Psychological Reports, 1992, 70, 35-39. @ Psychological Reports 1992
UNUSUAL CLEANING BEHAVIOR I N T H E LUTEAL PHASE ' KATHLEEN M. DILLON AND DEBORAH BROOKS Western N e w Englond Colkge Summary.-18 undergraduate women recorded episodes of unusual cleaning, defined as excessive cleaning or cleaning of things not usually cleaned, and the dates of their menstruation over a 2-mo. period. Unusual cleaning was significantly more likely to occur during the luted phase than at any other time in women not using oral contraceptives. Possible links between changes in progesterone levels and obsessive compulsive disorders are suggested.
Cleaning behavior can be motivated by external events, by habit, or by internal events. When one is motivated by internal events, one may feel a strong urge to clean something not usually cleaned or to clean something one usually does but in an excessive way. I t is t h s type of cleaning, what we will call unusual cleaning, that is the subject of this study. The most obvious example of unusual cleaning in its extreme form is found in certain people with obsessive compulsive disorders. Although this disorder can have many manifestations, cleaning and washing are some of the most common compulsive symptoms (Swedo & Rapoport, 1989). I n this extreme condition, a person feels compelled to carry out an activity they usually recognize to be excessive or unreasonable (American Psychiatric Association, 1987). The unusual cleaning behavior being investigated here is not of the pathological type, but the kind of behavior normal individuals find themselves doing on infrequent occasions. However, there may, in fact, be a link or a continuum between this type of unusual cleaning behavior and compulsive cleaning behavior. Rapoport (1989) in her case book of obsessive compulsive disorders writes, "I have not resolved in my own mind where the obsessionality of everyday life leaves off and O C D [obsessive compulsive behavior] begins. Take being neat or messy" (p. 178). Although there is a research literature on gender differences and politics of cleaning behavior (Hochschild, 1989; Matthews, 1987), there are no studies, to our knowledge, of the type of unusual cleaning behavior done by normal individuals to which this study refers. The idea for this study comes rather from anecdotal observations that this unusual cleaning behavior, when it does occur, usually happens just prior to menses. I t should be noted that this cleaning need not refer to only housecleaning. Using an idealized menstrual cycle of 28 days, the follicular days can be 'Address correspondence co K. M. Dillon, Psychology, Western New England College, Springfield, MA 01119.
36
K. M. DILLON & D.BROOKS
defined as Days 1-13 (with Day 1 being the onset of menses), Day 14 as ovulation, and Days 15-28 as the luteal phase (Fox, 1991; Mader, 1990). "Progesterone is almost undetectable during the follicular phase. After ovulation progesterone is secreted by the corpus luteum; the levels reach a peak shortly after the midluteal phase and sharply decline as the menses approach. Basal body temperature follows the same pattern as progesterone" (Halbreich & Endicott, 1985, p. 16). O n the average, progesterone reaches a level measured in ng/rnl ten times higher in the luteal phase than in the follicular phase (Severino & Moline, 1989). Progesterone levels also continuously increase during pregnancy followed by a drop at delivery (Mader, 1990). Swedo (1989) is currently studying five cases of postpartum obsessive compulsive disorder. "One women was first plagued by cleaning and counting rituals two weeks following the birth of her second cMd. Subsequently, these rituals waxed and waned in sequence with her menstrual cycle" (p. 280). Although obsessive compulsive disorder occurs equally often in men and women (American Psychiatric Association, 19871, behaviors often first appear in girls when they are 15 to 19 (Burke, Burke, Regier, & Rae, 1990), an age not long after the usual start of menses. In contrast to the paucity of human literature relating hormonal changes to cleaning, there is some infrahuman literature directly relating nesting behavior to progesterone, either naturally released during pregnancy or artificially injected in nonpregnant animals (Rapoport, 1989; Saito, 1987; Swedo, 1989). For example, Saito (1987) showed a parallel increase in progesterone levels and amount of nesting material taken into the cage in mice up to seven days after mating. What will be investigated here is whether unusual cleaning behavior can be observed in a normal population of women and whether its occurrence will coincide with the luteal phase of the menstrual cycle.
