Dear Dr. Michelle:
We have a daughter that is 23 years old that has returned to live with us. We cared for her when she was a young teen as a foster child, but we have always considered her to be our own daughter. She had a long history of abuse and neglect as a child and as a result has had a difficult time. She has been diagnosed with bipolar disorder and depression, but she seems to do better when she lives with us because we provide a consistent environment. We love and care about her very much and we will always be there for her.
The concern we have is that she does not take very good care of her hygiene and does not keep herself clean. When she was younger, we were able to manage this, but now that she is an adult, we cannot parent her the same way. Even though we try to encourage her to keep herself clean, she does not seem to understand how bad it is and how it affects those around her. How should we handle this situation?
Thank you, Donnie and Shannon
Dear Donnie and Shannon:
Thank you both for being foster parents. The world needs more people like you to open their homes to children in need. It is also wonderful to hear that your daughter has remained an important part of your family and that you continue to care for and love her. I am sure that you are right - your consistency is probably very good for her and helps her feel safe and loved.
It is not uncommon for people who have experienced childhood trauma (abuse and neglect) to have issues related to hygiene. This can also be true for those struggling with mental health concerns, particularly when the mental health is exacerbated by childhood trauma.
Why People Disconnect Themselves
When experiencing trauma, it is natural for a child to learn to disconnect from themselves, both physically and emotionally. What this means is that sometimes victims of trauma can lose awareness of their physical body and may not feel physical sensations or they may avoid experiences that will result in feeling physical sensations. This type of disconnection can develop as a resiliency response, or protective factor for someone going through abuse.
A negative effect of disconnection from one’s physical body is that a person can also disconnect from their sense of smell and comfort as it relates to their own body. Not only can this impact a person’s motivation to maintain good hygiene, but the actual practice of proper physical hygiene requires one to be comfortable feeling physical sensations related to showering, brushing teeth, and changing one’s clothes. These types of activities can make a person very vulnerable and exposed, and when childhood trauma has occurred, being physically vulnerable has never been safe. As a result, the person may avoid such activities as much as possible.
How To Address Hygiene Issues
There are several recommendations I would make for addressing the hygiene issues. Start by dealing with it directly and talking to your daughter. Make sure the person who has this conversation with her is the same gender parent to lessen the embarrassment. In your case, this means that Shannon needs to be the one to initiate this conversation. It seems that your daughter trusts you both and is open to your help. She will likely be open to hearing feedback, particularly when it is done in a loving and sensitive way. Make sure your tone is supportive and soft. Avoid shaming, embarrassing, or lecturing her. The conversation should be informative and educational.
In having this conversation, talk to your daughter about the fact that other people can smell and observe the effects of her hygiene (dirty hair, soiled clothing, dirty teeth, bad breath). Explain the importance of good hygiene and that sometimes it is necessary to do things to make other people comfortable even if we don’t need it for ourselves. Try to impress upon her their discomfort is being able to smell her.
Take note that your daughter might be able to smell her own body odor but has simply grown accustomed to it. If this is the case, it will require you to educate her that the odor she is smelling on herself is the odor that is the problem.
It is typical for those with hygiene issues to think that standing under water is enough to constitute a shower, but we know proper hygiene includes more steps. Therefore, another part of the conversation might need to include explaining each step involved in taking a proper shower (wash hair, clean ears, and use a lot of soap on the entire body). Even if you think she knows this information, repeating it will ensure that she understands. I would also suggest walking through the steps for oral hygiene. Explain how to floss, how to use mouthwash, how to properly brush one’s teeth and that brushing should happen two times a day.
How To Support Practicing Good Hygiene
To support her in practicing good hygiene, there are additional steps you could take to assist. I would recommend you pay for the shampoo, conditioner, soap, toothpaste, and mouthwash. Consider getting a scented body wash and a body scrubby. Let her pick out the color of the scrubby and her favorite scent of body wash as well as the brand of shampoo/conditioner so she is actively involved in taking care of herself.
Consider doing her laundry instead of relying on her to do it. To ensure it is getting done properly, you will want to request that she gather her clothes and bring them to the washer. You could wash and dry them and then have her help you fold them and put them away. This suggestion might seem absurd and off-putting – we usually want to encourage our adult children to be self-sustaining and expect them to do their own laundry. However, your daughter has endured some experiences that call for a different level of intervention.
Another step you can take to support her proper hygiene would be to have certain rules in the house. Parents have the right to set basic ground rules in the home, particularly for returning adult children. The rules I am suggesting would be related to keeping her bedroom clean. Set the expectation that she not eat in her room, that you must be able to see the main floor of the room at all times (which will encourage things to be picked up and put away) and that she allow you to wash her sheets once every 1-2 weeks (her part can be to strip the bed and bring the sheets to the washer upon your request).
To encourage her to practice these hygiene activities, think about a special way to reward her for taking the proper steps – such as agreeing to treat her to her favorite restaurant a couple of times a month. Establishing a reward can reinforce proper hygiene behaviors and in this case lead to a special outing where she can be around other people and treat herself to a nice meal.
Finally, if your daughter’s trauma is affecting her hygiene habits, then it is likely that she has not fully addressed her trauma, and in doing so will not only be good for her physical health, but for her emotional and mental health as well. I would recommend your daughter go to therapy with a licensed therapist that has experience treating trauma. If she is already receiving counseling, seek your daughter’s permission to go to one or two therapy sessions with her and utilize the help of the therapist to talk about the hygiene problems. If that is not possible, then encourage your daughter to talk about the hygiene issue with the therapist on her own. When physical disconnection from one’s body is an issue, a properly certified therapist can do what is called exposure therapy to help your daughter get more comfortable with physical and smelling sensations.
Dear Dr. Michelle blog posts are informational in nature. The posts are not meant to take the place of consulting your physician, mental health professional, or other qualified health providers regarding your well-being or the well-being of others.
