What is Ablutophobia?

Ablutophobia, an extreme and irrational fear of bathing, washing and cleaning oneself, can be an extremely debilitating phobia that has a significant negative impact on many aspects of an individual’s life, including their mental and physical health.

Because ablutophobia is a type of specific phobia, it is not known how many people in the UK are currently experiencing this phobia. However, because this is a relatively unknown phobia, it is thought that many people experiencing this condition may never seek a diagnosis or medical treatment.

Today, we are going to look at ablutophobia in more detail, including the common causes, triggers, symptoms and treatments.

What is ablutophobia?

Ablutophobia is the extreme, irrational and overwhelming fear of bathing, cleaning or washing. The fear of bathing, cleaning or washing refers to the individual themselves, such as washing their skin and hair. However, this phobia can extend to a fear of washing or cleaning anything that comes into contact with your body.

Ablutophobia can result in excessive fear, anxiety, panic or distress when bathing or washing, or at the thought of bathing or washing. An individual with this phobia may also experience fear or anxiety if they see something that reminds them of bathing, such as soap, a sponge or washcloth, or a bath.

Ablutophobia is a type of specific phobia, meaning it is an enduring, overwhelming and irrational fear of a specific object, situation, place or person; in this case, an extreme fear of bathing, cleaning or washing. Phobias are also a type of anxiety disorder, as it is an extreme and irrational fear that usually results in severe anxiety about something that poses little or no actual danger.

Bathing is an essential part of daily life, not only for health and hygiene reasons but also for social reasons. Refusing to bathe or wash can result in bacteria and viruses spreading more easily, particularly if you don’t wash your hands.

This can result in you contracting more illnesses than usual. People who refuse to bathe may also develop skin infections, fungal infections and develop skin conditions, such as dermatitis. Bathing regularly is also considered to be good social etiquette and not washing can result in bad body odour, lice and an unsightly appearance which can result in judgement from other people in society and social isolation.

Ablutophobia is an individualised phobia and can manifest in many different ways. Some people with ablutophobia experience negative thoughts, feelings and behaviours in relation to all types of bathing, washing and cleaning, whereas other people only experience symptoms in relation to certain bathing habits.

Someone with ablutophobia may experience fear, anxiety, panic or distress about all or only some of the following types of bathing, washing or cleaning:

• Showering.
• Taking a bath.
• Washing your hands, for example, after coughing or going to the toilet.
• Brushing your teeth using water.
• Washing your face.
• Washing your hair or going to the hairdressers/ barbers.
• Being submerged in water.
• Touching water in any way.
• Washing your clothes.
• Cleaning your home or car.

An individual with ablutophobia will experience extreme fear, anxiety or panic at the thought or reality of washing and bathing. They may experience negative patterns of thoughts, negative feelings and damaging behaviours surrounding bathing which can be overwhelming and significantly impact their everyday life. It can also affect their mental and emotional health and well-being.

Someone with ablutophobia may experience difficulties functioning normally or concentrating in certain places or situations, because of the fear that they may be required to wash or bathe. They may become consumed with the thought of washing and bathing and find themselves constantly alert for water or things that can make them dirty.

The fear, anxiety and panic that they feel can have a significant impact on their mental and emotional well-being and their behaviour. In some cases, ablutophobia can extend into a fear of all water or soap and the individual can become consumed with the thought of water and constantly check that there is no water around them, or they are not likely to encounter water or soap.

This fear, anxiety and panic can result in avoidance behaviours. The individual may go to extreme lengths to prevent themselves from becoming dirty, for example, by refusing to spend time outside or refusing to touch things that could require them to wash their hands. Although preventing yourself from getting dirty can elongate the required time between washes, it doesn’t prevent you from needing to wash.

Avoidance behaviours can also have a significant impact on someone’s day-to-day life and their ability to function normally within society. Although avoidance behaviours are designed to help someone avoid bathing and prevent them from experiencing negative thoughts and feelings and adverse symptoms, they can actually have a paradoxical effect instead.

Avoiding places and situations where you might become dirty or touch germs can not only limit your life and impact your social life and relationships, but it can also reinforce your fear and result in more severe symptoms in the future.

