mental illness Archives

mental health hygiene — *Today’s guest blog post was written by Kathleen Corcoran.*

Mental health and cognitive decline can have a serious impact on a person’s ability to maintain regular hygiene and grooming routines. At the same time, changes or lack of regular hygiene and grooming routines can seriously impact a person’s mental health. Today is World Mental Health Day, a good day to consider how hygiene and mental health are woven together.

You’ve probably heard the saying “cleanliness is next to godliness” at some point. Many people subconsciously apply this moral judgement to the personal hygiene of those around them. As society’s standards of hygiene and grooming have changed over the centuries, so have the judgements on those who do not meet those standards.

This can have deleterious impacts on people already struggling with mental health or cognitive ability. Social stigma can deter people from reaching out for help, whether to mention their struggle to a therapist or ask for physical assistance. Self-consciousness about grooming standards may then contribute to isolation and loneliness.

“Unfortunately, at both ends of the spectrum, a lack of personal hygiene or an obsession with personal hygiene create additional stress and anxiety for the sufferer,” says Carla Manly, PhD, a clinical psychologist and author.

Depression

*Maybe chicken flavored toothpaste makes oral hygiene easier?*

The fatigue and lack of motivation that often characterize depression make otherwise routine tasks monumentally impossible. Executive dysfunction can be paralyzing in the face of all the minor steps needed to shower or bathe.

Additionally, depression sometimes causes sensory issues that make bathing physically painful. The temperature changes, scents, or lights can be overwhelming for someone with severe depression.

Instead of traditional bathing practices, those with mental health challenges might turn to alternative methods of hygiene. Dry shampoo, mouthwash, and wipes can enable someone with depression to stay clean when everything is difficult.

Alzheimers and Dementia

People with cognitive decline issues, such as Alzheimer’s and dementia, often have trouble maintaining regular bathing and grooming routines. They may bathe repeatedly, forgetting that they have already done so. Or they may forget to bathe entirely. Alternatively, they may have physical issues that prevent them from bathing. Issues with regular bathing can lead to health complications, such as skin infections or gum disease.

People who can live alone may be able to address this by setting alarms or writing reminders. Maintaining a routine for daily grooming and hygiene can help it become automatic rather than something to remember. Adjustments like hose attachments and rubber mats can remove some of the physical impediments to routine bathing.

Nurses, caregivers, and health aides can help patients who need more assistance with bathing. Keeping up habits established over the course of a lifetime can make assisted bathing easier. Bathing at the same time, using the same products or scents, might make a patient less agitated. Focusing on hygiene rather than grooming can help eliminate stress.

Ablutophobia

Many young children fear taking a bath or shower, but they generally grow out of it as they become more familiar with the routine or associate the bath with pleasant sensations. However, some people develop ablutophobia, an extreme fear of bathing or washing. This may be due to a sensory processing disorder, a traumatic experience, changes in brain function, or an underlying anxiety disorder.

When people with ablutophobia try to perform routine hygiene or grooming rituals, they may experience the symptoms of a panic attack or dissociation.

In the short term, people with ablutophobia can use alternative forms of cleaning, such as wipes or dry shampoo. However, treating ablutophobia will ultimately require psychotherapy or medication, which may allow a patient to uncover and address an underlying cause.

PTSD and Anxiety Disorders

Both post traumatic stress disorder (PTSD) and anxiety disorders can cause difficulties with regular standards of cleanliness. These mental health challenges can cause people to go to either extreme of hygiene and grooming. Sometimes people avoid bathing entirely because it triggers traumatic memories or causes a spike in anxiety. At other times, people fixate on removing dirt, performing ritualized grooming behaviors, controlling elements of their environment, or perfecting their outward appearance.

At either extreme, a person will likely feel an increased sense of social stigma and isolation, compounding the pain from mental illness.

*Some people may prefer to take dust baths rather than water baths.*

Short-term solutions may include changing the method of bathing, such as cleaning body parts individually to limit vulnerability, or switching from baths to showers. Changes to the bathing environment may also help, such as removing or installing locks on doors, turning down the temperature of the water heater in the home, or removing harsh scrubbers.

“The ultimate goals with such behaviors are to reduce a sense of being violated and ‘dirty’ and to increase a sense of safety,” says Carla Manly.

Schizophrenia

People struggling with schizophrenia often have difficulty maintaining regular routines and lose interest in daily activities. This includes habits like showering, brushing teeth, or changing into clean clothes.

Additionally, many medications to treat schizophrenia have side effects that contribute to problems with hygiene or grooming. Antipsychotic drugs often cause dry mouth, which can lead to gum disease, cavities, and halitosis. These medicines may also cause incontinence, which makes maintaining hygiene very difficult.

Some people find written reminders or alarms helpful to encourage regular hygiene or grooming rituals. Adjusting medications or dosages may help with side effects. Chewing gum and drinking lots of water can help with dry mouth, improving oral hygiene.

Bottom Line: Hygiene and grooming serve two different functions in our lives. When mental health issues make everything more difficult, focus on hygiene rather than grooming.

