Obsessive-Compulsive Disorder For Dummies E-Book

Charles H. Elliott

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 590

Veröffentlichungsjahr: 2008

Beschreibung

Arguably one of the most complex emotional disorders, Obsessive Compulsive Disorder is surprisingly common. Furthermore, most people at some time in their lives exhibit a smattering of OCD-like symptoms. Obsessive Compulsive Disorder For Dummies sorts out the otherwise curious and confusing world of obsessive compulsive disorder. Engaging and comprehensive, it explains the causes of OCD and describes the rainbow of OCD symptoms. The book shows readers whether OCD symptoms represent normal and trivial concerns (for example, a neat freak) or something that should be checked out by a mental health professional (for example, needing to wash hands so often that they become raw and red). In easy to understand steps, the authors lay out the latest treatments that have been proven to work for this disorder, and provide practical and real tools for living well long-term. Whether you or someone you care about has this disorder, Obsessive Compulsive Disorder For Dummies gives you an empathic understanding of this fascinating yet treatable mental disorder.

Leseprobe

Obsessive-Compulsive Disorder For Dummies®

Table of Contents

Introduction

About This Book

An Important Message to Our Readers

Conventions Used in This Book

What Not to Read

Foolish Assumptions

How This Book Is Organized

Part I: The Ins and Outs of OCD

Part II: Starting Down the Treatment Path

Part III: Overcoming OCD

Part IV: Targeting Specific Symptoms of OCD

Part V: Assisting Others with OCD

Part VI: The Part of Tens

Part VII: Appendixes

Icons Used in This Book

Where to Go from Here

Part I: The Ins and Outs of OCD

Chapter 1: Reviewing Obsessive-Compulsive Disorder (OCD)

What Is OCD?

Suffering shame

Wrestling with risk

Counting the Costs of OCD

Encouraging OCD through the Media

Exploring Treatment Options for OCD

Changing the way you think with CBT

Approaching OCD mindfully

Modifying behavior through ERP

Controlling OCD with medications

Helping People with OCD

Chapter 2: Scrutinizing OCD

Coming to Terms with What OCD Is

The OCD anxiety cycle

Thinking and believing

Inspecting impulses

Seeing the Two Sides of OCD

Obsessing about obsessions

Considering compulsions

Categorizing the Types of OCD

Doubts, fears, and uncertainties

Contamination, germs, and dirt

Collecting and hoarding

Shame, embarrassment, and inappropriate thoughts and behaviors

Superstitions and rituals

Symmetry and perfectionism

Separating OCD from Normal Worries

Getting to a Diagnosis of OCD

Avoiding self-diagnosis

Avoiding misdiagnosis

Chapter 3: Meeting the Relatives and Associates of OCD

Meeting the Relatives of OCD

Body dysmorphic disorder (BDD): A seriously distorted self-image

Hypochondriasis: “I think I’m really sick”

Trichotillomania: Pulling your hair out

Tics and Tourette’s syndrome: Involuntary sounds and movements

Skin-picking and nail-biting

Eating disorders: Intense fear of fat

Impulse control disorders: Unstoppable bad habits

Recognizing Associates of OCD

Mood disorders

Anxiety disorders

Attention deficit disorders (ADD)