Someone with ablutophobia may also go to extreme lengths to deny, even to themselves, that they need to wash and may implement a variety of behaviours to extend the time between washes or avoid washing altogether. For example, they may wear excessive amounts of perfume, chew gum constantly and avoid standing too close to people. They may also begin to avoid their family and friends to prevent them from judging them negatively or telling them that they need to wash.

It is important to keep in mind that not everyone follows the same bathing and grooming habits. Some people do not bathe as frequently as others and may even go weeks between showering. However, this may be a personal choice or ‘laziness’ rather than a phobia.

Similarly, even though ablutophobia is usually more prevalent in children compared to adults, there is a distinct difference between a child who dislikes bathing and refuses to bathe and a child who has a genuine fear of bathing. Although there are some situations where it is normal to avoid bathing or to feel some anxiety surrounding bathing (for example, following surgery or if you have a painful wound), someone with ablutophobia will experience negative thoughts and feelings in any situations involving bathing, washing or cleaning – even if there is no risk to them.

To be classified as ablutophobia, your fear of washing, bathing and cleaning will include:

• Feelings of intense fear, panic or anxiety that are difficult to manage.
• Fear or anxiety that is out of proportion to the true risk.
• A fear of bathing, washing and cleaning that lasts for at least six months.
• Engaging in avoidance behaviours to prevent the need to bathe, wash or clean.
• A fear of bathing, washing or cleaning that interferes with your day-to-day life, overall well-being or sense of safety.

Because ablutophobia is irrational and the fear is disproportionate to the true risk, having a phobia of bathing can significantly impact your everyday life and result in you experiencing fear, anxiety and panic even in situations where there is no risk or danger. Someone with the phobia may also have difficulties concentrating or functioning normally in certain situations.

If you have ablutophobia, you may be aware that your fear of bathing, washing and cleaning is irrational and that the risks associated with bathing are low. However, you may still find that you are unable to control your fear or anxiety and are unable to manage or prevent your physiological, psychological or behavioural responses to bathing or thinking about bathing.

Ablutophobia may be connected to and occur in conjunction with other phobias, such as:

• Aquaphobia: An extreme fear of water.
• Ombrophobia: An extreme fear of rain.
• Social anxiety disorder: An extreme fear of social situations.
• Agoraphobia: A type of phobia that often manifests as a fear of leaving your home.

How common is ablutophobia?

Because ablutophobia is a type of specific phobia, any diagnoses will fall under the umbrella of specific phobias, meaning that there are no individual statistics available that show how many people have a phobia of bathing and washing.

There are more than 5 million confirmed diagnoses of specific phobia in the UK. However, ablutophobia is thought to be a relatively uncommon phobia, with a low number of reported cases in the UK.

Similarly to other phobias, ablutophobia could be an underdiagnosed mental health condition, with the number of diagnoses not representing the true figures of how many people experience a phobia of bathing, washing and cleaning.

There are several reasons why phobia diagnosis statistics may not be accurate, such as:

• Many people have not heard of ablutophobia so may not realise they are experiencing a diagnosable medical condition.
• Someone with this condition may not be aware that effective treatment options are available so may never seek a diagnosis.
• Ablutophobia is more common in children than adults and children may be unable to articulate their fear or may be expected to grow out of their fear.
• Avoidance behaviours can mean that the individual reduces the frequency with which they need to bathe.
• Someone with ablutophobia may withdraw from their friends or family or from society, making it easier for them to hide their difficulties.

It is also important to consider that, as mentioned earlier, not everyone who dislikes bathing or refuses to bathe is experiencing ablutophobia. Lack of personal hygiene can be characteristic of several other mental health conditions, such as depression and schizophrenia. Additionally, there may be another reason why someone refuses to bathe, such as the water or soap causing them pain.

Negative thoughts and feelings surrounding bathing can occur on a spectrum, ranging from mild fear and anxiety that may be situation dependent or a short-term issue to severe, fear, anxiety, panic and distress that impacts your everyday life, affects your decision-making, results in changes in your behaviour and occurs for a minimum of six months.

Who is at risk of ablutophobia?

