The word “germaphobia” gets lobbed around perhaps more than any other phobia-related term—especially in the wake of the COVID-19 pandemic. It’s used colloquially to justify various (often ordinary) germ-evading behaviors, from using hand sanitizer frequently to declining a sip from someone else’s beverage.

For someone with true germaphobia (aka mysophobia, the fear of germs), though, it’s not so casual. “While it’s normal to be concerned about germs and practice good hygiene, germaphobia involves an overwhelming, often irrational fear that leads to significant distress or impairment in social, occupational, or other important areas of functioning,” explains Evan Vida, PsyD, a postdoctoral fellow at the Center for Anxiety & Behavior Therapy who specializes in anxiety disorders, including phobias. A person’s germaphobia could manifest as excessive showering or hand washing, refusing to touch or see other people for fear of germs, avoiding public restrooms at all costs, or feeling the need to wash clothes after wearing them for even a short time.

“Germaphobia causes significant distress and disrupts normal activities, unlike a manageable concern about cleanliness.” —Alexander Alvarado, PsyD, clinical psychologist

In this post-pandemic age, however, the line between vigilant and germaphobic can seem a bit tricky to parse. (Who didn’t go through a “sanitizing groceries” phase in 2020?) Here, experts break down germaphobia, including how to know if you or someone you know is a germaphobe, what to do about it, and when to seek help.

What are the symptoms of germaphobia?

“Germaphobia manifests as an intense fear of germs, leading to excessive washing or cleaning and avoiding places considered ‘dirty,’” explains Alexander Alvarado, PsyD, a licensed clinical psychologist at Thriving Center of Psychology, whose expertise includes using virtual reality exposure therapy to treat phobias.

Someone with germaphobia will experience intense anxiety at the thought of germs or being contaminated with germs, go to great lengths to avoid them, and engage in cleaning rituals to remove potential contact, Dr. Vida says. These behaviors may lead people to distance themselves from others, feel incapable of doing daily activities, or deal with other secondary effects—for example, dry and irritated skin as an effect of over-washing hands.

Specific phobias like germaphobia are considered to be a type of anxiety disorder; it is also common for phobias to coexist with other mood disorders, such as generalized anxiety or depression, according to the Mayo Clinic.

These are all specific symptoms of germaphobia to look out for:

• Intense anxiety or fear at the thought of germs or the potential of being contaminated with germs
• Going to extreme lengths to avoid germs
• Engaging in cleaning rituals to remove potential contact with germs
• Physical feelings of anxiety, including sweating, rapid heartbeat, tight chest, trouble breathing, shaking or trembling
• Social isolation

How to tell the difference between a general dislike of germs and germaphobia

There are some distinct differences between germaphobia and just a general dislike of germs. It’s reasonable not to want to share breathing space with someone who has a cold, or to feel the need to wash your hands after touching something dirty. You may also be worried about how dirty your cell phone case is or if hand sanitizers work. But this isn’t necessarily germaphobe territory, experts say.

“The key difference between germaphobia and a general dislike or concern about germs lies in the intensity of the fear and its impact on a person’s life,” Dr. Vida says. He says that germaphobia involves a fear that is “overwhelming” and can significantly impact a person’s life. “For example, if someone is unable to perform their job or hold their baby due to fear of germs, that’s an example of significant impairment and cause for more deliberate intervention,” he says.

Dr. Alvarado agrees that impact on daily life is the best indicator: “Germaphobia causes significant distress and disrupts normal activities, unlike a manageable concern about cleanliness,” he says.

What causes someone to be a germaphobe?

The research is mixed as to what causes germaphobia, says Tirrell De Gannes, PsyD, licensed clinical psychologist at the Thriving Center of Psychology. Some professionals believe it stems from a history or traumatic event that involved interacting with bad germs (and, usually, becoming ill), he says. (For example, someone may be able to trace their germaphobic behaviors back to a severe case of food poisoning they had as a kid.) Others think it’s a result of generalized anxiety or theorize that it’s a subset of obsessive-compulsive disorder (more on that, below).

Often, the cause is multifaceted and can include a combination of environmental factors, personal experiences, and a predisposition to anxiety disorders, Dr. Alvarado says.

For example, a personal or family history of anxiety disorders can increase your chances of developing a specific phobia¹, Dr. Vida says. And women, in general, are more likely to have a specific phobia than men, according to the National Institute of Mental Health. “Ultimately, like most psychological conditions, there’s a combination of both nature and nurture [at play],” Dr. Vida says.

What is the difference between OCD and germaphobia?

There are a few differences between germaphobia and obsessive-compulsive disorder (OCD). OCD is a mental health condition in which people experience recurring intrusive, unwanted thoughts—and to get rid of them, they often feel driven to do something repetitively, according to the American Psychiatry Association (APA). OCD is distinct from germaphobia, but the two can absolutely overlap, Dr. Vida says. In fact, research shows that OCD and specific phobia commonly coexist².

“OCD commonly involves obsessional fears of contamination from germs and measures to avoid contact with contaminants,” Dr. Vida says. This cluster of OCD symptoms is sometimes referred to as contamination OCD³. However, not everyone with OCD has these symptoms. The condition can include a wide range of symptoms, and germaphobic behaviors are just one of the ways OCD can manifest, Dr. Gannes says.

The key difference between germaphobia and OCD can be found in the type of emotions experienced and the behaviors done to deal with them. For phobias, the dominant emotions are fear and anxiety, while OCD often presents with other primary emotions⁴, such as disgust and shame. “In OCD, there are usually repetitive, ritualized behaviors to prevent or remove contact, such as washing hands excessively, in a particular fashion, or some other action that may not be directly related to the fear, such as touching a certain object to prevent the development of an illness,” Dr. Vida explains.

