Fear of Germs: Living Daily Life With Anxiety About Catching Illness

What is a fear of germs? Avoiding door handles, cash and public transport, the causes of contamination anxiety and ways of coping with this fear.

You get on the metrobus and in the crowd you need to hold on. You reach for the rail, change your mind at the last moment and try to keep your balance with your elbow. When you get off at your stop you take the hand sanitiser out of your bag and rub plenty into your hands. When you get home your child runs to the door wanting to hug you; you say, "Wait, let me wash my hands and change my clothes first." You see the disappointment on their face and feel guilty, but this fear acts faster than your love. A fear of germs can turn the ordinary contacts of daily life into moments of danger. In this article we explain how contamination anxiety works, what feeds it and what can be done to widen your life again.

What Is a Fear of Germs?

A fear of germs is an intense and persistent anxiety that germs, viruses, bacteria or other disease-causing agents will be passed on to you or your loved ones. This anxiety pushes the person towards avoiding contact, excessive cleaning and disinfecting, and being constantly on guard. From a clinical point of view, it is usually considered part of the contamination-themed form of obsessive compulsive disorder; in some people it may overlap with a specific phobia or with health anxiety.

What distinguishes a fear of germs from ordinary attention to hygiene is the intensity of the anxiety and the extent to which it narrows life. Washing your hands before eating, taking precautions during an epidemic or cleaning your hands after a hospital visit are healthy behaviours. But if a person stays uneasy for hours because they touched a door handle, and so cannot go to work or hug their child, the anxiety has gone beyond common sense.

Fear of germs, cleaning OCD and health anxiety

These three concepts are often confused:

• With a fear of germs, the focus is on contamination coming from outside. The person tries to stay away from things they consider dirty.
• With cleaning OCD, the focus is more on cleaning rituals and getting rid of the feeling of being "dirty". Sometimes cleaning is done with no fear of illness at all, driven only by disgust or a feeling of incompleteness. We discuss this separately in our article on cleaning OCD.
• With health anxiety, the person fears that they are already ill or will develop a serious illness; they constantly monitor symptoms in their body and go from doctor to doctor. We address this in our article on health anxiety.

In many people these three can occur together. Understanding which one is in the foreground in therapy determines the direction of the work.

What Are the Symptoms of a Fear of Germs?

Avoidance behaviours

• Not touching door handles, lift buttons or stair rails with bare hands
• Avoiding touching banknotes and coins, paying only by card
• Not holding on or sitting down on public transport, or not using it at all if possible
• Not shaking hands with others; avoiding kissing elders' hands and hugging during the bayram (religious holiday)
• Being unable to eat out, not trusting food prepared by someone else
• Staying away from places such as hospitals, pharmacies and schools as much as possible

Protective and cleaning behaviours

• Always carrying sanitiser, wet wipes and gloves in your bag
• Wiping everything that comes in from outside, including shopping bags and parcels
• Putting clothes straight in the wash on arriving home, being unable to sit down without showering
• Wiping your phone, keys and wallet several times a day

Mental symptoms

• Repeatedly going over in your mind what you touched during the day
• Thinking for hours about the moment after seeing someone sneeze or cough
• The question "What if I get ill, what if I pass it on to my child?" constantly going round
• Frequently asking family and loved ones, "Did you wash your hands?"

Experiencing some of these symptoms does not on its own amount to a diagnosis. Assessment is always carried out by a professional.

What Causes a Fear of Germs?

A tendency to overestimate threat: An anxious mind magnifies both the chance of something happening and how bad it would be if it did. Touching a door handle can turn into the thought, "I'm definitely going to get ill, and seriously ill at that."

Intolerance of uncertainty: Germs cannot be seen. There is no way of knowing whether a surface is truly clean. This invisibility creates unbearable uncertainty for a mind seeking certainty.

A sense of responsibility: For many people the real fear is not about themselves but about their child, their elderly mother or a relative with a chronic illness becoming ill. The thought "If I pass it on to them, I'll never forgive myself" multiplies the anxiety.

Past experiences: Having had a serious illness, losing a loved one to an infectious disease or going through a serious illness as a child can lay the ground for this fear.

The epidemic period: The pandemic years changed the relationship all of us, as a society, have with contact, distance and hygiene. Precautions that were necessary at that time continued in some people even after that period ended. By the time the person notices, "Everyone else has stopped but I can't," these habits have usually already turned into a cycle.

Disgust sensitivity: Some people have a stronger disgust reaction to bodily fluids such as saliva, sweat and mucus. This reaction kicks in before any logical assessment of danger and spurs the person into action: "I need to get away from this right now." In people with high disgust sensitivity, the anxiety is fed not only by the thought of illness but also by this bodily reaction.

Information overload: Content shared on social media, of the "your phone has more bacteria than a toilet seat" kind, constantly produces new triggers for minds prone to anxiety.

The Effect of a Fear of Germs on Daily Life

This fear gradually narrows the person's range of movement. At first only certain things are not touched, then certain places are not visited, and finally time spent outside the home is kept to a minimum.

Imagine a woman in her thirties who works as a bank cashier and, after the pandemic, starts counting money in gloves all day. Despite the gloves she uses sanitiser after every customer and cannot eat at lunchtime, because she cannot be sure her hands are "completely" clean. When she gets home in the evening she takes a long shower before playing with her daughter. Because she avoids kissing her mother-in-law's hand during the bayram, there is hurt within the family. Her hands have developed sores, but the part of her that is most exhausted is her mind.