Subjects Eighteen female undergraduates volunteered to participate and completed this two-month study. Their ages ranged from 18 to 22 years, with a mean of 19.4 and a standard deviation of 1.5. All of the subjects were menstruating females, and four of the subjects reported taking the fixed-ratio type of contraceptive pills during the study. Materials and Procedure Each participant was initially asked to complete a questionnaire that covered a 4-wk. period followed by another questionnaire covering the next 4 wk. The participants were asked to indicate at the end of each day whether they were menstruating or not and whether they had engaged in their usual daily cleaning behavior or not. They were further instructed: "If
UNUSUAL CLEANING DURING LUTEAL PHASE
37
you did some cleaning that was out of the ordinary for you, for example, you cleaned something that hadn't been cleaned in a while or you spent a longer than usual time cleaning something, put an UN for unusual. For each UN day, describe in detail what you did and why it was unusual for you."
Altogether 1008 days of observations were made by the 18 women. Each of the reports of unusual behavior were examined. The following types of behavior listed as unusual by some of the subjects were not considered unusual as defined by this study: the behavior occurred primarily in response to an external cause (e.g., a number of students indicated they cleaned their rooms before leaving for Spring Break in response to a memo they received from the administration; another common external reason was that friends were coming over to visit); the cleaning behavior was cleaning of oneself rather than cleaning of an object (e.g., a number of women reported taking more showers during menstruation); the cleaning was considered unusual because the woman cleaned less than she usually did or because only an UN was listed with no description following. O n the other hand, reports such as "I cleaned the wall by the desk," "I cleaned the back of the microwave," "I dusted my pictures," "I cleaned the top of the refrigerator," "It wasn't my turn to d o the &shes but I did them anyway," "I picked fuzzies off my rug," and "I cleaned before going to my class; I don't usually do this" were considered acceptable in that they were considered out of the ordinary for these women and they had no obvious external precipitating event. There were 14 recordings of unusual cleaning made by 10 of the subjects that meet the definition of this study. Because no test of ovulation was made for each subject, two weeks before the onset of menstruation for each subject was defined as the luteal phase. Eleven of the 14 unusual cleaning reports occurred during this luteal phase, and three occurred outside of this phase (X,2 = 4.57, p < . 0 5 ) O n e of the three episodes that occurred outside of the luteal phase occurred 15 days before menstruation. The four subjects on oral contraceptives reported no acceptable unusual cleaning episodes. Cleaning due to external factors occurred the same or a similar number of times in both phases. For subjects not using oral contraceptives, two episodes occurred during the luteal phase and two outside of the luteal phase. For subjects using oral contraceptives, two episodes occurred during the luteal phase and three outside.
What has been shown in this study is that unusual cleaning behavior was observed, albeit rarely, in 71% of the subjects not taking oral contraceptives and that it occurred significantly more often in the luteal phase than at any other time. This finding can be compared to excessive cleaning caused
38
K. M. DILLON & D. BROOKS
by external factors which was equally likely to occur in the luteal phase and outside of the luteal phase. While progesterone might seem to be a hkely cause for unusual cleaning due to the changes in its levels during the luteal phase and because of the evidence cited from the animal models, it remains an hypothesis in this study. Progesterone levels or perhaps basal temperature levels of each subject would need to be measured directly and correlated with the unusual cleaning behavior to make any link. Measuring progesterone directly would also confirm self-reports of contraceptive use. I n this study, only four subjects (or 22%) reported using oral contraceptives. Mosher (1770) reported that 59% of women aged 15 to 19 years and 68% of women aged 20 to 24 years were on the pill in 1788. I n fact, a smaller number of subjects in this study may have been on the pill or the use of the pill in more recent years is declining (perhaps as the use of the condom is increasing due to the threat of AIDS). Also, either subjects in this study may not have reported they were on the pill when they were for fear of being found out, or subjects on the pill were less likely to volunteer