Substance abuse

Personality disorders

Chapter 4: Blaming the Brain for OCD

Looking at the Brain’s Role in OCD

Connecting genetics with OCD

Getting inside your head

Exploring Four Regions of the Brain

Hiding out with the hindbrain

Minding the midbrain

Deciphering the diencephalon

Finding the forebrain

Tracing the Brain’s Circuitry

Transmitting Thoughts between Brain Cells

Using electricity and chemicals to communicate

Singling out serotonin and dopamine

Chapter 5: Developing and Reinforcing OCD

Developing OCD as a Child or Adult

Developing OCD early

Developing OCD as an adult

Reinforcing OCD with Positives and Negatives

Supporting OCD with positive reinforcement

Supporting OCD with negative reinforcement

Combining positive and negative reinforcement: A double whammy

Worsening OCD with Bad Thinking

Exaggerating risk

Not accepting uncertainty

Needing everything perfect

Controlling thoughts

Being too responsible

Viewing thoughts as real

Thinking magically and illogically

Part II: Starting Down the Treatment Path

Chapter 6: Overcoming OCD Obstacles to Change

Realizing Resistance is Futile

Fearing treatment

Handicapping against treatment success

Believing the worst about yourself

Seeing that Resistance Can Be Overcome and Change Is Good

Embracing the process of change

Defeating self-handicapping

Dismantling change-blocking beliefs

Taking one step at a time

Chapter 7: Getting Help for OCD

Going After the Types of Help You Need

Educating yourself about OCD

Getting support from family, friends, and others

Choosing a professional to help you

Understanding What to Expect in Therapy

Keeping your therapy private

Digging deep into an OCD diagnosis

Speaking the truth to your therapist

Evaluating your therapist

Part III: Overcoming OCD

Chapter 8: Cleaning Up OCD Thinking with a CBT Reality Check

Realigning Interpretations with Reality

Seeing common types of OCD distortions

Using CBT to correct distorted thinking

Defeating unreasonable doubts

Ending exaggerating risk

Rethinking the idea that thoughts have real power

Unconfusing facts and feelings

Overcoming the need for perfection

Sidestepping obsessive thoughts

Letting go of feeling excessively responsible

Pushing Out OCD Thinking with New Narratives

Creating made-up, OCD-like stories

Writing down your OCD narratives

Assessing and rewriting OCD narratives

Chapter 9: Managing the OCD Mind

Separating Your Thoughts from Who You Are

Acquiring the Attitudes of Mindfulness

Making time to be mindful

Pursuing patience

Letting go of striving for striving’s sake

Discovering acceptance

Suspending judgment about emotions

Living in the now

Minding Meditation

Breathing meditation

Walking meditation

Chapter 10: Tackling OCD Behavior with ERP

Exposing the Basics and Benefits of ERP

Understanding why and how ERP works

Seeing the upsides and downsides of ERP

Exploring an alternative when ERP isn’t appropriate

Working through ERP Therapy

Determining your OCD theme

Tallying up your OCD triggers and assigning Ugh Factor Ratings

Placing your OCD triggers on an ERP staircase

Preparing to engage in ERP

Stepping up through your triggers with ERP

Managing the ERP Process

Knowing what’s cheating and what’s not

Troubleshooting ERP

Rewarding yourself

Limiting ERP

Chapter 11: Considering Medications for OCD

Deciding whether Medication Is Right for Your OCD

Getting a thorough check-up

Coming clean with your doctor about your health and medications

Looking at reasons for medicating your OCD

Understanding the side effects and risks of medications

Looking at Your OCD Medication Options

Seeking serotonin with SSRIs

Trying tricyclics

Adding other medications

Chapter 12: Responding to and Recovering from Relapse

Knowing the Risks of Relapse

Medication relapse rates

ERP relapse rates

CBT and mindfulness relapse rates

Responding Well to Relapse

Strategies for Reducing Relapse

Knowing the difference between a lapse and a relapse

Prolonging treatment

Phasing out your sessions gradually

Staging a fire drill

Remaining vigilant

Zeroing in on especially problematic beliefs

Recognizing events that trigger relapse

Part IV: Targeting Specific Symptoms of OCD

Chapter 13: Dealing with Doubting and Checking OCD

Defining Categories of Doubting

Harming your home through negligence

Harming others through negligence

Harming others with your car through negligence

Harming your health through negligence

Categorizing Approaches to Checking

Obvious or overt checking

Mental checking

Getting others to check

Taking Steps to Defeat Doubting and Control Checking

1. Searching for signals, triggers, and avoidance

2. Identifying obsessional doubts

3. Compiling compulsions

4. Disputing obsessional doubts

5. Applying ERP to doubting and checking

Chapter 14: Subduing OCD-Driven Shame

Surveying Shaming OCD

Being afraid of losing control

Questioning established sexual identity

Taking religious or moral beliefs to the extreme

Treating Shaming OCD

Changing OCD thinking by challenging the evidence

Using ERP to change shaming OCD behavior

Complementary Treatments for OCD Shaming

Revealing to others

Experimenting with being “off duty”

Experimenting with self-critical versus self-accepting views

Chapter 15: Messing with “Just So” OCD

Being Driven to Make Things “Just So” All the Time

Enforcing order and symmetry on life

Trying to get it right by repeating and redoing

Taking Steps to Change “Just So” OCD

Rearranging your thinking

Redoing your responses to repeating

Chapter 16: Throwing Out OCD: Hoarding

Defining Hoarding OCD

Describing characteristics of hoarding

Seeing the consequences of hoarding

Uncovering problems in thinking

Assembling uncommon collections

Treating Hoarding OCD

Tallying up the costs and benefits

Questioning beliefs about hoarding

Tackling thoughts that fuel accumulating

Learning to organize

Developing New Strategies for Keeping and Tossing Things

Resisting accumulating

Imagining tossing stuff out

Doing a real cleanup

Chapter 17: Shrinking Superstitious OCD

Seeing When Superstitions Constitute OCD

Revealing Common OCD Superstitions and Rituals

Changing Thinking about OCD Superstitions

Creating competing superstitions

Managing discomfort differently

Deflating the Power of OCD Superstitions with ERP

Facing off with scary superstitions

Defeating the power of superstitious charms

Chapter 18: Uncovering OCD Accomplices

Concerning Counting

Miscounting on purpose

Resisting the act of counting

Taking Charge of Touching

Messing with your touching

Discontinuing touching

Doing Away with Doodling

Doodling in different ways

Denying the urge to doodle

Speeding Up Slowness

Mixing things up

Speeding things up

Chapter 19: Dealing with OCD-Related Impulsive Problems

Changing Behavior to Reduce Impulsive Problems

Increasing awareness of your impulsive problems

Relaxing away impulsive problems

Sidetracking impulsive problems with something different

Reinforcing positive gains in overcoming impulsive problems

Changing Thinking to Reduce Impulsive Problems

Finding reasons to change

Pushing hopelessness aside

Undoing unfairness worries

Designing supportive self-statements

Applying ERP to Impulsive Problems

Treating Impulsive Problems with Medication

Part V: Assisting Others with OCD

Chapter 20: Determining Whether Your Child Has OCD

Understanding Childhood OCD

Recognizing possible symptoms

Ruling out normal growth and health issues

Sorting through other childhood disorders

Observing the Effects of OCD

Having problems at home

Experiencing problems at school

Having difficulties with friends

Finding the Right Help for Your Child

Chapter 21: Helping Your Child Overcome OCD

Separating Who Your Child Is from the OCD

Helping Your Child and Working with the Therapist

Parenting differently and not being the therapist

Managing your emotions

Working with the therapist

Explaining OCD to Family, Friends, and Schoolmates

Chapter 22: Helping Family and Friends Overcome OCD with Coaching

Discerning What It Takes to Be a Coach

Understanding how OCD challenges you

Assessing whether you’re the right person to coach

Knowing your limits

Applying Appropriate Coaching Techniques

Recognizing OCD’s dirty tricks

Coaching with kindness

Part VI: The Part of Tens

Chapter 23: Ten Quick OCD Tricks

Breathing Better

Considering a Delay

Distracting Yourself

Accepting Discomfort

Counting Every Exposure

Realizing It’s Not You, It’s Your OCD

Making Flashcards

Going to an Online Support Group

Minding Meditation

Taking a Hot Bath

Chapter 24: Ten Steps to Take After You Get Better

Forgiving Yourself

Searching for Meaning

Strengthening Family Ties

Finding Friends

Reaching Out to Others with OCD

Helping Others

Benefiting from Exercise

Learning New Skills

Pursuing Hobbies

Finding Healthy Pleasures

Chapter 25: Ten Dirty Little Secrets about Dirt

Defining Dirt

Living Dirt

Digging Dirt

Dirt Just Isn’t What It Used to Be

Chimps Who Eat Dirt

Speaking of Washing Off Dirt

Building with Dirt

People Who Eat Dirt

Kids Who Eat Dirt

Pica

Part VII: Appendixes

Appendix A: Resources for You

Appendix B: Forms to Use Against OCD

Obsessive-Compulsive Disorder For Dummies

by Charles H. Elliott, Ph.D. and Laura L. Smith, Ph.D.

