Automysophobia is the irrational fear of being dirty. It makes no difference to ask how or why someone acquires such a phobia, because most phobias evolve from causes too deep-seated for amateurs to uncover.

The word comes to us from the Greek. It is widely known that the prefix "auto" refers to the self, and "mysos" means dirt. With automysophobia, what the patient is actually afraid of is not the garden variety of dirt but his own actual physical dirt. People who suffer from this phobia are disturbed by the idea that they have body dirt and odor that they are unaware of. They fear that they appear dirty and smell bad to other people. Their fear disables them from impartial judging of their own level of cleanliness. It prevents them from holding down a job or going to school. Affected people spend an inordinate amount of time bathing their bodies, washing their clothes, and cleaning the environment around them.

Just like any phobia, automysophobia evokes feelings of panic, especially if the person is pressed into a situation where he must confront his fear. Panic symptoms can include increased heart rate or palpitations, a feeling of tightness in the chest, dizziness, and sweating-which of course contributes to the phobia, in this case. Sufferers can even experience paresthesias, which are sensations that the skin is numb or tingling in specific areas, or a feeling of choking. They can feel extremes of either hot or cold. All of these panic symptoms are just symptoms-the person is not actually choking or flushing hot, but the sensations are just as real to him as if he were.

This type of patient also becomes depressed from the limitations his phobia poses on him. Another common symptom is the loss of interest in whatever is going on in the world around him, also called anhedonia.

Because of their obsession with personal cleanliness, automysophobia often subjects its victims to obsessive compulsive disorder. The persistent urge to bathe and clean can intrude into all areas of his life.

This phobia often actually falls into the broad category of social anxiety disorders. The patient develops a fear of being dirty that is morbid, which means that the fear itself causes the patient to be unwell. Because his fear revolves around the way he will appear and smell to others, he cannot stand the idea of socializing. He has an unrelenting sense that he is socially unacceptable. He worries alternately that he will disgust others or that they will make fun of him. Just the thought creates such dread that he lashes out at family members who encourage him to mingle with others.

This is best treated with anti-anxiety medication and especially behavior therapy. Behavior therapy, or cognitive-behavior therapy, helps the patient to realize that this is just a phobia and not a fact. Therapy must come from a trained professional in order to individualize the treatment with the right anti-anxiety medication for a given person. The patient should understand that no medication will eliminate his phobia, but it will help him to deal with it.

It is also beneficial for the patient to have a physical exam by a medical doctor so that the patient understands that there is no medical reason to assume that he is dirty or that he smells bad. The therapist also must devote months to teaching the patient that his symptoms are nothing more than sensations with no physical basis, and bringing him to the point at which he can interact socially without incident.