for this study for the same reason. Because the number of subjects reporting to be on oral contraceptives was small, n o conclusions can be drawn about their lack of unusual cleaning behavior. Of interest, however, are studies reporting remission or improvement of obsessive compulsive disorder using drugs that involve sexual hormonal modulation (Swedo, 1989). All the subjects using oral contraceptives in this study were using the fixed-ratio type of oral contraceptive which means their progesterone levels remain fairly high and constant throughout. Measuring progesterone directly would also be of benefit in analyzing the data from women not using contraceptives. Prior, Vigna, Schechter, and Burgess (1990), studying a group of 66 women over a year, discovered that only 13 had continued to ovulate normally for the entire time and that more than 50% of the women had low progesterone levels. This finding was true of women who did not exercise at all, women who ran but not intensely, and women who were marathon runners. Unusual cleaning behavior might only occur during months when ovulation and subsequent progesterone changes occur. Finally, directly measuring progesterone levels would precisely define the luteal phase for each subject and allow assessment of whether unusual cleaning can be tied to certain levels or changes in levels of progesterone. To understand the role progesterone levels play in premenstrual syndrome, Trunnell, Turner, and Keye (1988) have recommended progesterone levels be "assessed daily and perhaps hourly during the luteal phase" (p. 435). The only problem with this suggestion is its feasibility. The technique involves obtaining whole blood by venipuncture which would be difficult on a daily basis and impossible on an hourly basis for a nonpatient population. Rapoport (1989) often alludes to the atavistic quality of the behavior of
UNUSUAL CLEANING DURING LUTEAL PHASE
39
some of her obsessive compulsive patients. "I am fascinated by the resemblance of my patients' compulsive rituals to the fixed behaviors of some animal species" (p. 176) and "Do compulsive patients lack 'free will?"' (p. 176). What we may be witnessing in this study is a similar hormonaly driven need or urge to clean in normal women. Because it is infrequent and of short duration in normal women, unusual cleaning was seen as bemusing by many of the women rather than distressing as it does to obsessive compulsive sufferers. This study, however, may open the way to further research of cleaning behavior gone awry. REFERENCES ASSOLIATION. (1987) Diagnostic and statistical manual of mental disorAMERICANPSYCHJATRIC ders. (3rd ed., Rev ) LVastungton, DC: Author. BURKE,K. C., BURKE,J. D , KEGIER, D. A., & RAE, D. S. (1990) Age of onset of selected mental disorders in five community populations. Archives of General Psychiatry, 47, 511518. Fox, S. I. (1991) Perspectives on human biology. Dubuque, IA: Brown. H ~ R E I C HU.,, & ENDICOIT,J. (1985) The biology of premenstrual changes: what do we really know? In H . J. Osofsky & S. J. Blumenthal (Eds.), Premenstrual syndrome: current findings and future directions. Washington, DC: American Psychiatric Press. Pp. 15-24. HOCHSCHILD, A. (1989) The second shift: working parents and the revolution at home. New York: V i g . MADER,S. S. (1990) Human biology. (2nd ed.) Dubuque, I A : Brown. MATMEWS,G. (1987) "Just a housewife": the rise andfall o/domesticity in America. New York: Oxford Univer. Press. MOSHER,W. D. (1990) Contraceptive practice in the United States, 1982-1988. Family Planning Perspectives, 22, 198-205. PRIOR,J. C., VIGNA,Y. M., SCHECHTER, M. T., & BURGESS, A. E. (1990) Spinal bone loss and ovulatory disturbances. New England Journal ofMedicine, 323, 1221-1227. RAPOPORT, J. L. (1989) The boy who couldn't stop washing. New York: Dutton. SAITO, T. R. (1987) Plasma progesterone levels and maternal nest building behavior dur~ng pseudopregnancy and early pregnancy in the IVCS mouse. Annab of Animal Psychology, 36, 101-105. SEVERINO, S. K., & MOLINE,M. L. (1989) Premenstrual syndrome: a clinician's guide. New York: Guilford. SWEDO,S. E. (1989) Rituals and releasers: an ethological model of obsessive-compulsive disorder. In J. L. Rapport (Ed.), Obsessive-compulsivedisorder in children and adolescents. Washington, DC: American Psychiatric Press. Pp. 269-288. SWEDO,S. E., & RAPOPORT, J. L. (1989) Phenomenology and differential diagnosis of obsessive-compulsive disorders in children and adolescents. In J. L. Rapoprt (Ed.), Obsessive-compulsive disorder in children and adolescents. Washington, DC: American Psychiatric Press. Pp. 13-32. TRUNNELL, E. P., TURNER,C. W., & KEYE, W. R. (1988) A comparison of the psychological and hormonal factors in women with and without premenstrual syndrome. Journal of Abnormal Psychology, 97, 429-436.
