find themselves in voluntarily-compelled isolation, feel unnecessary and lonely, and this is the way to depression.

Uncontrolled fear can result in panic attacks, the development of neurosis, increases the likelihood of somatic health disorders. As you know: "all diseases are from nerves."

Someone follows the rules of hygiene more conscientiously and wash their hands more often. This is not a phobia, but if fear arises even with the thought of pollution and it is impossible to get rid of it, vegetative symptoms appear and mood spoils, then it is worth analyzing your behavior and going to a consultation with a psychologist. Any phobia in the initial stage lends itself well to correction.

Moral misophobia usually does not hurt other people, but it brings a lot of suffering to the patient and, according to research, is difficult to treat. In the final stage, even a certain intellectual deficit develops, in which experts see a resemblance to schizophrenia. Therefore, with the desire to “wash off” moral dirt, it is also better to seek advice immediately as soon as it begins to periodically obsessively disturb.

Diagnostics of the misophobia

The diagnosis of any phobia is made on the basis of the patient's complaints. There are no other methods. A detailed interview with a list of sensations and somatic symptoms makes it possible to distinguish between a natural and even somewhat exaggerated fear of phobia. Since just frequent washing of hands more likely reflects a commitment to personal hygiene, misophobes usually go to the doctor in advanced conditions, when the patient already has somatic complaints, panic attacks, and a neurosis-like disorder that significantly complicate his life.

On the Internet there are many questionnaires to independently determine whether a person’s fear reaches the height of phobias, and to which one he is predisposed. It is hard to say how much you can trust the results of such testing. If there is a problem and it bothers, it is better to contact a specialist.

The most reliable and authoritative test for ZARS misophobia is the Zung Anxiety Rating Scale. It is used by professionals in the field of psychology of different countries to measure the severity of anxiety disorders: panic attacks, phobias, neurasthenia, etc. As a preliminary diagnosis, according to experts, this questionnaire is quite effective. It is about fear of any nature, and not just fear of dirt. An object that causes fear does not matter much. After instructing, the patient awards a certain number of points to his pathological signs, and the severity of anxiety disorder is determined by the total number.

Differential diagnosis

Differential diagnosis may be required if there is a suspicion of a serious mental disorder or somatic disease. In this case, in order to confirm or exclude suspicion, for example, for schizophrenia or obsessive-compulsive disorder, different types of examinations can be prescribed at the discretion of the doctor. A more specific differentiation, for example, hermophobia and misophobia, that is, fear of germs or any kind of dirt (including moral) in general, does not matter much in determining treatment tactics. The choice of treatment methods is based on the severity of the disorder, the presence of somatic symptoms, concomitant diseases, and the response to the therapy.

Treatment of the misophobia

The fear in the clinical form of a phobia is almost impossible to overcome on your own. It does not lend itself to logical persuasion, it is almost impossible to get rid of it through auto-training and mastering the technique of breathing exercises. Most patients require the help of specialists in the field of psychotherapy, in some cases hypnosis helps. In addition, drug therapy is used to relieve concomitant and life-disturbing symptoms.

According to the World Health Organization, cognitive-behavioral therapy is recognized as the most effective psychotherapeutic technique for getting rid of a phobic disorder, as a result of which the patient must completely get rid of negative thoughts about objects of his fear.

The basis of this method is the assertion that the patient himself thinks that he feels unwell after getting into an alarming situation, that now there is no way to avoid troubles. In our case, dirt and microbes swarming in it will certainly lead to a serious illness. In the process of cognitive-behavioral therapy, the patient, under the control of the psychotherapist directing his thoughts in the right direction, gradually gets rid of negative thoughts and replaces them with positive ones, plunging into a disturbing situation, meeting his fears. During therapy, the patient learns to control his fear, he develops habits to react impartially to situations that previously caused uncontrolled anxiety.

Hypnosis is also used. In addition, at home, the patient is advised to conduct auto-training - repetition of verbal formulas that reinforce a positive attitude in the subconscious.

The doctor may prescribe medications to stop the symptoms associated with a phobic disorder - sleeping pills, anti-anxiety drugs. Most often these are psychotropic drugs. By themselves, they will not be able to eliminate the phobia, they will only help reduce the physical manifestations of anxiety. Medicines perform an auxiliary function, they are taken strictly following the doctor’s instructions.

Prevention

People subject to the development of phobias have certain personality characteristics - increased suggestibility and anxiety. It is the individual characteristics of the psyche that experts call the main risk factor. Fears that develop into a phobia arise from them in the absence of sufficient information necessary for a correct assessment of the situation and the establishment of control over it. Prevention of the appearance of unreasonable fears is the formation from childhood of rational thinking based on knowledge of the world.

In addition, it is recommended to watch TV less, leave the room during the broadcast of commercials, overestimate your fears of pollution, parasites and microbes, based on completely available scientific information about them.

There is a lot of literature on how to overcome your fear, anxiety, how to cope with a phobia. For example, the series of books "Pocket Therapist." Such books about misophobia, and not only about it, help people learn how to use their psyche and cope with serious problems.

Misophobia is quite widespread, therefore films are also shot whose heroes suffer from this ailment. These are not films about misophobia, they raise other topics, but this feature is played out in them.

Forecast

Uncontrolled fear can significantly reduce a person’s standard of living. However, misophobia is treatable. The help of a qualified specialist and the desire of the patient himself are needed, then everything will work out.