In this sense, OCD behaviors can often involve more “magical thinking”—actions that aren’t logically connected with the fear but that someone believes will, in this case, protect them from germs. “The compulsions in OCD are often actions we feel driven to perform even though we recognize them as senseless or excessive,” Dr. Vida continues. “Someone with a phobia may not have intrusive thoughts and will protect themselves in ways that appear more logically connected.” For example, someone with OCD may feel they need to wipe a doorknob six times in order to be protected from germs, while someone with a phobia may simply be insistent that the doorknob be cleaned immediately and often.

Is germaphobia a mental disorder?

Strictly speaking, there’s no listing for germaphobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), the authoritative guide health professionals use to diagnose mental disorders. That is to say, it’s not a mental disorder in itself.

However, if a fear is irrational and severely impacts one’s life, it can be classified as a “specific phobia.” Specific phobias are “excessive and persistent fear of a specific object, situation or activity that is generally not harmful,” according to the APA. Specific phobias, as mentioned earlier, are recognized within the spectrum of anxiety disorders in the DSM-5, Dr. Alvarado says.

Germaphobia may also be a symptom of another DSM-5 diagnosis, such as OCD or illness anxiety disorder, Dr. Vida says. So, while germaphobia itself isn’t named as a specific mental disorder in the DSM-5, it can undoubtedly be considered one if it falls under the diagnosis of specific phobia, OCD, or another anxiety disorder.

How is germaphobia diagnosed?

Diagnosing germaphobia involves a comprehensive psychological evaluation to understand how germ-related behaviors impact your daily functioning and to determine if they align more closely with OCD or another anxiety disorder where fear of germs is a predominant concern, Dr. Vida explains. “An evaluation can help distinguish the overall feared consequence of germ contamination, whether it’s the possibility of the person themselves developing an illness, or potentially spreading an illness to someone else.” In the case of emetophobia (fear of vomiting), for example, a fear of germs is purely a symptom of the real fear of throwing up.

There isn’t a “test” to diagnose germaphobia; a mental health professional will typically ask you about your symptoms and how they’re affecting you. They might ask how germs make you feel, for example, how often you think about them, or if you have a family history of certain mental health conditions like anxiety or OCD.

How is germaphobia treated?

Effective treatments for germaphobia include cognitive behavioral therapy, exposure therapy, and sometimes medication to manage anxiety symptoms, Dr. Alvarado says. Here’s a little more about all three.

Cognitive Behavioral Therapy

Cognitive-behavioral therapy (CBT) is a form of psychological treatment that involves changing your thinking patterns, according to the APA. Basically, you’d work with a therapist on techniques that help you challenge the thoughts and beliefs that contribute to your germaphobia. CBT one of the most researched therapy methods, and there’s ample scientific evidence⁵ showing that it helps reduce symptoms in specific phobias. “These types of fears are very responsive to CBT interventions,” Dr. Vida says, “so expect to gain control of your life in a relatively short amount of time.”

Exposure Therapy

Exposure therapy is a common part of CBT treatment for specific phobias and anxiety disorders, Dr. Vida says. “This involves working very gradually and collaboratively with a therapist to confront your fears and test and challenge thoughts related to germs,” he explains. This might look like getting you to just talk about germs, or look at pictures of things you feel are particularly germy. Then it might level up to something like touching a surface and then not washing your hands and seeing how that feels. By gradually and safely exposing yourself to what you’re scared of, you can learn to manage your response to it. There’s a lot of promising research⁶ on exposure therapy for phobias, and new technology is making it easier than ever with virtual reality.

Medication

CBT and exposure therapy tend to be fairly successful in treating phobias, but there are times and places when medication can help, Dr. Vida says. If you suffer from more generalized anxiety, medication can be a helpful tool to manage those symptoms. Beta-blockers or sedatives may also be used in short-term situations where it’s necessary to face a fear (think: going on a plane or to the hospital), according to the Mayo Clinic.

Coping with germaphobia

If your mental health symptoms are interfering with your ability to live your life, it’s a good idea to seek professional help. Germaphobia can be debilitating and oftentimes requires the extra support and the training of an expert to address. But if you’re unsure if what you’re dealing with falls into full germaphobe territory, there are some things you can try at home to start managing more mild symptoms.

Experiment with testing your fears (safely)

Consider these words of wisdom from Dr. Vida: “Treat your fears as hypotheses to be tested, not fact,” he says. “Try to challenge yourself by creating small experiments to test out these hypotheses.” For example, if you feel compelled to wash your hands after touching any light switch in your home, consider trying, just once, to skip it, and see what happens. (Most likely, nothing bad!) These little wins can help you slowly re-think what’s worth worrying about and regain power over your fears.

Try mindfulness techniques

When you’re feeling anxious or fearful, mindfulness techniques can help you learn how to manage those feelings in the moment and reduce avoidance behaviors. Recent research suggests that slow diaphragmatic breathing can help reduce stress and anxiety symptoms⁷ in people with anxiety disorders (including phobias). Relaxation techniques can also help, Dr. Alvarado says. This can include deep breathing or progressive muscle relaxation, which can help you cope with the physical symptoms of anxiety and stress.

When to see a doctor

If you’ve tried DIY techniques with little success, it’s time to see a doctor or mental health professional. Find a therapist, like a cognitive behavioral therapist, who can help you create a plan and walk you through how to accomplish your goals, Dr. Vida says.

Even if you haven’t tried self-treating your germaphobia, when your fears start to significantly impact your life, it’s a good sign to see a professional, Dr. Vida says. Anxiety and phobias are very treatable, and there’s no need to “white-knuckle your way through life, albeit with a significant amount of pain and suffering,” he says.