Although anyone can develop ablutophobia, certain risk factors can increase the likelihood of you developing a fear of bathing, washing or cleaning, including:

• Having a previous traumatic, scary, negative or painful experience while bathing, for example, slipping and injuring yourself in the shower or nearly drowning in the bath.
• Having another related phobia, such as aquaphobia.
• Having a skin condition or injury that makes bathing or using water or soap painful.
• Having a condition such as alopecia, as your hair loss may be more visible when washing your hair or you may be distressed at the thought of not being able to wash your hair.
• Being exposed to ablutophobia during childhood or adolescence.
• Having a close family member, for example, a parent or sibling, with ablutophobia.
• Having a close family member, for example, a parent or sibling, with another phobia.
• Being an intrinsically more anxious or nervous person.
• Having a sensory processing disorder or sensory difficulties.
• Having an allergy to water (aquagenic urticaria (AU)) or an allergy to soaps and other products.
• Currently experiencing or having a history of anxiety disorder or other mental health difficulties.
• Going through a significant life stressor, having higher than usual stress levels or being in a heightened mental state (particularly if you are exposed to a fear of bathing or have a negative experience involving bathing during this time).
• Having a substance use disorder, such as an addiction to drugs or alcohol.

It is important to note that although the risk factors above can increase the likelihood of someone developing ablutophobia, they do not guarantee this. Someone with none of the above risk factors can develop a phobia of bathing unexpectedly, whereas someone with several of the above risk factors may never develop ablutophobia.

Although ablutophobia can occur at any age, it is more likely to occur during childhood, particularly if the child experiences a traumatic, negative or painful event while bathing or while in water. Stress and trauma can result in feelings of anxiety and fear and can reduce a child’s ability to cope with certain situations.

Children are also less able to manage the fear and anxiety that occurs as a result of the initial trauma and are less able to understand and rationalise any negative thoughts and feelings they are experiencing. For example, while an adult may be able to rationalise that falling and injuring themselves in the shower was an accident that is unlikely to happen again, children are less able to rationalise their thoughts and may fear any situation that reminds them of the original trauma.

How to deal with ablutophobia

As well as medical intervention and official treatment options, there are other effective strategies you can implement to help you deal with your phobia. There are certain coping and calming strategies that can help you to effectively manage and reduce the symptoms of your phobia and reduce the negative impact your fear has on your life. Coping and calming strategies should be combined with lifestyle changes to help you to alleviate your symptoms and reduce the impact your phobia has on your day-to-day life and your health and overall well-being.

Some coping and calming strategies are most effective when you engage in them long term and should be implemented as part of your regular routine. These can help to reduce the frequency and severity of your symptoms over time and enable you to bathe or wash in the future without experiencing negative thoughts and feelings.

Other strategies are most effective when implemented short term and should be utilised when you are faced with your triggers. Short-term strategies are designed to minimise or prevent any physiological, psychological or behavioural symptoms in the moment and to prevent a triggering situation from worsening and your negative thoughts and feelings from taking over.

Some of the long-term and short-term coping and calming strategies that you could implement to help you effectively manage your phobia of bathing, washing and cleaning are:

