Cognitive Motivations for the Initiation of Ritualistic Hand Washing in Obsessive–Compulsive Disorder

Background: There is little research on cognitive factors that characterize the initiation of compulsive washing in obsessive–compulsive disorder (OCD). The present study seeks to contribute to a better understanding of the goals that are salient at the start of compulsive hand washing. Methods: Thirty-eight individuals diagnosed with OCD with predominantly hand-washing compulsions and two comparison groups, one with 41 individuals diagnosed with OCD without washing compulsions and one with 43 nonclinical individuals, were interviewed about a situation when they needed to wash their hands. Participants’ goals for the wash and step-by-step descriptions of the wash were categorized and compared between groups. Results: Findings indicate that some factors involved in the maintenance and termination of a compulsive wash might already be established at the outset of the wash, such as goals being characterized by higher levels of abstractness and importance for participants with predominantly hand-washing compulsions compared to controls. Number of goals was associated with number of repetitions of the compulsive wash. Conclusions: Individuals with hand-washing compulsions might have goals in mind right from the start of the wash that are very difficult to reach. If our findings are confirmed in future studies, therapeutic implications could include exploring the adaptiveness of having abstract goals and their exaggerated importance.