Jan 20, 2021

Washing your hands with soap and water on a regular basis is desirable – even mandatory – during the current COVID-19 pandemic. But there are some people, victims of obsessive-compulsive disorder (OCD), who wash their hands excessively and repetitively in an attempt to relieve severe distress associated with obsessive and irrational fears of contamination. 

This often-debilitating condition inferferes with daily living and one’s quality of life, leaving little time for normal activity. About16% of all OCD patients suffer from some form of washing compulsion, which is manifested by frequent long and ritualized compulsive handwashings up to 50 to 100 times daily a day. 

Other symptoms of OCD, which is estimated to occur in two percent of the world’s population at some time in one’s life, include obsessive and repetitive thoughts, images or urges with compulsions consisting of repetitive rituals and behaviors. 

The causes of OCD and compulsive handwashing are not clear, but psychiatrists and neuroscientists believe it involves biological and psychosocial factors. It is thought the neurotransmitter serotonin plays a role in the development of the OCD as multiple trials have shown selective serotonin reuptake inhibitors (SSRIs) may help manage the symptoms of OCD, along with cognitive behavioral therapy (CBT), in which patients learn to overcome their behaviors.

Compulsive handwashing can also cause physical harm including skin infections such as atopic dermatitis, allergies, blistering, itching, swelling and other chronic conditions. 

Now, Israeli researchers at the Hebrew University of Jerusalem believe that drinking caffeine-rich coffee – of all things – might help relieve compulsive handwashing. 

Dr. Eyal Kalantroff and doctoral students Hadar Naftalovich and Noa Tauber from the psychology department have just published their findings in the Journal of Anxiety Disorders under the title: “But first, coffee: The roles of arousal and inhibition in the resistance of compulsive cleansing in individuals with high contamination fears.” 

“Inhibition plays a crucial role in reducing intrusive thoughts and compulsive behaviors, such as handwashing, in response to the feeling of disgust. The current study examines whether manipulating arousal can facilitate inhibition and the resistance of compulsive cleansing,” they wrote. But Naftalovich stressed that “caffeine raises stimulus levels only in a spotty and momentary manner and therefore cannot constitute a treatment for OCD. More research must be conducted on the matter in the future.” 

The included in their study 47 participants with high contamination fears and divided them into a caffeine group or a no-caffeine group. The study included only participants who underwent the initial clinical screening performed by a psychologist and were diagnosed – without a shadow of a doubt – with a strong fear of infections and compulsive behaviors

Participants touched a potentially contaminated and disgusting stimulus (“dirty” diapers) and were asked to wait as long as they could before washing their hands. Only the caffeine group exhibited greater pre-post stop-signal reaction time improvement in the stop-signal task, indicating improved inhibition. 

Participants did not know and could not guess whether they drank coffee with or without caffeine. To their surprise, the research team found that subjects could wait a long time without cleaning their hands and even reported lower distress levels if they drank one cup (containing 200 milligrams of caffeine) of caffeinated coffee, compared to subjects who drank one cup of decaffeinated coffee.

They also found that those in the caffeine group showed significantly lower subjective distress and urges to wash their hands both after touching the stimulus and while waiting to engage in the cleansing behavior. In addition, the caffeine group resisted the urge to compulsively cleanse for about twice as long as those in the no-caffeine group. Time spent washing, subjective distress levels and urge-to-wash levels after participants washed their hands were similar between groups. The current findings support the notion that increased arousal improves inhibition, which may play a role in improving the ability to resist intrusive disgust and compulsive cleansing behaviors.

“Neuro-cognitive research shows us that arousal systems involved in arousal can directly affect cerebral systems that are involved in the inhibition of unwanted behaviors and thoughts,” they wrote. “Higher arousal not only led to an improvement in the ability to inhibit compulsive behavior despite exposure to repulsive stimuli, but also to weaken the intensity of the urge to behave compulsively and contributed to the reduction of personal distress. It has been shown that arousal has reduced not only unwanted behaviors but also unwanted thought.”