• Desensitisation – Desensitisation is one of the most effective ways to reduce the severity of a phobia. In order to work successfully, desensitisation should happen slowly over time. It involves gradual exposure to your triggers in an environment where you feel safe. Desensitisation should not be sudden or overwhelming. For example, it could begin by watching a video of someone washing their hands, followed by being in the same room as someone washing their hands, then turning on the tap, running your hands under water, sanitising your hands without water until you eventually lead up to washing your hands. Gradually desensitising yourself can prevent future bathing or washing from triggering a reaction or can result in a less severe reaction. This can reduce the impact your phobia has on your daily life and your well-being.
• Gain a deeper understanding of your fear – Think about your fear carefully to help you try and understand what initially caused you to develop a fear of bathing. Gaining a deeper understanding of your phobia can help you to address the root cause of your fear, deal with any negative thought processes, feelings and behaviours attached to your phobia and understand your triggers in more detail. This allows you to understand and rationalise your phobia, reduce your automatic fear response and reduce the frequency and severity of your symptoms.
• Join a support group – Getting support from other people who have experienced similar things can be a great way to deal with your phobia. A support group is usually run by a professional and consists of people who have faced or overcome similar challenges. You can gain important information and advice from the sessions as well as having your thoughts and feelings validated and receiving reassurance and empathy from other people in your group. There are both in-person and online support groups available.
• Find your support network – A support group is not for everyone, and some people prefer creating a support network of people they feel they can trust and who won’t judge their feelings and behaviour. Your support network could be made up of your family, friends, co-workers or other people. Ensure your support network is aware of the difficulties you face and knows the best ways to help you manage your phobia.
• Create a fear ladder – A fear ladder can help you to analyse and understand your fear of bathing, washing and cleaning and can also help you to identify which of your triggers creates more severe anxiety and panic than others. Because phobias are highly individualised, everyone’s fear ladder is different. An example fear ladder is shown below:
  – 1 = Washing your hair in the bath.
  – 2 = Having a bath without washing your hair.
  – 3 = Having a shower where the shower head is over the bath.
  – 4 = Running a bath.
  – 5 = Having a shower.
  – 6 = Hearing the sound of running water.
  Once you have created your fear ladder, you can then confront your triggers one at a time, starting at the bottom of the ladder (the trigger that results in the least phobic response). This can help you to slowly deal with your phobia and the triggers that are worsening the symptoms of your phobia.
• Visualise overcoming your phobia – Visualisation techniques can be extremely effective in helping you to overcome your phobia and any anxiety you are feeling. It works by imagining yourself successfully confronting and overcoming your fear, for example, by visualising a situation that you would usually find triggering, such as washing your hair, and imagining how you would overcome your fear and how you would feel when you overcame your fear. The human brain often cannot differentiate between thoughts and reality so visualising positive bathing experiences can reassure your brain that there is no danger and that you are able to overcome your fear.
• Challenge negative thoughts and feelings – If you have ablutophobia, you may experience increased distress when thinking about or talking about bathing, or when recalling a previous negative experience involving bathing. Avoid escalating your fear by disrupting and challenging negative thoughts and memories. Remember that bathing is not dangerous and that your fear is unfounded. Remind yourself that your fears are disproportionate and that the feeling will soon pass.
• Avoid negative portrayals of bathing and water – For many people with ablutophobia, their fear is connected to or worsened by water and the thought of water. Being exposed to negative portrayals of water in TV shows, films or news stories can validate and reinforce any negative connotations you might already have and may result in increased anxiety and fear. To prevent your phobia from escalating, avoid triggering or negative depictions of water or bathing.
• Practise mindfulness – Mindfulness can be beneficial in treating a variety of anxiety disorders, including phobias. It can help you to focus your breathing and attention and reduce the likelihood that you will experience physical symptoms of your phobia. Mindfulness can also help you to manage stress and anxiety and be more in control of the connection between your mind and body.
• Practise yoga or meditation – You can reduce or eliminate your anxiety and fear responses by practising yoga or meditation. Ablutophobia causes a fight-or-flight response and the release of stress hormones in triggering situations. By practising yoga and meditation, you can counteract the fight-or-flight response by achieving a highly relaxed state and reducing your stress levels. You can also learn how to control your breathing and manage your body’s negative response to your triggers. This can help you to reduce the negative thoughts, feelings and responses you may have when bathing in the future. Practise daily to help you improve the symptoms of your phobia long term.
• Learn deep breathing exercises – Deep breathing exercises can be effective in helping you to manage the symptoms of your phobia if you encounter a trigger. They do this by prompting your brain to relax and calm down and helping you to manage your anxiety. If you engage in deep breathing exercises every day, this can help you to effectively reduce your stress levels, relieve tension in your body and reduce your anxiety long term.

What triggers ablutophobia?

Ablutophobia can manifest in different ways in different people. There are many potential triggers, with the triggers varying from person to person. Some people find that their phobia has only one or two triggers, whereas other people’s phobia has multiple triggers.

The types of triggers and the number of triggers experienced by different people can vary depending on what initially caused their phobia of bathing, washing and cleaning to develop, their perception of the potential risk, the severity of their symptoms and their current mindset and mental health.

The most common triggers of ablutophobia are:

• Showering.
• Having a bath.
• Washing your hands.
• Washing your hair.
• Running water.
• Feeling water on your skin.
• Seeing a sponge, soap, cloths and other cleaning products.
• Watching a video or seeing a picture of someone bathing.
• Seeing dirt on your hands or skin.
• Walking down the cleaning or toiletries aisle of a shop.
• Hearing running water or another sound you associate with cleaning.
• Seeing a bath, shower or sink.
• Smelling soap or other cleaning products.
• Thinking about bathing or about getting dirty and needing to bathe.
• Another person telling you that you smell or need to bathe.
• Being submerged in water, for example, when swimming.