Accepted December 10, 1991.
UNUSUAL CLEANING BEHAVIOR I N T H E LUTEAL PHASE ' KATHLEEN M. DILLON AND DEBORAH BROOKS Western N e w Englond Colkge Summary.-18 undergraduate women recorded episodes of unusual cleaning, defined as excessive cleaning or cleaning of things not usually cleaned, and the dates of their menstruation over a 2-mo. period. Unusual cleaning was significantly more likely to occur during the luted phase than at any other time in women not using oral contraceptives. Possible links between changes in progesterone levels and obsessive compulsive disorders are suggested.
Cleaning behavior can be motivated by external events, by habit, or by internal events. When one is motivated by internal events, one may feel a strong urge to clean something not usually cleaned or to clean something one usually does but in an excessive way. I t is t h s type of cleaning, what we will call unusual cleaning, that is the subject of this study. The most obvious example of unusual cleaning in its extreme form is found in certain people with obsessive compulsive disorders. Although this disorder can have many manifestations, cleaning and washing are some of the most common compulsive symptoms (Swedo & Rapoport, 1989). I n this extreme condition, a person feels compelled to carry out an activity they usually recognize to be excessive or unreasonable (American Psychiatric Association, 1987). The unusual cleaning behavior being investigated here is not of the pathological type, but the kind of behavior normal individuals find themselves doing on infrequent occasions. However, there may, in fact, be a link or a continuum between this type of unusual cleaning behavior and compulsive cleaning behavior. Rapoport (1989) in her case book of obsessive compulsive disorders writes, "I have not resolved in my own mind where the obsessionality of everyday life leaves off and O C D [obsessive compulsive behavior] begins. Take being neat or messy" (p. 178). Although there is a research literature on gender differences and politics of cleaning behavior (Hochschild, 1989; Matthews, 1987), there are no studies, to our knowledge, of the type of unusual cleaning behavior done by normal individuals to which this study refers. The idea for this study comes rather from anecdotal observations that this unusual cleaning behavior, when it does occur, usually happens just prior to menses. I t should be noted that this cleaning need not refer to only housecleaning. Using an idealized menstrual cycle of 28 days, the follicular days can be 'Address correspondence co K. M. Dillon, Psychology, Western New England College, Springfield, MA 01119.
36
K. M. DILLON & D.BROOKS
defined as Days 1-13 (with Day 1 being the onset of menses), Day 14 as ovulation, and Days 15-28 as the luteal phase (Fox, 1991; Mader, 1990). "Progesterone is almost undetectable during the follicular phase. After ovulation progesterone is secreted by the corpus luteum; the levels reach a peak shortly after the midluteal phase and sharply decline as the menses approach. Basal body temperature follows the same pattern as progesterone" (Halbreich & Endicott, 1985, p. 16). O n the average, progesterone reaches a level measured in ng/rnl ten times higher in the luteal phase than in the follicular phase (Severino & Moline, 1989). Progesterone levels also continuously increase during pregnancy followed by a drop at delivery (Mader, 1990). Swedo (1989) is currently studying five cases of postpartum obsessive compulsive disorder. "One women was first plagued by cleaning and counting rituals two weeks following the birth of her second cMd. Subsequently, these rituals waxed and waned in sequence with her menstrual cycle" (p. 280). Although obsessive compulsive disorder occurs equally often in men and women (American Psychiatric Association, 19871, behaviors often first appear in girls when they are 15 to 19 (Burke, Burke, Regier, & Rae, 1990), an age not long after the usual start of menses. In contrast to the paucity of human literature relating hormonal changes to cleaning, there is some infrahuman literature directly relating nesting behavior to progesterone, either naturally released during pregnancy or artificially injected in nonpregnant animals (Rapoport, 1989; Saito, 1987; Swedo, 1989). For example, Saito (1987) showed a parallel increase in progesterone levels and amount of nesting material taken into the cage in mice up to seven days after mating. What will be investigated here is whether unusual cleaning behavior can be observed in a normal population of women and whether its occurrence will coincide with the luteal phase of the menstrual cycle.