Obsessive-Compulsive Disorder For Dummies®

Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com

Copyright © 2009 by Wiley Publishing, Inc., Indianapolis, Indiana

Published by Wiley Publishing, Inc., Indianapolis, Indiana

Published simultaneously in Canada

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About the Authors

Charles H. Elliott, PhD, is a clinical psychologist and a Founding Fellow in the Academy of Cognitive Therapy. He is also a member of the faculty at Fielding Graduate University. He specializes in the treatment of adolescents and adults with obsessive-compulsive disorder (OCD), anxiety, anger, depression, and personality disorders. Dr. Elliott has authored many professional articles and book chapters in the area of Cognitive-Behavioral Therapy (CBT). He presents nationally and internationally on new developments in the assessment and therapy of emotional disorders. Dr. Elliott and Dr. Laura L. Smith are coauthors of Seasonal Affective Disorder For Dummies, Anxiety & Depression Workbook For Dummies, Depression For Dummies, and Overcoming Anxiety For Dummies, all published by Wiley, as well as Hollow Kids: Recapturing the Soul of a Generation Lost to the Self-Esteem Myth (Prima Lifestyles), and Why Can’t I Be the Parent I Want to Be? (New Harbinger Publications). He also is coauthor of Why Can’t I Get What I Want? (a Behavioral Science Book Club selection from Davies-Black Publishing).

Laura L. Smith, PhD, is a clinical psychologist who specializes in the assessment and treatment of adults and children with obsessive-compulsive disorder (OCD), as well as personality disorders, depression, anxiety, attention deficit hyperactivity disorder (ADHD), and learning disorders. She is often asked to provide consultations to attorneys, school districts, and governmental agencies. She presents workshops on cognitive therapy and mental-health issues to national and international audiences. Dr. Smith is a widely published author of articles and books for the profession and the public, including those coauthored with Dr. Elliott.

The work of Drs. Elliott and Smith has been featured in various periodicals including Family Circle, Parents, Child, and Better Homes and Gardens, as well as popular publications like the New York Post, the Washington Times, the Daily Telegraph (London), and the Christian Science Monitor. They have been invited speakers at numerous conferences, including the National Alliance for the Mentally Ill (NAMI), the Association for Behavioral and Cognitive Therapies, the International Association for Cognitive Psychotherapy, and the National Association of School Psychologists. They have appeared on television networks such as CNN and Canada AM, and, in radio, they are often featured as experts on various NPR programs as well as You the Owner’s Manual Radio Show and The Four Seasons Radio Show. They have committed their professional lives to making the science of psychology relevant and accessible to the public.

Drs. Smith and Elliott are available for speaking engagements, expert interviews, and workshops. You can visit their Web site at www.PsychAuthors.com.

Dedication

To Joey, who helped build our coyote fence, inspired our efforts, and always gave us a laugh when we desperately needed one.

Authors’ Acknowledgments

We’d like to thank our excellent editors at Wiley: Project Editor Stephen Clark, Acquisitions Editor Lindsay Lefevere, and Copy Editor Christy Pingleton, as well as our agents Elizabeth and Ed Knappman.

We also want to thank our publicity and marketing team, which included David Hobson and Adrienne Fountain at Wiley and our personal publicist, Diane Lewis of Common Sense Consulting.

We appreciate the hard work of Erika Hansen for helping us track voluminous amounts of literature about OCD. Thanks to Scott Love of Softek, LLC for his usual care and expertise in keeping our computers running and our Web site humming. Thanks to Trevor Wolfe for giving us feedback and updating our knowledge of current culture.

We want to thank Deborah Wearn and Pamela Hargrove for their support and encouragement as well as helping us to see that the time was right for an encore career as authors.

To Drs. Brad Richards and Jeanne Czajka from the Cognitive Behavioral Institute of Albuquerque, thanks for listening to our compulsive jabbering about obsessive-compulsive disorder. Oh, and thanks for the Chateau Lafite-Rothschild!

Finally, we are especially grateful to our many clients over the years who suffered from OCD. They helped us understand OCD in ways that we could not have without them. They demonstrated resolve, determination, and courage that inspired us.

Publisher’s Acknowledgments

We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Media Development

Project Editor: Stephen R. Clark

Acquisitions Editor: Lindsay Lefevere

Copy Editor: Christy Pingleton

Assistant Editor: Erin Calligan Mooney

Technical Editor: Rebecca Moredock Mueller, MD

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Diane Graves Steele, Vice President and Publisher, Consumer Dummies

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Introduction

Obsessive-compulsive disorder (OCD) was once thought to be very rare. Now, most estimates suggest that from 2.5 to more than 3.5 percent of adults suffer from OCD. That means that more than 3 million people in the United States and many millions more throughout the rest of the world have OCD. Furthermore, the diagnosis of childhood OCD has been mushrooming in the past several decades.

So, why the apparent increase in OCD? Well, part of the reason is that we do a better job of diagnosing the disorder. Another reason we see more OCD today is that people are more willing to admit to having problems. Other factors may be involved as well, such as stress associated with modern life. Perhaps even advertising makes a contribution, as we explain next.

For example, when your flight is delayed for hours, filling the time can be quite a challenge. Like us, you probably dread coming to the end of a novel, magazine, or movie brought to distract yourself from the endless waiting.

Perhaps, after hours of waiting, you resort to mindlessly pulling out the catalog of gadgets, gizmos, and gifts found in every seatback. Next time you’re bored, reach for that catalog and take a look at the advertisements for sanitizing devices. Many of these devices use UV lights and are touted as portable tools for disinfecting all sorts of surfaces, such as countertops, keyboards, cellphones, handrails, public toilets, toothbrushes, desktops, doorknobs, and even armrests on airplane seats. With the wave of a wand, the lights apparently destroy 99.9 percent of all bacteria, viruses, and molds — including E. coli, SARS, and salmonella — in about ten seconds.

Picture the world if everyone carried one of those light wands around. Imagine millions of people scanning everything in their environment that might have some hidden contaminants. Would the world become a safer, cleaner, less contaminated place? What if you added spray disinfectants, hand sanitizers, and face masks to the mix? You might avoid a few colds or bouts of the flu. But hold on, if you avoid all germs, studies show that your body’s immune system may not develop antibodies that combat illness. So maybe all that decontaminating isn’t so great after all.

Nevertheless, those ads can make you feel a little creepy with all their claims about germs, microbes, and bacteria — especially when you’re sitting on an airplane, maybe sweating a bit, smelling the bad breath of the guy next to you, and listening to the hacking coughs, sneezes, and other enjoyable noises of your fellow passengers. We’re not saying that travel hassles cause OCD or that advertising makes it worse. However, media’s obsessional attention to the dangers of dirt and germs sells lots of products and provides grist for the OCD mind.