What are the symptoms of ablutophobia?

The symptoms of ablutophobia can be wide-ranging and extremely varied. They can differ significantly from person to person, in the way they manifest, their severity and the types of symptoms they experience. Some people only experience mild symptoms and may only experience a few symptoms, whereas others experience more severe symptoms that can have a significant impact on their everyday life.

Differences in the severity of symptoms, how frequently they occur, and their manifestation can occur for multiple reasons, such as how acute your phobia is, your triggers, your perception of the situation and your current mental health and mindset.

The symptoms of ablutophobia can occur at any time, including if you are faced with a trigger or if you think about bathing. The symptoms of a phobia are often automatic and uncontrollable. It may feel like you are unable to control or manage your thoughts or feelings and that your phobia is taking over your body.

To be classified as ablutophobia, your symptoms will need to occur for at least six months.

The most common symptoms of ablutophobia are:

Psychological symptoms:

Psychological symptoms refer to the mental and emotional symptoms you experience as a result of your phobia of bathing and washing.

The most common psychological symptoms of ablutophobia are:

• Intense, overwhelming persistent, excessive and unreasonable fear, anxiety, panic or distress if you are bathing or washing or thinking about bathing or washing.
• Feelings of fear, anxiety or panic that are out of proportion to the risks.
• Being unable to control your fear, anxiety or panic even if you are aware that they are out of proportion to the risk.
• Being unusually stressed or agitated in triggering situations.
• Anticipatory anxiety in the lead-up to a triggering situation.
• Depersonalisation or derealisation (where you feel like you no longer understand what is happening around you or you have lost touch with reality).
• Feeling immobilised or frozen by your fear.
• Feeling defenceless or vulnerable.
• Having difficulties concentrating or functioning normally in triggering situations.
• Feeling like you are losing control.
• Experiencing frequent or distressing nightmares related to bathing or washing.
• Feeling like you are in danger or having a sense of impending doom.
• Feeling like you are dying or are going to die.

Behavioural symptoms:

These are any changes in your behaviour that occur because of your phobia. These behaviours will be negative or damaging and unusual or abnormal for the individual and/or society as a whole.

The most common behavioural symptoms of ablutophobia are:

• Withdrawing from friends and family and social situations.
• Social isolation as a result of unhygienic practices or because of embarrassment.
• Avoiding bathing, washing and cleaning.
• Avoiding any place or situation that could increase the likelihood that you will need to bathe or wash.
• Being unable to eat or having a lack of appetite during or in the lead-up to triggering situations.
• Difficulties sleeping or insomnia in the lead-up to triggering situations.
• Refusing to talk about or think about bathing.
• Being unable to stop thinking about the possibility of bathing or what will happen to you if you bathe.
• Refusing to watch a TV show or film that features a shower or bath scene or someone washing their hands.
• Feeling like you want to run away or hide in triggering situations.
• Refusing to wash or bathe, even if you are experiencing adverse health consequences, such as skin conditions and fungal infections.

Physiological symptoms:

Physiological symptoms are connected to your body. They are physical disturbances that affect your body as a result of your phobia. Physiological symptoms occur as a result of the fight-or-flight response, which is activated to help you fight off a threat or escape from danger. The anxiety, fear or panic that you experience when faced with a trigger causes the fight-or-flight response in your body and causes your sympathetic nervous system to release stress hormones, such as adrenaline and cortisol.

These can then cause physiological symptoms, such as:

• Difficulties breathing, rapid breathing or hyperventilation.
• Feeling like you cannot catch your breath.
• A fast heart rate, heart palpitations or feeling like your heart is pounding.
• Elevated blood pressure.
• Shaking or trembling.
• Unusual or excessive sweating, clamminess or chills.
• Feeling dizzy or lightheaded.
• Feeling confused or disorientated.
• Numbness or tingling, particularly in your hands, feet, arms or legs.
• Tightness in your chest or chest pains.
• Experiencing a choking sensation, finding it difficult to swallow or feeling like something is stuck in your throat.
• A dry or sticky mouth.
• Stomach pain, nausea, vomiting or feeling like you need to go to the toilet.
• Feeling like you have butterflies in your stomach.
• Unusual pains or severe headaches.
• Muscle tension or feeling like your muscles are stiff.
• An unusual sensitivity to hot or cold temperatures.
• Feeling tired or fatigued for no obvious reason.
• Pale or flushed skin, particularly in the face.
• Experiencing a panic attack.

