What is Automysophobia? (An Overview)

In this blog we will discuss the symptoms, causes and treatments of Automysophobia. 

An intense fear of being dirty is called Automysophobia. It is a type of specific phobia which comes under the category of anxiety disorders in the DSM-V.

Someone suffering from it will experience extreme anxiety when exposed to dirt.

Even the thought of getting dirty can instigate very high levels of anxiety. 

People suffering from Automysophobia will avoid any possible exposure with dirt.

They do so by the repetitive acts of washing and cleaning, to remove dirt in addition to lower their anxiety.

These people, if assumed that they are dirty can experience extremely high levels of anxiety, followed by full-blown panic attacks.

Automysophobia is said to be linked with Obsessive-compulsive Disorder (OCD). This is because, in both cases people fear getting dirty.

The repeated acts of avoidance, which include washing/cleaning are the same in both Automysophobia and OCD. 

However, in OCD the person does these rituals in order to lower the unpleasant feelings caused by the incompletion of these acts.

In Automysophobia, one does this to actually get rid of dirt. 

The DSM-5 suggests that the anxiety or acts of avoidance produced in Automysophobia affect one social and occupational functioning.

For example, if one is fearful of being dirty, they are very likely not to go outside the house.

They might even avoid physical contact with people, such as hugging or hand shaking due to the fear that they might get dirty. 

They socially distance themselves from others.

One may not go to school or work because of the chances of getting dirty  This affects their careers and academic life.

The sufferer isolates himself, which can result in him developing depression in the future.

The DSM-5 also claims that for someone to be diagnosed with Automysophobia, they should experience anxiety lasting for at least 6-months. 

Automysophobia is an irrational fear of getting dirty.

The name originates from the Greek word ‘auto’ meaning self, ‘myso’ meaning filth and ‘phobos’ meaning fear. 

Symptoms of Automysophobia 

Dirt is filthy, unclean and unpleasant to get. But, someone with Automysophobia feels traumatized when in contact with dirt (or when they think they got dirty).

In extreme cases, one suffers from high levels of anxiety by just thinking about being dirty. 

Their fear is not wholly irrational however, the exaggerated sense of threat and anxiety is what makes the sufferer unable to think logically or rationalize their thoughts and actions.

The anxiety can be so extreme that one has panic attacks.

In Automysophobia, the sufferer goes into flight or fight mode because of an adrenaline rush.

In this state, the body’s physiological responses help one make decisions when in fear causing situations.

They either decide to escape the situation (flight)-faint/experience panic attacks or stay and combat their fear (fight)- control their anxiety in a more counterproductive way.

Physiological symptoms that one undergoes in Automysophobia are: 

• Extreme anxiety when allegedly in contact with dirt 
• Extreme anxiety when thinking about getting dirty 
• Frequent handwashing
• Frequent use of hand sanitizers
• Frequently taking baths
• Inability to control anxiety
• Full-blown panic attacks
• Avoiding getting dirty 
• Indulging in time consuming activities to stay clean 
• Increased heartbeat
• Breathlessness
• Muscle tension
• Tremors
• Sweating
• Hot/cold flashes when in a flight or fight mode (A hot flash refers to the temporary heating up of the body when in a state of fear. And a cold flash means when the body suddenly starts to shiver or cool down, when encountered by a fear stimulus).
• Nausea
• Headache
• Feeling of restlessness

In order for someone to be diagnosed with Automysophobia, one must experience at least 3-5 of these symptoms, including anxiety. 

Causes of Automysophobia 

Automysophobia, like all other specific phobias, has no known cause.

These types of phobias can be a result of a number of factors such as biological (genetics) and or environmental (past experiences or social learning).

Genetics refers to the genes and neurotransmitters in our body. Someone with a family history of a phobia/mental disorder has a higher chance of having the same or different disorder in the future.

This is because the genes of the parents are transferred to their children, thus any alteration in the genes of one’s parents is inherited by the child.