About This Book

This book is about OCD. Our goals are to help you understand OCD as well as give you strategies for getting help and getting better. We also tell you what you can do to help a child or someone you care about who has OCD. We discuss the symptoms of other conditions, such as anxiety or depression, that can occur at the same time as OCD. In addition, we explain the differences and similarities of disorders that can be considered cousins of OCD.

Throughout the book we give you tips on when to consider getting more help from a mental-health professional. We provide sources and ways for you to choose the right person to assist your recovery.

This book covers the primary strategies used to treat OCD, including Cognitive-Behavioral Therapy (CBT), mindfulness, exposure and response prevention (ERP), and medication. The information is based on the latest scientific research.

An Important Message to Our Readers

This is the fifth book we’ve written in the For Dummies series. As with our other books, our intention is to share the latest and most accurate information about OCD, as well as to provide tools for effectively dealing with the symptoms.

We also want to keep your interest and provide a little entertainment, so we try to put a bit of humor in our writing. Sometimes we laugh at what we write, and we hope you will, too. But keep in mind that we are very aware that OCD is a serious and painful disorder. We only want to make you smile.

Conventions Used in This Book

Case examples are used throughout this book to illustrate points. These stories are based on symptoms, thoughts, and feelings from real people with OCD. However, the individual illustrations are composites of people rather than recognizable examples. The case examples leave out or change many details so that privacy and confidentiality are protected. Any resemblance to any person, whether alive or deceased, is entirely coincidental. We bold the names of people the first time they appear in order to alert you to the fact that we are presenting a case example.

Other conventions you’ll see throughout the book include the following:

In addition to introducing examples (as noted previously), bold indicates the action parts in numbered steps. It also emphasizes keywords in a bulleted list.

Italicized terms are immediately followed by definitions.

When we use acronyms (like OCD), we tell you what they mean the first time they’re used in each chapter. If we miss one or two, please complain to our editors — after all, they’re really the ones at fault!

Web addresses show up in monofont.

When this book was printed, some Web addresses may have needed to break across two lines of text. Rest assured that we haven’t put in any extra characters (such as hyphens) to indicate the break. Just type in exactly what you see in this book, pretending the line break doesn’t exist.

What Not to Read

This book is full of information and every word is well worth reading (and recommending to your family and friends). But you really don’t have to read every single word, sentence, or chapter to benefit. You can use the table of contents or index to look up what you want to know. There is no predetermined order to the chapters; you can read them in any order you choose. Sometimes, we suggest going back or checking out certain chapters or sections for more information, but that’s up to you.

Sidebars throughout the book provide you with what we think are interesting bits of information. Feel free to skip one or all of them if you’re in a hurry. Along the same lines, we have some technical stuff (indicated by the icon of the same name) that explains material in greater detail; don’t feel like you have to be obsessional about reading that, either.

Foolish Assumptions

If you’re reading this paragraph, we suspect that you may be holding this book in your hands (now that was a brilliant deduction). Maybe you’re interested in OCD because you think you have some symptoms. Or maybe you worry that someone you care about has OCD. Perhaps you’re simply intrigued by this very interesting disorder (possibly having seen it portrayed in movies or on television).

You may be a mental-health professional who wants to find out more about specific treatment options for OCD or look at books that may be helpful to your clients. Or you may be a student of psychology, counseling, social work, or psychiatry hoping to get a clearer picture of this complex problem.

Whatever reason you have for picking up this book, we promise a comprehensive depiction of everything you need to know about OCD.

How This Book Is Organized

We divide Obsessive-Compulsive Disorder For Dummies into 7 parts, 25 chapters, and 2 appendixes. Following is a brief overview of the content of each part.

Part I: The Ins and Outs of OCD

Part I describes what OCD looks like. It tells you about the different types of OCD and some of the common and not-so-common symptoms. The third chapter describes other disorders that some professionals believe are related to OCD. We tell you what they are and why they may be part of what is known as the OCD spectrum. Chapters 4 and 5 tackle the biological and psychological causes of OCD. The specific causes of OCD remain a mystery, but many believe biology and psychology both play a role.

Part II: Starting Down the Treatment Path

Chapter 6 explains why so many people want to get help but can’t seem to get going. Mental-health professionals call it resistance — putting the brakes on change. Some people are afraid of change, while others believe themselves incapable of change. We help you find the motivation for moving forward and tackling OCD.

Chapter 7 tells you who’s who in the treatment field. It spells out what to expect if you decide to seek professional help. This chapter also shows you how to evaluate your choice of a mental-health professional.

Part III: Overcoming OCD

This part contains the meat and potatoes — the different treatment approaches to OCD. We cover in depth the techniques that are usually referred to as Cognitive-Behavioral Therapy (CBT). Cognitive refers to how you think and how that can contribute to OCD. How the way you think effects you and how to change are discussed in Chapter 8. Chapter 9 looks at how mindfulness, becoming more aware of the present moment, can help you decrease symptoms of OCD. The gold standard of OCD treatment, exposure and response prevention (ERP) is the behavior part of CBT. We explain how it works and how to implement ERP in Chapter 10.

Chapter 11 takes a close look at the different types of medication that are commonly prescribed for OCD. Finally, Chapter 12 tells you about relapse — what to watch out for and how to deal with relapse if it occurs.

Part IV: Targeting Specific Symptoms of OCD

The seven chapters in this part take a closer look at specific types of OCD and how to treat them. We give you examples of treatment plans for widely diverse problems, such as a need for symmetry or counting, doubting and checking, hoarding, and superstitious thinking. The final chapter gives you advice on treatments for related disorders, such as hair-pulling and skin-picking.

Part V: Assisting Others with OCD

OCD often begins in childhood. The first chapter in this part helps you determine whether your child has symptoms that suggest OCD. It also helps you find a good mental-health professional for evaluating and treating your child. Chapter 21 describes how parents or concerned family members can help a child with OCD. Although we suggest that parents enlist the help of a professional, there are many things parents can do to support therapy and their child. The last chapter in this section gives you tips on becoming a coach for someone else with OCD, including the dos and don’ts.

Part VI: The Part of Tens

Turn to these quick chapters for a little fun. You can read about quick fixes, find out how to move beyond OCD, and get some dirt on dirt.