The Pooka (or Poukha or Puca), an Irish nightmare

A character’s “night life” can provide depth to the characterization and understanding for the reader. Nightmares and night terrors are both frightening, but the two sleep disorders are frightening in different ways to very different audiences. Knowing the distinctions will help you use them effectively in your writing.

Adequate sleep, with all the different stages and cycles, is a crucial part of overall physical and mental well-being. Dreaming is absolutely necessary to good mental health. There is far too much detail to get into here, but research is clear. Indeed, repeatedly waking someone to prevent dreaming is a well-known form of torture.

What Are Nightmares?

Depiction of the **Nightly Parade of 100 Demons**
*Japanese Folklore*

Nightmares are vividly realistic, disturbing dreams that rattle a person awake from a deep sleep. They often affect the body in the same way waking danger does. Adrenaline spikes, heart rate and respiration rate increase, and the body increases sweat production.

**Rakshasa**, a Hindu demon causing nightmares

Nightmares tend to occur most often during rapid eye movement (REM) sleep, when most dreaming takes place. Because periods of REM sleep become progressively longer as the night progresses, people experience nightmares most often in the early morning hours.

**A Dream of Crime & Punishment** (1847) by JJ Grandville

Some people wake from nightmares crying, while others may wake shaking from fear. After a nightmare, people often have trouble falling back to sleep. The combination of the stress hormones flooding through the body with whatever lingering images from the nightmare are stuck in the mind make it very difficult to relax enough to fall back asleep. Particularly disturbing nightmares can cause sleep disruptions for days and stick around in the brain for years.

What are Night Terrors?

Night terrors are recurring nighttime episodes that happen while a person remains asleep. They’re also commonly known as sleep terrors. When a night terror begins, a sleeper will appear to wake up. They might call out, cry, move around, or show other signs of fear and agitation.

**Lady Macbeth Sleepwalking** *by Artus Scheiner*

Other common reactions:

Screaming or crying
Staring blankly
Flailing or thrashing in bed
Breathing rapidly
Having an increased heart rate
Becoming flushed and sweaty
Seeming confused
Getting up, jumping on the bed, or running around the room

A sleeper may become aggressive if a partner or family member tries to restrain them or keep them quiet. The episode can last for a few seconds or up to several minutes, though the sleeper typically doesn’t wake up. Most people fall right back to quiet sleep after a night terror.

**Takagi Umanosuke Confronts the Ghost of a Woman**
*by Tsukioka Yoshitoshi*

Night terrors are more common in young children, but they can disturb adults as well. An estimated 2 percent of adults also experience night terrors. In reality, this number may be higher, since people often don’t remember having night terrors.

Night terrors usually happen earlier in the night, during the first half of the sleeping period. This is when a sleeper is in stages 3 and 4 of non-rapid eye movement (NREM) sleep, also called slow-wave sleep. It’s uncommon to have them twice in one night, though it can happen.

What is the Difference Between Night Terrors and Nightmares?

**Dream-Land** etching (1883) by S.J. Ferris after a painting by C.D. Weldon

Night terrors may might seem similar to nightmares, but the two are different. In addition to the immediate mental and physical effects, the effect on witnesses or other members of a household are very different for night terrors and nightmares.

**The Last Judgment** (detail) by Jan van Eyck

When a sleeper wakes up from a nightmare, they will probably remember at least some of what the dream involved. Come morning, the sleeper is quite likely to remember the episode, though the memory may be vague.

During night terrors, the sleeper remains asleep and usually doesn’t remember what happened when they do wake up in the morning. The sleeper might remember a scene from a dream they had during the night terror episode, but it’s uncommon to recall any other part of the experience.

**The Orphans Dream** (ca. 1900) by James Elliott

A partner, roommate, family member, or other witness to a night terror episode is likely to remember the experience quite well. The daughter of a friend has fairly frequent night terrors, during which she will wander out of the house in her pyjamas or physically attack her partner in his sleep. In the morning, she occasionally has grass on her feet or bruised knuckles but no memory of how she got them.

What Causes Sleep Disorders?

**SPECT Readout of a Sleepwalking Patient**, from the Lancet

Many adults who experience nightmares or night terrors live with mood-related mental health conditions, such as depression, anxiety, or bipolar disorder. Night terrors have also been associated with the experience of trauma and heavy or long-term stress.

Physical factors can also contribute to the frequency of night terrors and nightmares. Sleep apnea is a very common cause of other sleep disorders. Some other possible causes

**Khumbhakarna**, a bringer of nightmares, in a temple in Bali

Travel-related sleep disruptions
Restless leg syndrome
Sleep deprivation
Medications, including stimulants and some antidepressants
Fever or illness
Alcohol use

Frequent disruptions to sleep cycles (such as night terrors or nightmares) cause fatigue and, eventually, sleep deprivation. Fatigue and sleep deprivation increase the likelihood of having night terrors or nightmares. There’s no escape!

**Nightmare** (1810) by Jean Pierre Simon

Bottom Line for Writers: Characters can be just as interesting when they sleep! Why would your character have disrupted sleep, and how would they react? Would the sleep disruption be more effective if experienced by the narrator (nightmare or confusion after night terrors) or by someone close to the narrator (night terror or discussing remembered nightmare)?

Vivian Lawry

Writer

mental illness

Hygiene and Mental Health