Symptoms of ablutophobia in children:

Children can experience many of the same symptoms as adults. However, in younger children, the symptoms of a phobia often manifest differently. This could be because children are less able to manage intense emotions, such as fear and anxiety, may be less able to rationalise and understand the way they are thinking and feeling and may be less constrained or less likely to hide the way they are feeling.

Some symptoms of ablutophobia in children are:

• Crying, screaming or having a tantrum.
• Lashing out by hitting or kicking people or objects that are close to them.
• Trying to run away or hide.
• Clinging to a parent, guardian or another safe person.
• Shaking or trembling.
• Showing signs of extreme anxiety, fear or panic.

What causes ablutophobia?

Because ablutophobia is an individualised phobia, there are many possible causes, with some people developing a phobia of bathing for one clear reason, and other people having multiple factors that contributed to them developing ablutophobia. It can be difficult for some people to determine exactly what caused them to develop ablutophobia, particularly if their phobia developed a long time ago or during childhood, or if the symptoms manifested slowly over time.

However, identifying the root cause of a phobia is usually extremely beneficial, as it allows you to address your initial triggers and any negative patterns of thought or feelings that are attached to these triggers. This can make it easier to manage your symptoms and reduce the impact your phobia has on your life.

The causes of ablutophobia can vary from person to person. The causes can be psychological, environmental, societal or genetic.

 The most common causes of ablutophobia are:

• A negative, traumatic, scary or painful experience that occurred when bathing, washing or cleaning – Also known as traumatic conditioning or a direct learning experience, a traumatic experience is the most common cause of ablutophobia. The experience may not seem traumatic to other people or may not actually have involved real danger; however, as long as the person involved felt real distress or fear at that time, this can lead to them developing a phobia. The traumatic experience is more likely to lead to a phobia if it happened during childhood or adolescence or during a vulnerable phase of your life, such as when you were experiencing other mental health difficulties. Examples of traumatic experiences include:
  – Slipping in the shower and injuring yourself.
  – Nearly drowning in the bath.
  – Your hair becoming stuck in the plug hole of a bath.
  – Your hair falling out while you were washing it.
  – Having a painful or severe reaction to soap or other bathing products.
  Following the traumatic experience, you may begin to have intrusive and negative thoughts or memories of the trauma and begin to avoid trauma-related triggers, for example, by avoiding showering. This can cause the fear or anxiety you felt at the time of the experience to linger or worsen and can lead to you developing a phobia.
• Multiple less severe negative experiences involving bathing – A phobia of bathing can develop because of multiple negative experiences that all contributed to the development of a phobia. A small number of these experiences alone may not have resulted in the development of a phobia particularly if there was no trauma involved; however, multiple experiences combined can contribute to someone developing ablutophobia. For example, shampoo stinging your eyes, handwashing giving you a rash, and nearly falling on a shower curtain can be smaller events that could result in you developing a phobia, particularly if the events happened in a similar timeframe or if they all happened during childhood.
• Having an allergy to water, soap or other hygiene products – Having an allergic reaction to water or cleansing products can result in red, itchy hives, a rash, wheezing, shortness of breath, swollen eyes, and even anaphylaxis. The fear that bathing will result in an allergic reaction can contribute to someone developing a phobia, particularly if their allergy is severe or if they have previously felt embarrassed about the symptoms of their allergy. If your allergy has existed since childhood, you may have been repeatedly warned of the dangers of your allergy, which may have resulted in avoidance behaviours and may increase the likelihood of you developing ablutophobia.
• Fear rumination – Fear rumination is a common cause of phobias and usually occurs following a negative experience involving bathing, washing or cleaning. Fear rumination involves engaging in repetitive negative thought processes and persistently and repeatedly recapping a traumatic, scary, negative or painful experience. Over time, these thoughts and memories can become increasingly upsetting and intrusive and can make you remember the event as being more negative or scary than it was in reality. Fear rumination reinforces your natural fear responses, creates additional anxiety and can result in you developing ablutophobia.
• A learned phobia – Also known as an observational learning experience, a learned phobia usually means you observed a fear of bathing, washing or cleaning in another person and learnt to be scared of these actions yourself. For example, you could learn to associate bathing with fear or danger. You are more likely to learn a phobia if you are exposed to it during childhood or adolescence – children who grow up with a close family member, such as a parent or sibling, with ablutophobia are more likely to develop the condition themselves. However, a learned phobia can also develop during adulthood.
• Cultural differences – Cultural differences can contribute to someone developing a phobia of bathing. For example, certain cultures and communities still practise communal bathing or bathing in natural bodies of water, such as rivers, lakes and waterfalls. Some cultures bathe less frequently than others or may not have access to clean water. Differences in bathing habits can affect their beliefs and attitudes surrounding bathing and can even contribute to them developing feelings of unease or a dislike of bathing. A phobia of bathing and washing is more frequently diagnosed in some areas of the world so it is not possible to rule out that cultural differences can contribute to ablutophobia.
• Childhood aversion – Childhood aversion to baths and showers is not uncommon. This can happen for a number of reasons, such as a fear of getting water or soap in their eyes, a dislike of having their hair washed, a dislike of the change of temperature and sensory issues related to water. If their fear of water is perpetuated by their parents or siblings, they experience a damaging reaction from others (such as forcing them under the water) or they receive the positive attention they were craving, this aversion to water can be maintained long term, even into adulthood, and can eventually develop into a phobia.
• An informational learning experience – You can develop ablutophobia if you are exposed to information about bathing that scares you. For example, about the number of drownings that occur each year or the number of people that injure themselves in the shower. Exposure to negative information can create feelings of fear or anxiety around the situation which can cause someone to begin avoiding bathing. This fear and aversion could then develop into a phobia.
• Experiencing significant or higher than usual stress levels – Significant, long-term stress can result in a disproportionate fear response or an inability to manage intense situations. This can make it more likely that you will develop a phobia, such as ablutophobia, particularly if you have a negative experience involving bathing or are exposed to the fear of bathing while experiencing higher levels of stress. A stressful or distressing event, such as a death, can also trigger a phobia, as you may be less able to manage your emotions and thought processes when experiencing grief, which can result in a disproportionate fear response.

