Is there a relationship between ptsd and cleanliness?

[anthony]

After some research through scholarly journals and texts, there does not seem to be a direct link to PTSD in relation to a sufferer being extremely clean and tidy due to a lack of available data or discussion.

Substantial data exists to support personal cleanliness in relation to victims of sexual abuse. It is common that a victim of sexual abuse shower more than is necessary, spend excessive time cleaning themselves and other behaviors related to the want--or the need--to feel clean.

Substantial data exists to support cleanliness in relation to Obsessive Compulsive Disorder (OCD). OCD is a statistical minority as a comorbid disorder to PTSD, in that it can certainly be present, but the low incidence of comorbidity with this diagnosis does not warrant inclusion within the list of PTSD comorbid disorders.

One's trauma may contain an element of behavior modification, and this can answer for certain compulsions to maintain severe cleanliness, such as behavioural modification as part of military training as well as victims of child abuse where they were forced to maintain a clean environment or endure abuse as a punishment. In both cases, prior behavioural teachings can certainly be credited for a PTSD sufferer believing they require a clean environment without it actually being related to PTSD itself.

 

[hodge]

I’m the opposite, actually. I find it very difficult to touch myself, hence cleaning is a problem.

 

[Northof60]

They have not studied Indigenous People from residential schools.

 

[notsurewheretoturn]

Initially I went the other way, I didn’t wash, didn’t change my underwear and basically went out of my way to make myself as unattractive as possible to my attacker and indeed everyone else. But at the time I was a child and he was an adult, I guess it was the only weapon I had against him.

Even now when the PTSD is really showing itself, I’ll wear the same clothes for a couple of days, not clean my teeth and basically tell everyone (in my own way) to stay away and leave me alone.

 

[Anne1]

I should probably put a triggering warning on this…

I’m glad that Anthony posted this question, and not surprised that it took so long for responses, or that they all alluded to problems with cleanliness, rather than excessive need to clean. Ablutophobia is a common, but not often discussed, result of child abuse.

I wonder if it mightn’t be true that those who’ve grown up without violence or degradation – and then experienced one life-altering violent attack – would feel the need to clean in order not to feel so sullied by it – and are able to do so simply because their ability to clean wasn’t ruptured by their experience. OTOH, those who’ve grown up with repeated violence and degradation as a matter of course (which is often associated with terrorizing in day to day activities like cleaning), may not be able to clean due to trigger responses (for all kinds of reasons – too many to list here).

For what it’s worth, I think we’ve improperly defined PTSD as a fear based disorder. Or perhaps it would be more accurate to say that I think we’ve conflated two disorders which should be considered separately, and used the definitions from the less troubling disorder to define the whole. I believe to help some survivors we need to look past the emotion of ‘fear’, and consider the impact of the emotion ‘disgust’.

I’ve been working with trauma survivors for years now (I’m a survivor myself), and I’ve yet to see a single case of PTSD solely as a result of fear. Most cases of C/PTSD I’ve seen are as a result of dehumanization &/or degradation, not so much about fear. From everything I’ve read, degradation and dehumanization are results/symptoms of the emotion of disgust in the abuser. (Any of Jonathon Haidt’s articles on Disgust (e.g. the Disgust Scale: The Disgust Scale Home Page) are eye-opening.)

In order for an abuser to intentionally degrade and dehumanize another human being s/he must first view them with disgust. Often, their intent is to transfer that sense of disgust to the victim to then carry themselves, in essence doing the abuser’s work for him/her without the abuser being present.

According to Haidt, the origins of the feeling of disgust come from biological contamination. Hence the issue of cleanliness: either feeling the need to clean, or being terrified of cleaning despite feeling dirty (often as a result of being punished for trying to humanize themselves). Abuse is a threat which creates fear in the victim, to be sure, but what I’ve heard from countless survivors is that fear is something powerful but quick, and goes through you cleanly. Abuse based on disgust, otoh, (usually using fear to reinforce it), is intended to permanently mark the person as non-human (often as garbage, or at minimum as ‘unclean’) – even if only in their own consideration of themselves. But it’s intended to be long-term. To do that, the abuse is usually done in a way to maintain life and consciousness, for that’s the only way to guarantee the victim’s prolonged suffering (unless the actual target for the suffering is someone who cares about the victim).

Fear is usually toward something external – ‘other’ to one’s self. The whole point of abuse from disgust , otoh, is to transfer that feeling to the target so that he or she feels it about themselves; that’s usually done by making the victim feel dirty. For the worst offenders, it’s reinforced by physically defiling the victim and then giving him or her the message that they aren’t allowed to (or capable of, or will be punished for) being clean (&/or ‘normal’), usually through selected aversive conditioning.

It’s easy to spot once you recognize it (e.g. rapists who anally rape before orally raping, child abusers who force their children to eat vomit, feces, rancid/moldy food, hair from the drain, etc…), and I believe the injuries it creates are different (deeper and longer-lasting, and more isolating from society at large) than those from fear. Most people will reach out to help someone in pain and distress, even at risk to their own lives. Most people – even decent human beings – will pull away from someone they perceive as disgusting. It’s a very powerful force.

 

[anthony]

An interesting read, thanks Anne.

I looked up https://en.wikipedia.org/wiki/Ablutophobia, did not know that one.

I have the disgust scale on my to read list. Looks fascinating.

 

[Anne1]

Thanks for starting the discussion Anthony. If you’re not finding a lot of research connecting cleanliness and PTSD, perhaps the connection is more through the link between squalor and abusive personalities: how comfortable they are with it, and how they can use it as a weapon of abuse?