Subjects Eighteen female undergraduates volunteered to participate and completed this two-month study. Their ages ranged from 18 to 22 years, with a mean of 19.4 and a standard deviation of 1.5. All of the subjects were menstruating females, and four of the subjects reported taking the fixed-ratio type of contraceptive pills during the study. Materials and Procedure Each participant was initially asked to complete a questionnaire that covered a 4-wk. period followed by another questionnaire covering the next 4 wk. The participants were asked to indicate at the end of each day whether they were menstruating or not and whether they had engaged in their usual daily cleaning behavior or not. They were further instructed: "If
UNUSUAL CLEANING DURING LUTEAL PHASE
37
you did some cleaning that was out of the ordinary for you, for example, you cleaned something that hadn't been cleaned in a while or you spent a longer than usual time cleaning something, put an UN for unusual. For each UN day, describe in detail what you did and why it was unusual for you."
Altogether 1008 days of observations were made by the 18 women. Each of the reports of unusual behavior were examined. The following types of behavior listed as unusual by some of the subjects were not considered unusual as defined by this study: the behavior occurred primarily in response to an external cause (e.g., a number of students indicated they cleaned their rooms before leaving for Spring Break in response to a memo they received from the administration; another common external reason was that friends were coming over to visit); the cleaning behavior was cleaning of oneself rather than cleaning of an object (e.g., a number of women reported taking more showers during menstruation); the cleaning was considered unusual because the woman cleaned less than she usually did or because only an UN was listed with no description following. O n the other hand, reports such as "I cleaned the wall by the desk," "I cleaned the back of the microwave," "I dusted my pictures," "I cleaned the top of the refrigerator," "It wasn't my turn to d o the &shes but I did them anyway," "I picked fuzzies off my rug," and "I cleaned before going to my class; I don't usually do this" were considered acceptable in that they were considered out of the ordinary for these women and they had no obvious external precipitating event. There were 14 recordings of unusual cleaning made by 10 of the subjects that meet the definition of this study. Because no test of ovulation was made for each subject, two weeks before the onset of menstruation for each subject was defined as the luteal phase. Eleven of the 14 unusual cleaning reports occurred during this luteal phase, and three occurred outside of this phase (X,2 = 4.57, p < . 0 5 ) O n e of the three episodes that occurred outside of the luteal phase occurred 15 days before menstruation. The four subjects on oral contraceptives reported no acceptable unusual cleaning episodes. Cleaning due to external factors occurred the same or a similar number of times in both phases. For subjects not using oral contraceptives, two episodes occurred during the luteal phase and two outside of the luteal phase. For subjects using oral contraceptives, two episodes occurred during the luteal phase and three outside.
What has been shown in this study is that unusual cleaning behavior was observed, albeit rarely, in 71% of the subjects not taking oral contraceptives and that it occurred significantly more often in the luteal phase than at any other time. This finding can be compared to excessive cleaning caused
38
K. M. DILLON & D. BROOKS
by external factors which was equally likely to occur in the luteal phase and outside of the luteal phase. While progesterone might seem to be a hkely cause for unusual cleaning due to the changes in its levels during the luteal phase and because of the evidence cited from the animal models, it remains an hypothesis in this study. Progesterone levels or perhaps basal temperature levels of each subject would need to be measured directly and correlated with the unusual cleaning behavior to make any link. Measuring progesterone directly would also confirm self-reports of contraceptive use. I n this study, only four subjects (or 22%) reported using oral contraceptives. Mosher (1770) reported that 59% of women aged 15 to 19 years and 68% of women aged 20 to 24 years were on the pill in 1788. I n fact, a smaller number of subjects in this study may have been on the pill or the use of the pill in more recent years is declining (perhaps as the use of the condom is increasing due to the threat of AIDS). Also, either subjects in this study may not have reported they were on the pill when they were for fear of being found out, or subjects on the pill were less likely to volunteer for this study