Jana Mettwali

ENG 210

Professor Zayas

Research Paper – Final Draft

April 9, 2025

The Invisible Weight: Cleaning OCD as a Neurological and Psychological Battle

            Obsessive-Compulsive Disorder (OCD) is misrepresented in popular culture as a personality quirk or neatness obsession but is in reality a serious mental condition that is known for its repetitive behaviors (compulsions) and intrusive thoughts (obsessions). One of the better known of the OCD subgroups is fear of contamination, loosely known as “cleanliness OCD.” Those afflicted with this type of OCD are usually plagued by an excessive fear of germs or filth, leading to excessive washing of the hands, staying away from crowds, or elaborate cleansing routines that take over their lives. These compulsions are based not on preference but on fear of what will happen if the routines are not completed.

This research paper discusses the multi-dimensional aspect of contamination-type OCD, integrating neuroscience, psychology, and advances in treatments in crafting an enhanced knowledge base of the condition. In reviewing previous literature, it discusses the neurological underpinnings of driving compulsions, the psychological and emotional systems reinforcing them, as well as the advances in treatments that hold out hope. In addition, the paper critiques social misrepresentation of the condition as well as its effects. By crafting an informed, science-oriented, as well as empathetic, picture of OCD, especially the contamination subtype, in this way, we can create greater support, earlier detection, as well as better care.

Understanding the neurological aspects of OCD

Cleanliness OCD is not the result of choice or learned behavior but is strongly linked with the structure and chemistry of the brain. In the last few decades, research in the field of neurosciences has shed considerable light on how OCD functions within the brain. Fineberg et al. (2013) uncovered that people with OCD have abnormal activity in certain regions of the brain, such as the orbitofrontal cortex, anterior cingulate cortex, and the striatum. These regions are important for decision-making, impulse control, and emotional adaptation. In their state of hyperactivity, the brain is unable to suppress unnecessary thoughts, leading to rumination and increasing the tendency to do repetitive activities like cleaning.

Another central element is serotonin, a neurotransmitter linked with mood as well as anxiety. Pauls et al. (2014) describe how imbalances in serotonin circuits may increase obsessive thinking and compulsion. Though those who have cleanliness OCD might recognize that their anxieties are irrational, they are often helpless to prevent the rituals due to an improperly functioning feedback loop in the brain. The brain is trapped in what amounts to a repetitious loop in which the mind is convinced that harm is perpetually imminent.

In a newer study, de Joode et al. (2023) utilized sophisticated neuroimaging technology in order to observe shifts in brain metabolism when OCD symptoms were induced. Abnormal activity in the lateral occipital cortex revealed that OCD is not just based in the structure of the brain but in its chemistry as well. These findings highlight the medical reality of OCD and push it away from outdated beliefs that mental illness is simply psychological or “in someone’s head.”

Emotional Processing and Psychological Roots

Whereas the neurological aspect describes the failure of the brain, the psychological aspect reveals how OCD is expressed emotionally. OCD symptoms tend to result from an emotional need for safety, order, or moral certainty within. Reuven, Liberman, and Dar (2014) found that for most people with cleanliness OCD, the cleaning compulsion is emotionally motivated—people feel “morally impure” or contaminated, and they employ rituals as an attempt at soothing such feelings.

Such an overview explains the relationship between OCD and feelings of guilt, particularly in those milieus or lineages that place high emphasis on standards of behavioral norms as well as hygiene standards. According to Reuven et al. (2014), cleaning rituals serve as emotional coping devices, allowing the individual to momentarily escape discomfort but making the compulsion worse in the long run. This creates an addictive effect where relief at having washed feels so good that it creates an unhealthy cycle in which avoidance as a means of controlling inner emotions becomes the norm.

Psychological principles also account for why cleanliness OCD may be so entrenched and resistant to treatment. Individuals become “stuck” in incorrect thinking that contamination is perilous, based on beliefs that are emotive, not logical. Cognitive-behavioral therapy (CBT) is important in the treatment of this because it allows such irrational thinking patterns to be uncovered and challenged.

Stephenson et al. (2021) carried out research integrating electronic CBT with imaging of the brain. Participants did not just get better psychologically but showed quantifiable changes in the function of their brains. This intersection of brain and behavior confirms the efficacy of psychological intervention in demonstrating its effects on physical mechanisms in the brain. It is also an indication of the increasing potential of technology-driven mental health intervention, which might make it easier for people who are unwilling or incapable of pursuing conventional therapy.

Standard and Novel Therapies

There is no cure for OCD, but it can be effectively managed or decreased. Most often, this is done through the use of a combination of CBT in the form of Exposure and Response Prevention (ERP) and medication in the form of Selective Serotonin Reuptake Inhibitors (SSRIs). ERP is done by placing the patient in situations that trigger anxiety but stopping them from engaging in their typical ritual, slowly teaching them that nothing disastrous is going to happen. Stein et al. (2019) states that this approach is highly effective and is regarded as the gold standard of treating OCD.