How is ablutophobia diagnosed?

If you think you may be experiencing ablutophobia, you should first make an appointment with your GP, or your primary physician. Before referring you to a psychologist, your GP will first want to ensure that your symptoms are not occurring as a result of another medical condition or any medication or supplements you are taking.

To do this, your GP may conduct a physical examination, may look at your medical history and may ask about your symptoms. If your GP thinks there is a possibility you are experiencing ablutophobia, they will then make a referral to a mental health specialist.

During your appointment, the mental health specialist will ask for a wide range of information, such as:

• The symptoms you experience, including what your symptoms are, how frequently they occur and how severe they are.
• The initial onset of your fear, including when your symptoms first began and what initially triggered your fear.
• Your medical history, including whether you are currently or have previously had any anxiety disorders, panic disorders, phobias or other mental health conditions.
• Whether you have a family history of phobias.
• How much your fear interferes with your day-to-day life, your well-being and your behaviour.

To gain more information about your thoughts, feelings and behaviours, the psychologist will also likely conduct a phobia questionnaire. Because ablutophobia is a type of specific phobia, to receive a diagnosis, your symptoms will be compared to the diagnostic criteria for specific phobias.

Your symptoms will need to correspond with the seven key criteria, as listed below:

1. The fear must be persistent, excessive and unreasonable. It can occur either when the individual is bathing or when they are not.
2. Bathing or exposure to a trigger leads to an immediate anxiety response in the majority of situations.
3. The fear is excessive and disproportionate to the threat, and this is recognised by the individual.
4. The individual avoids bathing or places or situations where they are required to bathe.
5. The anticipation of bathing and the avoidance behaviours associated with avoiding their triggers can have a significant impact on the individual’s day-to-day life.
6. The fear has lasted for a minimum of six months.
7. The phobia is not associated with another disorder or mental health condition.

If your symptoms fit the diagnostic criteria, you will be diagnosed with a specific phobia, specifically ablutophobia. Depending on the frequency and severity of your symptoms, you may then be offered treatment.