This genetic tendency to develop a mental disorder/specific phobia can also be referred to as a Diathesis-stress relationship.

According to this, one with a genetic predisposition will not develop symptoms of Automysophobia until and unless there is some trigger event, instigating anxiety or fear of getting dirty. 

As mentioned earlier, one can develop Automysophobia as a result of OCD.

Thus, someone who is already diagnosed with this disorder is more likely to have this irrational fear of dirt. 

An environmental trigger event can be for example, a traumatic childhood experience with dirt.

One who has some kind of skin allergy will be fearful of staying dirty. 

Also, someone who might’ve gotten skin because of being unclean can also develop Automysophobia. 

Someone who already has a fear of germs (Mysophobia) will be afraid of contracting germs via dirt, thus fear being dirty. 

An individual who has parents who are hygiene freaks or conscious of cleanliness also have a higher chance of developing Automysophobia. 

Thus, Automysophobia is caused by both a genetic predisposition and environmental trigger events. 

Treatment of Automysophobia 

Automysophobia, like all other specific phobias, has no exclusive type of treatment that is specifically designed to treat it.

Like all the other specific phobias, Automysophobia is treated by a number of different therapies including, Exposure Therapy, Cognitive-behavioral Therapy (CBT) and or medications that lower downs the anxiety or other physical symptoms.

• Cognitive-Behavioral Therapy (CBT)

It is one of the most frequently used treatments for patients with almost all kinds of mental disorders.

Automysophobia is defined as the irrational fear of being dirty.

Thus, the therapist helps the patient in replacing these irrational thoughts with more rational ones.

The patients are helped out in analyzing and justifying the way they feel about getting dirty.

Therapists assist them in uncovering the reasons behind their fear and later they provide them with alternate, pleasant thoughts.

The patient is told to maintain a thought diary (with ABCD column) which provides them a replacement for every irrational thought they have, when thinking about a particular situation. The ABCD stands for:

i.      A (antecedents) a situation or triggering event.

ii.     B (belief) the thought that comes to one’s mind when in that triggering situation.

iii.    C (consequences) the symptoms/feelings caused by that event/thought

iv.    D (dispute) alternate, rational thoughts provided by the therapist in an attempt to    dispute/challenge those irrational beliefs.

This last section of the thought diary is what really plays a role in helping the person feel good/less anxious. 

• Exposure Therapy

It is one of the most frequently used ways of treating patients with Automysophobia (or any other kind of specific phobia).

In this therapy, the patient is exposed to the source of his fear over a certain span of time.

To begin with the therapy, the therapist exposes the patient to the least triggering stimuli, a picture of someone dirty.  

As the therapy progresses and the patient is able to control his anxious feelings, imagery can be used to take the treatment a step further.

In this part of the treatment the patient is asked to visualize/imagine a situation in which he gets dirty.

During this process of imagery, one actually feels being in that particular situation or place, experiencing various senses.

 Once the person successfully, without feeling anxious clears this step of the therapy, he is then exposed to real dirt. 

While the patient is being exposed to different intensities of stimuli during the various stages of therapy, the therapist simultaneously teaches them coping exercises.

These include, breathing techniques or muscle relaxation methods to lower their anxiety, when in an actual fear/anxiety causing situation.

This teaches them how to remain calm when exposed to the fear stimuli.

Before actually starting the exposure therapy, the therapist needs to figure out the intensity of the patient’s fear, as to deduce whether they will be able to undergo this treatment, without any physical or psychological harm caused to them during the exposure processes.

However, these steps desensitize one to their fear of being dirty, by exposing them to that stimuli repeatedly, until they learn to undergo the situation without anxiety/panic attacks.

• Mindfulness-Based Stress Reduction (MBSR)

MBSR is a meditation therapy, used to manage stress or anxiety.

It is an 8-week program which includes group sessions. Mindfulness meditation and Hatha yoga are practiced in these sessions.