SSRIs like fluoxetine (Prozac) or sertraline (Zoloft) manage serotonin levels in the brain and minimize the occurrence and severity of intrusive thoughts. In some cases, medication is not enough, even for severe or resistant OCD patients. Approximately 30–40% of patients are not responsive enough to conventional therapies, inspiring researchers to look for alternative means.

One of those is Deep Brain Stimulation (DBS), surgery in which electrodes are implanted in parts of the brain to modulate abnormal activity. Another non-surgical alternative is Transcranial Magnetic Stimulation (TMS), utilizing magnetic fields to stimulate nerve cells. Both are experimental, but initial studies—including those discussed in Stein et al. (2019)—have indicated substantial reduction in symptoms in patients who had little response with standard treatments.

These new methods have great potential but are not without their challenges. DBS, for one, is associated with the risks of surgical procedures in the head and is typically reserved for the most serious cases. While TMS is less invasive and widely accessible, it is still costly and may be not be reimbursable on all plans. In any case, both indicate greater movement toward personalized and brain-focused therapeutic options.

Stigma and Social Misrepresentation

Even with increasing scientific awareness, OCD continues to be grossly misunderstood in the popular imagination. It is commonly misrepresented in popular culture as applying any sort of order or neatness to one’s affairs. Cleanliness OCD is especially dismissed or made light of in popular culture as well as in common conversation. Such downplaying can be dangerous for those who experience the condition, leading them away from intervention or toward feelings of shame and isolation.

The paper Behind the Scenes: Revealing the Misrepresentation of Obsessive-Compulsive Disorder in Film and Television (2024) talks about how movies and television shows tend to oversimplify OCD as hyper-cleanliness behaviors, bypassing the emotional pain along with the mental fatigue underlying the compulsions. Such misrepresentation not just propagates misinformation but even aids in creating the perception that OCD is no “real” disease.

It is vital that raising awareness as well as encouraging accurate representation of OCD is key towards early intervention and enhanced support. Raising awareness through public campaigns, mental health school curriculums, as well as professional training can help reframe OCD as an important, treatable condition. Making people speak freely about mental health allows one to get assistance at an earlier stage without feeling embarrassed about their condition.

The Road Ahead: Synthesizing Science, Compassion, and Advocacy

cleanliness-OCD is at the crossroads of chemistry in the brain, emotional processing, and reinforcement behaviors. It is not just a dirt aversion but a crippling condition fueled by neurological impairment and intense psychological suffering. Though the most effective treatments still center on CBT and SSRIs, newer treatments such as DBS and TMS are increasingly offering hope for non-responders.

In addition to the science, the social and emotional nature of OCD cannot be dismissed. Stigma as well as the disease can be as destructive as the disease, stressing the need for humanizing the experience as well as for treating the afflicted with compassion. As research is illuminating the biology of OCD, we also need to keep the personal experience of those who experience it in the forefront of our minds.

In the end, an effective response to OCD will require ongoing investment in research, better access to mental health services, and increased public awareness. By this multi-faceted effort, we will get within reach of the point at which those with cleaning OCD are not merely controlled but cared for—and comprehended.

References

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491–499. https://doi.org/10.1016/S0140-6736(09)60240-3

Behind the Scenes: Unveiling the Misportrayal of Obsessive-Compulsive Disorder in Film and Television. (2024). International Journal for Multidisciplinary Research, 6(5). https://doi.org/10.36948/ijfmr.2024.v06i05.29274

de Joode, N., van den Heuvel, O., Koster, M., Clarke, W., van Balkom, A., Schrantee, A., & Vriend, C. (2023). The Effect of OCD-Symptom Provocation on Neurometabolites in the Lateral Occipital Cortex and Their Relation to the BOLD Response, a Combined fMRS and fMRI Paradigm. Biological Psychiatry, 93(9), S242–S243. https://doi.org/10.1016/j.biopsych.2023.02.608

Fineberg, N. A., Reghunandanan, S., Brown, A., & Pampaloni, I. (2013). Obsessive-compulsive disorder: The role of neuroimaging in diagnosis and treatment. Neuroscience & Biobehavioral Reviews, 37(10), 2256–2272. https://doi.org/10.1016/j.neubiorev.2013.02.014

Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive disorder: An integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410–424. https://doi.org/10.1038/nrn3746

Reuven, O., Liberman, N., & Dar, R. (2014). The Effect of Physical Cleaning on Threatened Morality in Individuals With Obsessive-Compulsive Disorder. Clinical Psychological Science, 2(2), 224–229. https://doi.org/10.1177/2167702613485565

 Stephenson, C., Malakouti, N., Nashed, J. Y., Salomons, T., Cook, D. J., Milev, R., & Alavi, N. (2021). Using Electronically Delivered Therapy and Brain Imaging to Understand Obsessive-Compulsive Disorder Pathophysiology: Protocol for a Pilot Study. JMIR Research Protocols, 10(9), e30726. https://doi.org/10.2196/30726
 Stein, D. J., Costa, D. L. C., Lochner, C., et al. (2019). Obsessive–compulsive disorder. Nature Reviews Disease Primers, 5(1), Article 52. https://doi.org/10.1038/s41572-019-0102-3