Part VII: Appendixes

Appendix A contains important additional resources about OCD. We give you lists of books and Web sites you may want to review. Appendix B provides a few forms that you can use for some of the exercises we describe in various chapters. Feel free to make copies for your own use.

Icons Used in This Book

This icon highlights a specific strategy or tool for beating OCD, or an idea that can save you time and effort.

Watch out for this icon. It alerts you to information you need to know in order to avoid trouble.

This icon gives you information that you want to take from the discussion and file away in your brain, even if you remember nothing else. It’s also used to remind you of important information that appears elsewhere in the book.

This icon lays out material that we think is rather interesting or cool, but not needed for understanding the essentials.

This icon indicates lists that can be used to develop ERP staircases. This technique is introduced in Chapter 10 and repeated in a number of chapters that address specific forms of OCD.

Where to Go from Here

We expect that reading this book will thoroughly inform you about OCD and related disorders. The book spells out the major treatment strategies for OCD. We hope you find the text interesting and, at times, entertaining.

If you are reading this book to help you overcome OCD, we encourage you to get a notebook, write out the exercises, take notes, and reflect upon your efforts.

Unless you’re reading this book for your own interest or education (and not because you have OCD), you’re likely to want to consult a professional as well. We expect that most trained mental-health professionals will welcome the opportunity to work with you on the strategies outlined in this book.

Part I

The Ins and Outs of OCD

In this part . . .

In this part, we give you an overview of the symptoms and types of OCD. We cover the major treatment options that are available and most effective for OCD. We also tell you about some other emotional problems that may be related to OCD. Finally, we discuss the varied biological and psychological causes of OCD.

Chapter 1

Reviewing Obsessive-Compulsive Disorder (OCD)

In This Chapter

Finding out about OCD

Seeing how media obsessions can influence OCD

Discovering treatments available for OCD

Helping others who suffer from OCD

Depending on how you define the terms, everyone has a few obsessive or compulsive traits. In popular vernacular, obsessive is a word often used to describe someone’s intense interest in something. For example, a man who stalks a movie star is totally obsessed with her. Or a woman who spends hours putting on her make-up and doing her hair obsesses about her looks. An obsession also can refer to an intense interest in a sport, a hobby, or a career. On the other hand, compulsive often is used to refer to rigid patterns of behavior, as reflected in descriptions such as “He is compulsive about keeping his house clean,” or, “She compulsively balances her checkbook every week without fail.”

But mental-health professionals define these terms quite differently. In the mental-health field, obsessions are considered to be unwanted thoughts, images, or impulses that occur frequently and are upsetting to the person who has them. Compulsions are various actions or rituals that a person performs in order to reduce the feelings of distress caused by obsessions.

You can find examples of obsessions and compulsions in lots of places. For example, many major-league pitchers have elaborate good-luck rituals that can look pretty strange. Some feel compelled to hear the same song prior to the game; others eat exactly the same food. You probably have watched pitchers straighten their hats, smooth out the dirt on the mound, and spit in the sand before each pitch. Many baseball hitters have elaborate rituals they carry out with their bats. Other athletes have strange beliefs, good-luck charms, or compulsive acts that they must perform, allegedly to help their performance. If you are a major-league sports player making zillions of dollars to play a game, you can indulge in a few weird behaviors. No one will bother you.

Anyone can have a few obsessions or compulsions, and, in fact, most people do. But it isn’t obsessive-compulsive disorder (OCD) unless the obsessions and compulsions consume considerable amounts of time and interfere significantly with the quality of your life.

In this chapter, we introduce you to OCD. We reveal how it debilitates individuals who have it and what it costs society. We also provide an overview of the major treatment options — much can be done for OCD nowadays. Finally, because OCD treatment can be greatly enhanced by the help of friends and family, we provide tips on what you can do to help someone you care about who has OCD.

What Is OCD?

OCD has many faces. Millions of people are held prisoner by the strange thoughts and feelings caused by this disorder. Most people with OCD are bright and intelligent. But doubt, uneasiness, and fear hijack their normally good, logical minds.

Whether or not you have OCD, you can probably recall a time when you felt great dread. Imagine standing at the edge of an airplane about to take your first parachute jump. The wind is blowing; your stomach is churning; you’re breathing hard. Suddenly the pilot screams, “Stop! Don’t jump! The chute is not attached!”

You waver at the edge, terrified, and fall back into the plane, shaking. That’s how many people with OCD feel every day. OCD makes their brains believe that something horrible is going to happen. Some people fear that they left an appliance on and the house will burn down. Others are terrified that they may get infected with some unknown germ. OCD causes good, kind people to believe that they might do something horrible to a child, knock over an elderly person, or run over someone with their car.

Those with OCD almost always struggle with two major issues: shame and the intense desire to avoid all risks. We discuss these issues in the next two sections.

Suffering shame

Because the thoughts and behaviors of those with OCD are so unusual or socially unacceptable, people with OCD feel deeply embarrassed and ashamed. Imagine having the thought that you might be sexually attracted to a statue of a saint in your church. The thought bursts into your mind as you walk by the statue. Or consider how you would feel if you stood at a crosswalk and had an image come into your mind of pushing someone into oncoming traffic.

However, the frightening, disturbing thoughts of OCD are not based on reality. People with OCD have these thoughts because their OCD minds produce them, not because they are evil or malicious. It is extremely rare for someone with OCD to actually carry out a shameful act.

Throughout this book we often refer to the “OCD mind” rather than you or someone you care about with OCD. The reason we do that is to emphasize that you are not your OCD. You have these thoughts, urges, impulses, and rituals because of a problem with the way your brain works. OCD is not your fault.

Wrestling with risk

The OCD mind attempts to avoid risks of all kinds almost all the time. That’s why those with Contamination OCD spend many hours every single day cleaning, scrubbing, and sanitizing everything around them. People with Superstitious OCD perform rituals to keep them safe over and over again. Interestingly, most OCD sufferers focus on reducing risks around specific themes such as contamination, household safety, the safety of loved ones, or offending God. But those with contamination fears don’t necessarily worry about damnation. And those who worry about turning the stove off usually don’t obsess about germs.

Risks of all kinds abound in life. We don’t know of any human who has avoided the ultimate worry — death. And no one can ever know when death is about to knock on the door. The following famous people were living their lives with normal precautions and died of random, unexpected events:

Felix Faure: The president of France died in 1899 from a stroke while having sex.