How is ablutophobia treated?

There are several effective treatment options available for ablutophobia. However, not everyone with a phobia requires medical intervention. If your symptoms are mild, your phobia doesn’t impact your daily life or well-being or you have already implemented successful coping strategies, then formal treatment may not be required. However, you should always consult your doctor before making any decisions about treatment.

Treatment for ablutophobia is usually extremely effective, with treatment being successful in approximately 90% of cases. If your fear or anxiety is frequently triggered, if you find yourself changing your behaviour or avoiding bathing, if your symptoms are severe or if your phobia negatively impacts your life, then treatment will likely be recommended.

There are several effective treatment options available for ablutophobia. Because of this, your doctor will create a personalised treatment plan that is designed to effectively treat the root cause of your phobia, your symptoms and any negative thought patterns, feelings and behaviours that are connected to your phobia.

Your treatment plan will be based on several factors, such as:

• The severity of your symptoms.
• The frequency of your symptoms.
• The root cause of your phobia.
• How significantly your phobia impacts your life.

The most common treatment options for ablutophobia are:

Exposure Therapy:

Also known as systematic desensitisation, exposure therapy is one of the most effective ways of treating phobias. It is characterised by gradual and repeated exposure to anxiety-inducing situations and triggering stimuli. It aims to alter your fear response and desensitise you so that bathing or the thought of bathing no longer triggers a fear response.

Exposure will be gradual and take place over multiple sessions, with the number of sessions required depending on the severity of your phobia. The sessions will involve visualising and talking about your fear and experiencing triggering situations in real life. Exposure takes place in escalating phases and you will initially be exposed to triggers that create the lowest amount of anxiety, for example, watching a video of someone bathing. Once you are comfortable with this level of exposure, you will move on to the next trigger, before gradually building up to the most anxiety-provoking situations.

With each exposure, you should experience progressively lower anxiety with the aim that you can eventually bathe without experiencing a negative response.

By creating realistic thoughts and beliefs surrounding bathing, unlearning negative associations and patterns of thought, decreasing negative reactions and feelings towards bathing long term, and learning relaxation techniques and coping and calming strategies, exposure therapy can help you overcome your phobia.

Cognitive Behavioural Therapy (CBT):

CBT is a type of psychotherapy that aims to teach you techniques to help you reduce your fear and anxiety and identify connections between negative patterns of thought, negative feelings and triggering situations. You will try to deconstruct negative thoughts surrounding bathing into smaller fragments, which can then be worked on individually. The aim is to change the way you think about and respond to triggering situations.

CBT aims to help you understand your phobia and the underlying cause of your fear and any negative thought patterns that are contributing to your phobia. You will work with the psychologist to reduce or eliminate any negative connotations you have attached to your fear and reduce your psychological, physiological and behavioural responses to bathing.

CBT sessions can be conducted individually or as part of a group and will likely involve:

• Discussing your triggers and symptoms.
• Exploring what caused your fear of bathing.
• Learning how to recognise your negative thoughts and change the way you are thinking.
• Learning coping strategies and calming strategies, such as deep breathing exercises, distraction techniques and coping statements.

Clinical Hypnotherapy:

Hypnotherapy can help you address the root cause of your fear. It aims to help you gain a better understanding of your fear and enables you to repattern your existing negative thoughts regarding bathing.

During your hypnotherapy sessions, a combination of guided relaxation techniques and focused attention will be used to place you into a deeply relaxed state. You will then work to identify and overcome negative thought patterns, memories, feelings and behaviours that are contributing to your phobia. To help you reduce and manage your symptoms more effectively, you will also learn calming strategies.

Medications:

Although not a common treatment option, medications will occasionally be used to treat specific phobias, for example, if other treatment options haven’t been effective, if you are experiencing another mental health condition alongside your phobia, or if your phobia is so severe that it is having a significant impact on your health or well-being.

In these situations, you may be prescribed medications such as:

• Anti-anxiety medication (e.g. benzodiazepines).
• Anti-depressants (e.g. selective serotonin reuptake inhibitors (SSRIs)).
• Sedatives.

However, medication will likely not be recommended as a sole treatment option and will likely be offered in conjunction with psychotherapy, such as CBT or exposure therapy.