June 13, 2005
iranian.com

About Shokooh

QUESTION
Vas vaas or obsession?

Dear Shokooh,

I am writing to you about my sister. As long as I can remember, she has been very “vas vaas.” When we were growing up, she always took long showers, took extra time ironing her clothes, and kept her room very clean. While the habit was a little annoying when we were young, it has now gotten so bad that I think she may need therapy. She lives in another town and I went to visit her recently.

While there, I noticed that she was taking three showers a day and spending time washing the shower before getting in each time! This adds up to something like four and a half hours of her day devoted to either washing and preparing the shower or actually showering herself. I told her that this was excessive but she got very defensive and called me a slob. We ended up fighting and I left early.

Do you think there’s something wrong with this situation? I am very worried about her -- can you be too “vas vaas?” Does showering this way sound like an obsession?

Signed,

Worried Sister

REPLY

Dear Worried Sister,

In a word, yes.

My understanding of our culture is that the word “vas vaas” can be understood as being particular, or precise about things, such as with cleanliness and order. I have heard the word most often applied to women who are particular about the way they keep their homes. However, spending four and a half hours of your day showering is not what I would consider “vas vaas.” I would call this compulsive behavior.

I have not met your sister and thus cannot make a diagnosis. From your (edited) letter describing her behaviors, however, I can tell you that you are right to be worried about her. She is spending over half her waking hours consumed with cleaning the shower and herself. This clearly goes far beyond the “precise” or “particular” girl who was careful to dress neatly. It seems that things have shifted as she has grown, and her behavior has crossed the line into the category of worrisome.

Most patients I have seen with behaviors like those you describe (compulsive showering that results in spending excessive amounts of time preparing the shower for use and then actually using the shower to clean themselves) have a series of behaviors that are summarized into the category of Obsessive Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a potentially disabling anxiety disorder. The person afflicted with OCD becomes trapped in a pattern of repetitive senseless thoughts and behaviors that are very difficult to overcome. OCD is characterized by obsessions and compulsions. Obsessions are unwanted repetitive ideas or impulses.

Common examples include an unreasonable concern with becoming contaminated or an excessive need to do things perfectly. Again and again, the individual experiences a disturbing thought, such as, "I am not clean enough. I must keep washing” or "I may have left the door unlocked. I must check it." These thoughts are intrusive, unpleasant and produce a high degree of anxiety.

In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include repeating, hoarding, rearranging, and counting. Mentally repeating phrases, checking or list making are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals, such as washing the bathtub or showering a specific way or length of time.

Most people with OCD struggle to banish their unwanted thoughts and compulsive behaviors. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are engaged at school or work. But over time, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals make it impossible for them to have lives outside the home.

The good news is that a specific behavior therapy approach called "exposure and response prevention" is effective for many people with OCD. In this approach, the patient deliberately and voluntarily confronts the feared object or idea, either directly or by imagination. For example, a compulsive hand washer may be encouraged to touch an object believed to be contaminated, and then urged to avoid washing for several hours.

Her anxiety will, of course, increase dramatically. If, however, she stays with the feelings of anxiety and doesn’t try to escape them by washing, her anxiety will be diminished. Other time, and with repeated such exposures, there is a high likelihood that she will be able to extinguish the rituals. As treatment progresses, most patients experience less anxiety from the obsessive thoughts and are able to resist the compulsive urges.

I applaud you for having the insight to seek help in attending to your sister’s potential washing compulsion. Remember that these ideas I have shared are based upon your descriptions. Only after direct interaction should a qualified professional, such as a psychologist or psychiatrist, can diagnose OCD or any other condition. I hope your sister can find her way to a qualified resource to guide her treatment and help her on the path to recovery.

Be patient about your sister’s progress, no matter how slow. Encourage her steps towards recover and continue providing a support system for her. And remember -- you are not alone. Millions of Americans suffer from OCD. It is a treatable situation that she can overcome with help and support. I wish you and your family all the best.

Be well,

Shokooh

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This column is for general educational purposes only-- it is not a substitute for medical attention, counseling, or therapy of any kind. The Couch and the staff of this website urge you to seek immediate medical attention if you are in an urgent, harmful, or potentially dangerous situation. Psychiatric emergencies or urgent matters should be handled by calling 9-1-1 or going to the nearest emergency room.   Please note that your emails will not be answered on an individual basis and your confidentiality cannot be guaranteed. Top

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