Isadora Duncan: A dancer, Isadora was strangled to death when her silk scarf was entangled in the wheel of a car in which she was a passenger.

Sherwood Anderson: This famous author died after he accidentally swallowed a toothpick at a party.

Tennessee Williams: A playwright, Williams accidentally choked to death on the bottle cap of his nose spray.

Vic Morrow: An actor, Morrow was decapitated while making a movie when a helicopter went out of control and crashed.

Given scenarios like those in the preceding list, it’s hard to imagine how OCD rituals and behaviors could actually anticipate and save anyone from similar circumstances. But the OCD mind tries to create the illusion that almost all risks can be anticipated and avoided.

In truth, OCD doesn’t provide significant protection in spite of extraordinary efforts to reduce risks. In chapters to come, we give you ideas about how to accept a certain amount of risk in order to live a full life, no matter how long or short that life is.

Counting the Costs of OCD

People with OCD suffer. They are more likely than others to have other emotional disorders such as depression or anxiety. Due to embarrassment, they often keep their symptoms secret for years, which prevents them from seeking treatment. Worldwide, it is estimated that almost 60 percent of people with OCD never get help.

The pain of OCD is accompanied by loneliness. OCD disrupts relationships. People with OCD are less likely to marry, and, if they do, they are more likely to divorce than others. Those who do hang on to their families often have more conflict.

OCD also costs money. A study done in the ’90s reported that the estimated price tag of OCD was over 8 billion dollars in the United States alone. This amount represents the cost of treatment, lost productivity on the job, and lost days at work. Even with improved treatments, these costs have no doubt risen along with increased population and healthcare costs.

Encouraging OCD through the Media

OCD is not a new disorder. However, you can’t help but think that the appetite for sensation in the media accelerates OCD concerns. Recently, we saw a television special about people buying used mattresses. Reporters used special lights and took cultures to find all sorts of horrible matter (bed bugs, fecal matter, and body fluids) still clinging to supposedly refurbished bedding.

In another show, zealous reporters burst into hotel rooms armed with petri dishes and black lights to help them find filth and grime on the glasses left in the room, as well as on the carpet and bedding. Media also warns about such dangers as inadvertently inhaling gasoline fumes while pumping gas (of course, who can afford that anymore?) and kindergarten children inadvertently becoming intoxicated from magic markers.

Furthermore, the sales of cleaning products, sanitizers, personal hygiene products, and mouthwash have soared over the years. You can find antibacterial ingredients in products designed to clean your refrigerator, mop your floors, scrub your body, and disinfect your toilets. Antiviral ingredients are also becoming quite the rage.

Yet, try and find solid evidence about deaths from refurbished mattresses, less-than-pristine hotel rooms, incidental exposure to fumes, and homes not cleaned with every antibacterial and antiviral ingredient known to humans, and you’ll come up wanting. In fact, a clever study conducted by researchers at Columbia University in Manhattan provided households with free cleaning supplies, laundry detergent, and hand-washing products. All the brand names were removed. Half of the households were given products with antibacterial properties and the other half was provided supplies without antibacterial properties. The researchers carefully tracked the incidence of infectious diseases (runny noses, colds, boils, coughs, fever, sore throats, vomiting, diarrhea, and conjunctivitis) for almost a year. They found no differences between those who used antibacterial cleaning agents and those who did not.

If you spend loads of time cleaning and using antibacterial disinfectants, you may be doing yourself more harm than good! Scientists now believe that excessively clean environments may actually be causing an increase in allergies and asthma. Furthermore, excessive use of antibiotics appears to run some risk of encouraging the development of new, resistant bacteria.

No, we are not suggesting that people stop washing their hands — especially in hospitals! And we’re well aware of the long-term dangers posed by prolonged exposure to air pollution, insecticides, and toxic chemicals. Furthermore, we’re grossed out by a dirty hotel room as much as anyone else. At the same time, the media and advertisers have shown a disturbing obsession with issues involving excessive cleanliness and minimal exposure to low-level risks.

Germs: Resistance is futile

Some people with OCD spend hours vacuuming in hopes of defeating dust and dirt in their homes. However, research led by Dr. Charles Gerba at the University of Arizona found that household vacuum cleaners not only may spread germs throughout the house, but also may be a safe haven for accumulating bacteria. Vacuum brushes apparently harbor fecal material, mold, and even E. coli. What to do about this situation? One recommendation has been to spray antibacterial disinfectant on your vacuum brushes after every use. Another solution is to buy a new breed of vacuum that purportedly kills bacteria and germs through the use of an ultraviolet, germicidal light. Other researchers have found bacteria and fecal matter in ice machines at restaurants and on restaurant menus. Therefore, some suggest not using ice machines, not allowing a menu to touch your plate, and washing your hands after selecting your food from the infected menu. The problem with these studies and recommendations is that no one has proven that any of these sources cause significant amounts of illness or disease. Though reasonable precautions are always a good idea, you can easily start down the disinfectant road and never return. Bacteria and germs exist everywhere. You cannot eliminate all of them, and you can spend huge amounts of time and money trying.

Exploring Treatment Options for OCD

If you had OCD during the Middle Ages, you very well may have been referred to a priest for an exorcism. The strange, violent, sexual, or blasphemous thoughts and behaviors characteristic of OCD were thought to derive from the devil. If you had OCD during the dawn of the 20th century, you may have been sent for treatment based on Freudian psychoanalysis, which purportedly resolved unconscious conflicts from early development. For example, if your OCD involved sexual obsessions or compulsions, you were assumed to have unconscious desires for your mother or father. In fact, the common use of the word “anal” to describe people who are overly rigid, controlled, and uptight came from the Freudian idea that strict, early toilet training caused children to grow up with excessive concerns about neatness and rules.

However, neither exorcism nor psychoanalysis ultimately proved to have much impact on OCD. Only in the last 40 years or so have effective treatments evolved for OCD. And some of these treatments have only become widely available quite recently.

In the next few sections we provide an overview of the major treatment options for OCD that have shown significant promise based on scientific studies. For clarity, we have divided these therapies into the categories of CBT, mindfulness, ERP, and medications. In reality, rarely are any of these therapies used as a single, exclusive treatment for OCD.

What’s in a name?