Lectures and group discussions are also done to talk about mental health and increase interactivity.

In mindfulness meditation the person is told to, for example, to focus on the sensations felt while breathing or the rhythm of the chest rising and falling during the process.

This distracts the person’s attention from something stressful to something which is neutral and soothing.

For quick and effective treatment, patients are also given a set of home works, for example 45 minutes of yoga and meditation sessions for 6 days a week and to record their results/feelings in a book or diary for 15 minutes a day.

• Dialectical Behavior Therapy (DBT)

This is another effective therapy used to treat Automysophobia.

It is more commonly used with people suffering from personality disorders, but is also useful with patients suffering from this type of specific phobias. Coping skills are taught in the DBT group which lasts for about 6-months and can have a number of people (depending on how many join the group).

         i.  Half-smiling is the first module of DBT. It is a technique that is used with patients who are distressed because of their irrational thoughts.

The technique is known as ‘Half-smiling’ because the person is first advised to think about the stimuli that fears or upsets them, and while doing so they are told to lift the corners of their mouths by subtly smiling. Smiling is not that will help one get rid of these unpleasant thoughts, it is the person’s ability to constrain itself from thinking about those thoughts while half smiling.

       ii. Mindfulness, the second module, is another technique used in DBT groups which helps the individual in getting rid of those negative thoughts.

Individuals are told to focus on the present and be attentive to what is going on around them at the moment.

This helps in breaking the link between their mind and any negative thought that might come to them then. 

For example, a person is told to focus on his breath or on the smell of a certain food presented to them, making use of their olfactory sense.

      iii. The third technique or module of the DBT is distress tolerance skills.

This module teaches people to calm themselves down in healthy ways when they are distressed or emotionally overwhelmed.

Individuals are allowed to make wise, rational decisions and take immediate action, rather than being captured by emotionally destructive thoughts that might make the situation worse.

Reality acceptance skills are also learnt under this model so that people fully accept reality and later make plans on how to address the problem.

• Yoga/Meditation

They are not just one of the many treatment therapies used for Automysophobia, instead they are one of the most common ways of relaxation used by many people.

Yoga tends to stimulate the meditative state of one’s mind while the person is in a particular yoga posture.

Through yoga/meditation the mind is diverted towards something more productive and calm, allowing the person to escape the negative, distress causing thoughts.

Out of a number of yoga types, one can benefit from any yoga type/pose they like. Hatha yoga is one of the different types of yoga.

The breathing techniques or the imagery one creates while in a yoga posture are the real factors that makes the person feel less anxious and diverts their mind, away from the thoughts about being dirty. 

• Drug Therapy

Drugs are used to reduce the physical symptoms caused by Automysophobia.

Drugs are very quick in effectiveness, as they start showing progress in the patients’ health at least 2 weeks after the medicine is taken.

This type of biological treatment is usually more effective if the cause of the phobia is only genetic.

However, these drugs/medicines are not to be taken without a doctor’s prescription or consultation.

Two types of drugs are used in the treatment of this phobia:

                    i. Anti-anxiety Drugs

Medicines like Klonopin are anti-anxiety drugs.

They are most commonly used with patients who experience panic attacks and also lowers their anxiety by binding to receptor cells of the brain that cause these unpleasant symptoms.

                   ii. Antidepressant Drugs

These drugs, as the name suggests don’t only treat depression but are also very effective in treating phobias.

Medicines like Paxil reduce the anxious feelings of a person and makes him feel calm.

They need to be taken on a daily basis but not without a doctor’s advice.

Whether the cause of Automysophobia, or any other type of specific phobia is genetics, environmental or both, the best and the most effective way of treating them is by using a combination of both biological treatments (drugs) with cognitive treatment (for example CBT/exposure therapy).

Frequently Asked Questions 

Citations 

• www.psychtimes.com
• https://common-phobias.com/automyso/phobia.htm
• https://fearof.org/automysophobia/
• www.apa.org