Common effects of this fear include:

• At work: Shared areas such as the kitchen, toilet, keyboard or printer are a constant source of tension.
• In social relationships: Visiting people, attending weddings and funerals, and crowded family meals become difficult. Not shaking hands or not hugging can cause hurt on the other side.
• Within the family: The household, especially children, live with rules that must be followed when coming in from outside. Over time these rules become a subject of argument in the family.
• The effect on children: By observing their parents' anxiety, children can learn that the world is a dangerous place.
• Physical effects: Frequent washing and use of sanitiser can cause dryness, cracking and irritation of the hands.

Hospital visits and caregiving

A fear of germs often faces its toughest test in hospital corridors. Visiting a friend who has had an operation, waiting at the door of a relative in intensive care or caring for a bedridden parent at home leaves the person caught between their love and their fear. Some get by with phone calls instead of visits, then hear that their relative was hurt that "they didn't come"; others do visit but spend the next three days looking for signs of infection. In people who are caregivers, this fear is harder to distinguish because it is intertwined with a real responsibility. The aim here is not to abandon health precautions, but to be able to separate the precautions recommended by the doctor from the rituals that anxiety adds.

It is impossible to escape all germs; but it is possible to step out of a life run by anxiety.

What Can You Do to Cope With a Fear of Germs?

The following suggestions can help you change your relationship with anxiety. If you are experiencing intense symptoms, it is more helpful to apply them together with a professional.

1. Make a list of what you avoid. Write down what you do not touch, where you do not go and in which situations you reach for sanitiser. As the list grows longer, you can see how much room the fear takes up in your life.
2. Separate health advice from anxiety rules. Washing your hands before eating and after using the toilet is health advice. Using sanitiser after every touch is a rule set by anxiety. Ask yourself, "Is this something my health requires, or my anxiety?"
3. Start with small contacts. For example, try touching the door handle of your building with a bare hand and not wiping your hands straight away. Observe how the anxiety rises and then falls.
4. Put the sanitiser at the very bottom of your bag. You reach less often for something that is hard to get to. Even this small change helps you notice automatic behaviours.
5. Limit your information intake. Cut down on following news, videos and posts about germs and illnesses. For genuine health information, turn to reliable and limited sources.
6. Carry the discomfort for a few minutes. After touching something, rather than reacting straight away to the "dirty" feeling on your hands, watch it with curiosity for two or three minutes: where do you feel it, how intense is it, how does it change over time? Observing the feeling offers a different experience from running away from it.
7. Protect your children from fear. Teaching your children hygiene is different from passing on a fear of germs. Explain calmly why they wash their hands, and avoid giving the message that the world is full of dangers.

When Should You Seek Professional Support?

• You cannot go to work, school or use public transport because of anxiety about contact
• You find it hard to hug or touch your loved ones
• Cleaning and disinfecting take up a significant part of the day
• Your hands or skin have been damaged
• Your family has to follow your rules and this is creating tension at home
• The anxiety goes hand in hand with low mood and a sense of hopelessness

When symptoms are intense, an assessment by a psychiatrist may also be recommended alongside psychotherapy.

How Is a Fear of Germs Addressed in Therapy?

For contamination-themed anxiety, Cognitive Behavioural Therapy and the Exposure and Response Prevention (ERP) method are widely used. You can find the approach we take with anxiety-related problems on our anxiety and panic page.

Mapping the fear

In the first sessions we look in detail at which contacts cause anxiety, what the feared outcome is ("I'll get ill", "My mother will get ill", "I can't bear this feeling") and what is done to reduce this anxiety.

Gradual contact

Using a list of steps prepared together with the person, we move from contacts that cause little anxiety towards those that cause a lot. Touching a door handle and waiting for a while without washing your hands, shopping with banknotes, holding on while on public transport and eating out are examples of such steps. At each step, cleaning and disinfecting rituals are postponed or not carried out. This work is planned while maintaining reasonable hygiene rules and taking the person's health into account.

On probability and responsibility

The cognitive work addresses thoughts such as "If I touch it, I'll definitely get ill" and "If someone close to me gets ill, I'll be solely responsible." Information such as how the body's immune system deals with everyday contacts can help place the anxiety in a more realistic frame.

Making room for uncertainty

An important part of therapy is working with the demand "I must be sure I won't get ill." Nobody can be sure they will never get ill; yet a person with a fear of germs seeks this certainty almost as a condition for living. In therapy, the person experiences accepting that the possibility of illness always exists and still being able to carry on with their life. The sentence "I might get ill today, but I'm not going to put my life on hold for it" becomes one of the turning points of the process for many people.

Working with the family

Sessions with family members can also be held so that the household rules are gradually relaxed. In this way, daily life becomes easier both for the person and for the rest of the household.

Frequently Asked Questions

My fear of germs started during the pandemic and is still going on; is this normal?

It is understandable that some of the precautions taken during the pandemic turned into habits. However, if these precautions are restricting your life, causing you distress and cannot be dropped even though that period is over, it would be helpful to talk about this with a professional.

Do I need to stop using sanitiser altogether?

No. The aim is not to give up healthy hygiene habits, but to reduce the excessive use that anxiety imposes. In therapy, the line between reasonable hygiene and an anxiety ritual is drawn together.

Will my fear of germs be passed on to my child?

Children learn by observing their parents' reactions; so intense anxiety behaviours can lay the ground for similar fears in children. But this is not inevitable. Getting support for your own anxiety also helps your child develop a more flexible understanding of hygiene.

I have a chronic illness; isn't it realistic for me to be careful?

If you have an illness that affects your immunity, taking the precautions your doctor recommends is of course realistic and necessary. In therapy these precautions are maintained; what is worked on are the anxiety behaviours that go beyond them and narrow your life far more than your doctor has advised.

• #fear of germs
• #contamination anxiety
• #OCD
• #avoidance

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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