Cognitive-Behavioral Therapy (CBT) is a general term referring to a collection of techniques that aim to improve well-being by bringing about specific changes in the way you think and behave. Throughout this book, we use this more encompassing term. (We discuss CBT in detail in Chapter 8.) But sometimes we in the mental-health field get a little persnickety. So, just to keep things straight, we provide a bit more information here than most readers really need.Cognitive Therapy (CT) refers to methods primarily aimed at changes in thinking. Behavior Therapy (BT) focuses on making various behavioral changes. Exposure and response prevention (ERP), the subject of Chapter 10, is one specific form of BT. Just to confuse you a little more, mindfulness, which we cover in Chapter 9, is often considered a variant or offshoot of CBT. You will almost always see at least some small degree of ERP or other CBT techniques included in any given treatment of OCD, even if the approach goes by a single term such as ERP or Cognitive Therapy.

Changing the way you think with CBT

Cognitive therapy was developed by Dr. Aaron Beck in the early 1960s and is a major component of the broader term, Cognitive-Behavioral Therapy.

Originally, this approach was used to treat depression. Cognitive therapy is based on the idea that the way you feel is largely determined by the way you think or the way you interpret events. Therefore, treatment involves learning to identify when your thoughts contain distortions or errors that contribute to your misery. After you’ve identified those distortions, you can learn to think in more adaptive ways. Soon after it was adopted for treating depression, cognitive therapy was applied quite successfully to anxiety disorders and, ultimately, to a dizzying array of emotional problems, including eating disorders, oppositional defiant disorder, and even schizophrenia.

In the early years, cognitive therapy was not applied to OCD, perhaps because of the success of ERP (described in the section “Modifying behavior through ERP”). However, in recent years, the cognitive therapy component of CBT has been found to be quite effective in treating OCD. Usually, CBT includes at least some elements of ERP. Some practitioners believe that applying cognitive strategies first may make the application of ERP somewhat more comfortable and acceptable to the person contemplating that approach. See Chapters 8, 9, and 10 for more information about the various subtypes of CBT.

Approaching OCD mindfully

The OCD mind focuses on possible future calamities. The predictions almost never come true. Yet, the obsessive thoughts keep coming and demanding attention.

I worry about shouting obscenities, so maybe someday I’ll lose control and do it in church.

Maybe my thoughts of death will cause harm to someone I love.

Perhaps touching that doorknob will make me sick.

When it isn’t thinking about the future, the OCD mind dwells on possibilities from the past. The mind fills with thoughts about what might have occurred.

Maybe I left the stove on.

Maybe I ran that person over with my car.

Perhaps I was poisoned by that tuna fish sandwich.

Furthermore, the OCD mind judges people, the world, and even OCD itself harshly.

A bad thought is just the same as doing something bad.

Having OCD thoughts means that I’m crazy.

I am a weak person for having these thoughts.

Mindfulness is the practice of existing in the present moment without judgment or harsh evaluations. Thus, as you acquire a mindful approach to OCD, you understand that thoughts are truly just that — thoughts. Thoughts do not make someone good or bad. See Chapter 9 for more information about how to apply mindfulness to your life and your OCD. As you do, you will become more self-accepting and better able to quiet your OCD mind.

Modifying behavior through ERP

A true breakthrough in the treatment of OCD occurred in the mid 1960s when Victor Meyer tested a treatment called exposure and response prevention (ERP) with two patients suffering from severe cases of OCD. These patients had not improved with shock therapy, supportive therapy, or medication. The drastic measure of brain surgery was even being considered. One of the patients was obsessed with cleaning. Dr. Meyer and a nurse exposed this patient to dirt and did not allow her to clean (ergo, the term “exposure and response prevention”). This radical treatment was the first to help decrease the patient’s symptoms. The other patient was obsessed with blasphemous thoughts. She was told to purposefully rehearse those thoughts without doing the rituals that she had used to decrease her obsessions. Like the first patient, this woman was helped by ERP after years of other unsuccessful therapies.

ERP resulted in a substantial reduction in both patients’ OCD. The mental-health profession took notice because OCD treatments previously had shown little ability to ameliorate this disorder. Suddenly, the prognosis for OCD turned from utterly grim to quite hopeful.

However, ERP requires patients (and sometimes therapists) to get down-and-dirty — literally. Thus, patients may be asked to:

Not check the door locks

Refrain from cleaning up

Repeat blasphemous thoughts over and over

Say the number “13” over and over again

Shake hands

Stop arranging their closets in certain ways

Touch grimy surfaces

You may wonder whether carrying out ERP causes some distress. Indeed it does. Perhaps that’s why the strategy took quite a while to be embraced by large numbers of mental-health professionals. However, the discomfort is worth it because ERP is very effective. You can read all about this strategy in Chapter 10.

Controlling OCD with medications

Medications given for OCD had shown almost no effectiveness until Anafranil (Clomipramine) was found to work in 1966, a date roughly corresponding to when ERP was first tested. Thus, prior to 1966, about the only known strategy for treating OCD was psychosurgery — a rather radical approach involving the cutting of certain connections in the brain. Such surgery sometimes left the patient with devastating side effects, such as an inability to function normally. Obviously, psychosurgery was reserved for the most severe cases. Others were left to fend for themselves.

Today, some of the same medications used for depression (specifically, selective serotonin reuptake inhibitors or SSRIs) frequently work for OCD. However, they are thought to work in a different manner for OCD than they do for depression. The good news is that if medication is going to work, it will work fairly quickly for OCD.

Electrifying news in OCD treatment

Electroconvulsive Shock Therapy (ECT) has been used to treat severe cases of depression. In case you’re wondering, ECT does not seem to help OCD. However, a treatment that involves placing electrodes deep into brain structures shows some promise in the treatment of OCD, as well as depression, Parkinson’s disease, and other neurological disorders. A small continuing study at Brown University, the Cleveland Clinic, and the University of Leuven (in Belgium) found that deep brain stimulation brought at least some relief for all participants with severe OCD. However, the improvement varied a great deal, with study patients averaging about a one-third reduction in their symptoms. Nevertheless, these patients had proven to be highly resistant to other treatments, including ERP and medications. Unlike psychosurgery, deep brain stimulation can be adjusted or reversed. However, the number of studied patients remains small and the research is quite preliminary. So we don’t recommend that you sign yourself up for this strategy quite yet. Give the researchers a few more years to study this approach — many studies are underway at this time.