I think this is a very needed conversation, but most victims are usually too traumatized and humiliated to talk about it, at least as far as I’ve seen. Also, I’ve found that survivors who haven’t experienced that have a hard time listening to those who have.

(BTW, if this is pulling this thread too far off-topic, please go ahead and delete it!)

So many layers, and so many related issues: sadism, squalor, hoarding, torture, etc…

For instance, there is squalor &/or hoarding, alongside too early sexual experiences, in the background of a surprising number of serial killers and serial rapists – either their own or more often in their FOO. (This is true for both male and female rapists and SKs, btw). There seems to be an especially strong link with food hoarding or growing up in squalor. It’s so damaging to children.

I found an interesting post a few years ago (can’t find it at the moment): a therapist talking about how the children of hoarders (COH) are the clients who have the worst, deepest, and most intractable PTSD symptoms in her practice. I’ve found similar things in the survivors I deal with, but the trauma goes so deep that I can’t get anyone to talk about it.

When I refer to ‘hoarders’ here, btw, I’m not talking about people who have organizational challenges and who struggle to maintain order in their lives; I’m talking about aggressive personalities who embrace disorder in their physical environment. They’re the hoarding typology ‘Exploiter Hoarder’ in the HARC definitions (Hoarding of Animals Research Consortium – an excellent resource for anyone who is interested in learning more).

Children of hoarders often struggle with cleanliness and order throughout their lives – it is strongly associated with PTSD. Those who’ve received any kind of outside help learning about housework, etc… are often excessively clean and can’t abide any clutter or dirt. Others who never got that kind of intervention or whose hoarding parents were severely abusive are often severely traumatized by dirt, clutter and disorder, but can’t bring themselves to touch it.

I was reading somewhere that aggressive hoarders (and people who intentionally live in squalor) have a much less developed sense of disgust than their family members, who are often so traumatized by the mess and smells around them that they can’t cope. I believe the same is true of sadists. Also not widely known is that some hoarders (not all) use disgusting conditions as a method of controlling family members. The family of some hoarders will also tell you that before their family member became a hoarder they were obsessively clean and tidy (usually women in this case). In both cases, the state of cleanliness or clutter was used offensively to control others; no-one other than the hoarder is allowed to touch ‘their things’ in the common areas of the home, and often even in the children’s rooms. And I’ve heard the most horrific stories from children of hoarders: dead or starving pets; toxic air and living conditions (no toilets, heat &/or running water); stalking and harassment of grown children who’ve left but could ‘out’ the hoarder; being forced to eat rancid food; sexual abuse; mind control (partly a result of keeping the secret, but that goes well beyond that); emotional terrorizing and annihilation (such as destroying or intentionally soiling all pictures and mementos from a particular child); etc… Sadism is definitely a part of the picture for some of these people.

There are a lot of great resources out there now dealing with the impacts of hoarding, such as HARC (Tufts University: Hoarding of Animals Research Consortium – an excellent(!!!) site), Children of Hoarders; Squalor Survivors, etc…

In my experience there is a strong connection between trauma and cleanliness after experiencing sadism, but I haven’t found a lot of sites who deal (at least not in any meaningful way) with sadism and its particular effects on survivors (particularly in regards to female sadists, who often use disgust and dehumanization around childcare activities such as bathing, washing and cleaning).

Another aspect is Diogenes syndrome (severe adult self-neglect) which I believe is probably the geriatric manifestation of surviving severe childhood abuse and neglect.

I believe there is another connection between trauma and (lack of) cleanliness in the work of Dr. Barbara Knox on Childhood Torture. Dr. Knox is trying to get childhood torture recognized as a separate category of child abuse in the pediatric literature so that professionals will be better informed and able to intervene. She doesn’t make a direct connection, but I notice that squalor &/or hoarding are present in all her study cases.

 

[WaroleF]

Thank you very much for your input about children of hoarders. My mother was an abused woman and as her life spiraled out of control so did our environment. She became a hoarder, the piles became bigger and bigger. She could not let go of them. I fear that I am becoming like her. As life gets more out of control, I can not seem to manage and keep order. I know there must be a connection and this is giving me some insight. I am not sure how to change these repetitive patterns.

 

[livergirl70]

I agree that the opposite is more likely. You can shut yourself away and keep others away staying in the same clothes for days without washing.

 

[Anne1]

Hi Anthony,
Not sure if you’ve seen this, but this study: Link Removed
focuses on the `fear of being contaminated` (FBC) after child SA, which is very similar to Haidt`s take on `disgust`. They mention in the article:
“(Judith) Herman (1992) explicitly listed the FBC as one of the characterizing symptoms in her suggestion for the diagnosis of complex PTSD. The Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994) mentions a feeling of being permanently damaged as a further symptom of PTSD, which could also mean to feel permanently contaminated.”

 

[UniqueSunflower]

Hoarding can come in many forms, even if the environment isn’t containing elements of disgust, putrid odors, etc. Both of my parents struggle with accumulating items they don’t need and the feel compelled to keep. Dad’s an art collector & Mom’s a pile maker with letters, flyers, brochures, and text she can’t part with. Just like anything it’s along a continuum.

 

[Anita]

I’m an abuse survivor and have real issues around cleanliness, esp bathrooms and toilets and sinks. All hot areas for abuse memories. But it feels like I’m out of control sometimes, I can’t relax until I have cleaned, and just a tiny bit of mess feels threatening. How do you square memories of being abused over a toilet bowl, ( sorry) in the bath, and forced to eat choked up food or else be beaten with normal housework? its all too interconnected and the only safe way seems for everything to be really clean and tidy. Any advice on learning to tolerate a ‘normal’ level of crumbiness in kitchen and hairiness in bathroom?