Content warning: This article discusses sexual assault, trauma and PTSD in a way that may be distressing to some readers.
Cleanliness, as the saying goes, is next to godliness. Good hygiene is held up as not only a social norm but a moral good. This message comes across in a world of ways, from celebs going viral for commenting on how often they bathe their children to ongoing debates about how frequently people should wash their hair and the trends for 'clean skin' and 'clean makeup' as the epitome of beauty.
But the fact is that a routine that's easy for one person could be impossible for the next. Dee Johnson, a therapist at Priory Hospital, says there are a few potential explanations for this, including "an inability to self-organise or focus, sensory overload, a sense of emotional and physical detachment or a response to trauma". It could even be learned behaviour as a result of neglect.
It's easy to judge others for actions that many of us integrate into our daily lives without a second thought but doing so makes cleanliness a moral absolute and encourages shaming of whoever isn’t meeting your particular standards. That person could well be neurodivergent or reckoning with their mental health or trauma – or a combination of all three.
Libby (she/they) is 25 and has struggled with poor hygiene thanks to a combination of trauma and sensory issues since they were a teenager. They tell R29 about the complicated reasons they can go months on end without brushing their teeth, and why we need to work on questioning our automatic responses to other people’s hygiene.
"I think I've always struggled with hygiene. It was definitely due to a lack of motivation and sensory issues at first. But when I was at university it got really bad. At first it was linked to experiencing psychotic symptoms – I believed that there were cameras in the shower head at my university, so I stopped showering. After a while I managed to build up the courage to shower again but would shower in my underwear.
"From there I was trying to rebuild my routine around hygiene but had recently been through trauma around the time I turned 19. That brought up other traumas I'd been through and I convinced myself that if I was dirty and smelly, and I looked like I wasn't clean, I wouldn't get hurt again. That seems really ridiculous now because people don't hurt you sexually because you're clean, but my brain was trying to find any way for me to feel protected.
"I would go months and months without washing or brushing my teeth – I can't remember the longest I went but I know I went at least six months. But because the whole point of it was to be dirty and smelly, I couldn't even allow myself to wear deodorant or chew gum or use baby wipes. So all the things that people suggest you do when you don't have the energy or motivation to shower didn't work for me because those were just as scary.
I convinced myself that if I was dirty and smelly, and I looked like I wasn't clean, I wouldn't get hurt again.
"It wasn't really until I started to process some of the trauma more that I was able to start challenging myself with hygiene. And when I met my partner she made me feel safe. I didn't feel like she was going to hurt me, which made me want to be clean for her. But in pushing myself more and dealing with the anxieties, there was now room for the difficulties around the sensory part of showering.
"I don't really know where my sensory issues stem from – I'm not sure if it is completely trauma-based because I have a lot of traits of autism but I also have so much trauma in my life and there's so much overlap between complex PTSD and autism. The best way I can describe how the bristles [of a toothbrush] and the mint [of toothpaste] make me feel is like when some people cringe and wince at the sound of a knife scraping across a plate or nails on a chalkboard. You can feel in your entire body that this feeling isn't okay and you need to avoid it because it causes you so much discomfort. But because you can’t avoid it or make it stop, the panic sets in. Brushing your teeth is something you have to do twice a day for the rest of your life and that's really hard to deal with when it's something that causes you such distress. Now I’m pushing myself, I brush my teeth around two or three times a month and shower far more regularly than I used to.
"It really affects my daily life. Not washing or brushing my teeth is so ingrained that it’s normal for me now, so trying to make all these hygiene habits regular is genuinely hard. My mum or my fiancée will prompt me or give me physical help because I also deal with chronic pain and fatigue. You lose a bit of independence when you're having to retrain your brain completely to add things back into your day that come so naturally to everyone else. It's almost like you're a toddler again, learning how to look after yourself in such basic ways.
"Also, it can be really embarrassing. These things are expected of you and there's so much stigma around having poor hygiene as a result of mental illness or being neurodivergent. People don't talk about it as much because of that stigma and so when they do, they often get a lot of criticism, which makes it more stigmatised.
"I think the shame around it comes from so many different aspects: the patriarchal beauty expectations to look and smell amazing and constantly be at your best; classism and assuming that people who are visibly dirty or smelly are poor or they can't afford to look good and smell good; racism and the assumption that many Black hairstyles, for example, are 'unclean'; ableism and people automatically assuming that if you don’t 'look' disabled, you’re physically and mentally able. And that shaming just makes it all worse.
"It comes down to the fact that if that person you’re judging is a stranger, there could be a whole host of reasons why their hygiene routine doesn't match yours, ranging from disabilities to religion to culture to class and upbringing, even down to being abused. The only people you need to worry about are yourself and those you're responsible for. But a lot of people feel like they have a right to share their opinions on everything and judge you. Ask yourself: if you wouldn't say this to someone's face, why would you say it on social media?"
If you’re struggling to manage your hygiene and want to make changes, Dee recommends seeking support and pushing back against the idea that you are lazy and careless. "Many therapists specialise in these areas and can help you to understand your emotions and develop coping strategies. Speaking to your GP is often a good first step." She adds: "There are plenty of regulated organisations, support groups and bloggers who have the same experiences too, so engage with them when you can."
As for harm reduction, Dee recommends taking it one step at a time if the pattern feels impossible to break.
"If you find many things related to hygiene unpleasant, expose yourself slowly by reintroducing one at a time. Once you feel comfortable with it, introduce another. If today you managed to clean your teeth once, that’s a win and a step in the right direction. Check in when you have done it and see how it feels now, over time this will slowly get better."
"See time patterns as brief moments – in reality these acts of hygiene do not take long but your head will be fearing they will last for ages. Take note of how long it actually took and build the pattern that one brief action at a time can become."
For more tips on harm reduction, speak to your GP or therapist. Rayne Fisher Quann also has some great advice here.
If you or anyone you know has experienced sexual or domestic violence and is in need of support, please call 1800RESPECT (1800 737 732), the National Sexual Assault Domestic Family Violence Service. If you or anyone you know is experiencing depression or anxiety, please contact Lifeline (131 114) or Beyond Blue (1300 22 4636). Support is available 24/7.
This interview has been edited and condensed for clarity.