for the same reason. Because the number of subjects reporting to be on oral contraceptives was small, n o conclusions can be drawn about their lack of unusual cleaning behavior. Of interest, however, are studies reporting remission or improvement of obsessive compulsive disorder using drugs that involve sexual hormonal modulation (Swedo, 1989). All the subjects using oral contraceptives in this study were using the fixed-ratio type of oral contraceptive which means their progesterone levels remain fairly high and constant throughout. Measuring progesterone directly would also be of benefit in analyzing the data from women not using contraceptives. Prior, Vigna, Schechter, and Burgess (1990), studying a group of 66 women over a year, discovered that only 13 had continued to ovulate normally for the entire time and that more than 50% of the women had low progesterone levels. This finding was true of women who did not exercise at all, women who ran but not intensely, and women who were marathon runners. Unusual cleaning behavior might only occur during months when ovulation and subsequent progesterone changes occur. Finally, directly measuring progesterone levels would precisely define the luteal phase for each subject and allow assessment of whether unusual cleaning can be tied to certain levels or changes in levels of progesterone. To understand the role progesterone levels play in premenstrual syndrome, Trunnell, Turner, and Keye (1988) have recommended progesterone levels be "assessed daily and perhaps hourly during the luteal phase" (p. 435). The only problem with this suggestion is its feasibility. The technique involves obtaining whole blood by venipuncture which would be difficult on a daily basis and impossible on an hourly basis for a nonpatient population. Rapoport (1989) often alludes to the atavistic quality of the behavior of
UNUSUAL CLEANING DURING LUTEAL PHASE
39
some of her obsessive compulsive patients. "I am fascinated by the resemblance of my patients' compulsive rituals to the fixed behaviors of some animal species" (p. 176) and "Do compulsive patients lack 'free will?"' (p. 176). What we may be witnessing in this study is a similar hormonaly driven need or urge to clean in normal women. Because it is infrequent and of short duration in normal women, unusual cleaning was seen as bemusing by many of the women rather than distressing as it does to obsessive compulsive sufferers. This study, however, may open the way to further research of cleaning behavior gone awry. REFERENCES ASSOLIATION. (1987) Diagnostic and statistical manual of mental disorAMERICANPSYCHJATRIC ders. (3rd ed., Rev ) LVastungton, DC: Author. BURKE,K. C., BURKE,J. D , KEGIER, D. A., & RAE, D. S. (1990) Age of onset of selected mental disorders in five community populations. Archives of General Psychiatry, 47, 511518. Fox, S. I. (1991) Perspectives on human biology. Dubuque, IA: Brown. H ~ R E I C HU.,, & ENDICOIT,J. (1985) The biology of premenstrual changes: what do we really know? In H . J. Osofsky & S. J. Blumenthal (Eds.), Premenstrual syndrome: current findings and future directions. Washington, DC: American Psychiatric Press. Pp. 15-24. HOCHSCHILD, A. (1989) The second shift: working parents and the revolution at home. New York: V i g . MADER,S. S. (1990) Human biology. (2nd ed.) Dubuque, I A : Brown. MATMEWS,G. (1987) "Just a housewife": the rise andfall o/domesticity in America. New York: Oxford Univer. Press. MOSHER,W. D. (1990) Contraceptive practice in the United States, 1982-1988. Family Planning Perspectives, 22, 198-205. PRIOR,J. C., VIGNA,Y. M., SCHECHTER, M. T., & BURGESS, A. E. (1990) Spinal bone loss and ovulatory disturbances. New England Journal ofMedicine, 323, 1221-1227. RAPOPORT, J. L. (1989) The boy who couldn't stop washing. New York: Dutton. SAITO, T. R. (1987) Plasma progesterone levels and maternal nest building behavior dur~ng pseudopregnancy and early pregnancy in the IVCS mouse. Annab of Animal Psychology, 36, 101-105. SEVERINO, S. K., & MOLINE,M. L. (1989) Premenstrual syndrome: a clinician's guide. New York: Guilford. SWEDO,S. E. (1989) Rituals and releasers: an ethological model of obsessive-compulsive disorder. In J. L. Rapport (Ed.), Obsessive-compulsivedisorder in children and adolescents. Washington, DC: American Psychiatric Press. Pp. 269-288. SWEDO,S. E., & RAPOPORT, J. L. (1989) Phenomenology and differential diagnosis of obsessive-compulsive disorders in children and adolescents. In J. L. Rapoprt (Ed.), Obsessive-compulsive disorder in children and adolescents. Washington, DC: American Psychiatric Press. Pp. 13-32. TRUNNELL, E. P., TURNER,C. W., & KEYE, W. R. (1988) A comparison of the psychological and hormonal factors in women with and without premenstrual syndrome. Journal of Abnormal Psychology, 97, 429-436.
Accepted December 10, 1991.