The bad news is that a substantial number of people do not seem to benefit from medications for their OCD. And those who do benefit find that they relapse quickly if they discontinue the medication. Furthermore, side effects can be significant. For more information about the pros and cons of taking medication for OCD, see Chapter 11.

Helping People with OCD

If you’re reading this book because your child, a family member, or a close friend has OCD, there is much you can do to help. Here are a few points to keep in mind if you want to do more good than harm:

Don’t try to be a therapist. Generally speaking, we recommend that those with OCD consult a mental-health professional. Those with a very mild case may want to try some of the techniques described in this book on their own. However, treatment plans should either be designed by a professional and/or the person with OCD. At the most, you can make a few suggestions. Even if you are a professional therapist, you don’t want to take on that role for a friend or family member.

Understand OCD. Even if you’re not taking on the role of a therapist, knowing a lot about this disorder helps a great deal. Understanding OCD can help you feel compassion and acceptance for the one you care about. You will also know that your family member, child, or friend didn’t ask for OCD. No one wants to have this problem.

Encourage; don’t reassure. You want to encourage the one you care about to participate in treatment. At the same time, you don’t want to do what seems natural — reassure the person that everything will be okay. Please read Chapter 22 to find out how to devise alternatives to giving reassurance.

Don’t get sucked into rituals and compulsions. Those with OCD often try to elicit help with their rituals and compulsions. For example, they may ask someone to recheck that the doors are locked or that the oven is turned off. Though complying with the request may seem caring, doing so only makes matters worse.

Another mushrooming approach to OCD treatment?

The Journal of Clinical Psychiatry recently reported on a study involving psilocybin, the psychoactive substance found in psychedelic mushrooms. Psilocybin was provided to nine people with severe OCD. All nine participants reported that they were symptom-free for periods ranging from 4 to 24 hours. A few patients reported sustaining symptom reductions for several days. However, the primary investigator, Dr. Moreno, indicated that daily ingestion of this drug would likely be problematic. You see, psychedelic mushrooms can also trigger trips to past lives and other planets. Therefore, this is not a treatment that we would recommend at this time. Perhaps some chemical cousin or derivative of psilocybin will ultimately prove to be an effective treatment approach to OCD, but don’t hold your breath.

Chapter 2

Scrutinizing OCD

In This Chapter

Listening to obsessions

Checking out compulsions

Meeting the OCD cast of characters

Knowing whether your symptoms are OCD

Although it goes by a single name, obsessive-compulsive disorder (OCD) is actually a diverse disorder with multiple presentations. OCD can manifest itself as quirky behavior, exaggerated fears, or seriously disturbed thinking. Thus, in one instance, the diagnosis of OCD may be assigned to someone with the odd habit of hanging clothes exactly 1.2 inches apart in the closet, whereas in someone else, OCD may show up as excessive worries about germs and constant hand-washing. Alternatively, OCD could cause someone to adopt an endless number of cats and live in the midst of feces and filth.

You may be surprised to know that everyone occasionally has a few signs of OCD. And some symptoms of OCD are perfectly normal. For example, you may worry about whether you turned off the coffeepot, put the boarding pass in your briefcase, or left a light on as you rush off to the airport for an important business trip. Your mind tells you to stop your car and turn around to check. But usually you don’t because you realize that the odds are pretty much in your favor that your worries are exaggerated.

Occasionally feeling compelled to count steps, knock on wood, or arrange items on your nightstand in a particular pattern is also normal. These actions, although possibly unwanted or a little strange, are common. Just because you have one or more symptoms of OCD doesn’t mean that you have the disorder.

In this chapter, we explain OCD in plain words and provide clear examples of its symptoms, sorting out what’s normal and what’s OCD. OCD has two components — obsessions and compulsions. We describe obsessions, and then we explain compulsions. Finally, we introduce and briefly describe the wildly divergent mutations of OCD.

OCD can steal the minds and dismantle the lives of those affected. Therefore, we take a serious and respectful approach to reviewing the diagnosis and treatment of OCD. At the same time, let’s face it, the OCD brain can come up with some wild thoughts and strange actions. These thoughts and behaviors may look downright bizarre, and occasionally funny, but we assure you that they are real and serious. Finally, we do poke fun at ourselves and occasionally take a lighthearted look at OCD. However, we never, ever poke fun at those who suffer from this serious malady.

Coming to Terms with What OCD Is

People with OCD have obsessions and/or compulsions. Well, duh! How’s that for stating the obvious? These obsessions and compulsions can vary in both intensity and content over time. Thus, someone may have a terrible problem with compulsive hand-washing for two hours every day. After a year or so passes, the hand-washing may fall off, but compulsive rituals involving excessive cleaning of the house and arranging the furniture precisely emerge in its place.

OCD has been considered to be one of the anxiety disorders (which include generalized anxiety disorder, phobias, post-traumatic stress disorder, and panic disorder, among others) because people with OCD usually complain of feeling anxious, uneasy, or distressed. This feeling is often brought on by obsessive fears, thoughts, or images. See our earlier book, Overcoming Anxiety For Dummies, for more information about anxiety disorders. However, OCD involves more than anxiety. It also includes distorted thinking, and repetitious urges and impulses. Therefore, some professionals now believe that OCD should be categorized separately from the anxiety disorders.

The OCD anxiety cycle

In OCD, an obsessive thought, urge, or image occurs, sometimes out of the blue and other times triggered by an event, such as being near someone who sneezes. Once the obsessional worry about germs pops up in response to the sneeze, the person magnifies the risk or threat that the obsession poses. For example, the sneeze may be viewed as a spew of serious pathogens sprayed in the air. The OCD mind believes this threat is very serious and anxiety surges. The rising anxiety causes the person to feel desperate to reduce the distress. The OCD solution is to carry out a compulsion, such as spraying lots of antiviral gel in the nose to quell the anxiety. Completing the compulsion results in a short period of relief, which, in turn, actually increases the likelihood that the compulsion will be used again. To illustrate this OCD anxiety cycle, we use the following example of Cyan.

Cyan is a bookkeeper who worries excessively about getting AIDS from touching anything that other people may have touched. Thus, she avoids touching doorknobs, shaking hands, and using public restrooms. She works at home to avoid unnecessary contact with germs. She carries hand sanitizer and disinfectant in her purse. Even at home she disinfects her countertops and telephone dozens of times each day. She worries that germs float in the air and invade her home.