What is Contamination OCD?
Contamination OCD is a type of obsessive-compulsive disorder (OCD) that causes individuals to obsess over the idea of being contaminated, contracting an illness, or the spread of germs. Obsessive thoughts cause distress and lead to compulsive behaviors – such as excessive hand washing or avoiding crowds – aimed at alleviating distress. All types of OCD include obsessions and compulsions. Obsessions are persistent, unwanted, and intrusive thoughts, feelings, or urges that cause excessive worry or anxiety whereas compulsions are physical or mental behaviors performed as a response to relieve or prevent anxiety. Compulsions often have the intent of avoiding some dreaded outcome such as an illness.
People with contamination OCD are focused on fears of illness and germs, and may spend many hours a day burdened by obsessive thoughts. With OCD, fears are typically excessive, out of proportion to the realistic likelihood of bad outcomes, and cause significant distress to the point they impair daily functioning.
Common Contamination Obsessions
Common contamination obsessions include:
Fear of contracting an illness such as cancer or AIDS
Fear of contracting an infection such as an STI
Fear of germs and dirt including something feeling “dirty” or being contaminated by germs (garbage, household chemicals, spoiled food, certain substances, dirty clothing, etc.)
Fear of bodily fluids
Fear of spreading illness or germs to others
Fear that certain characteristics of others, such as someone being ill, can be magically transferred by thinking about them or coming into casual contact with the person
Common Compulsions
In reaction to these obsessions, people engage in compulsions. Common compulsions include:
Excessive hand washing, showering, or cleaning one’s body which may be done in a ritualistic manner (a certain order or number of times)
Repeatedly changing clothes
Excessively cleaning one’s environment, disinfecting, or getting rid of items believed to be contaminated
Separating contaminated and non-contaminated items, or creating separate “clean” and “dirty” areas
Using harsh cleansers/chemicals on one’s body
Excessively scraping/exfoliating skin deemed to be contaminated
Certain rituals such as saying specific words or repeating thoughts to oneself in the hopes of removing or canceling out obsessive thoughts about contamination transfer
Contamination OCD Compulsions Are Not Always Noticeable
Compulsions may not always be obvious, such as excessive handwashing, cleaning or reassurance-seeking behavior like constantly researching germs online or asking others if they believe something is dirty/contaminated to decrease distress. It can also include avoidance behavior such as avoiding crowds or areas where sick people may be such as a doctor’s office and repeatedly checking one’s body for signs of contamination.
Strong emotional support and encouragement from others is generally beneficial. However, specifically in the case of contamination OCD, it is important not to constantly seek reassurance from others. It is equally important for family and friends to practice not offering reassurance, as this maintains anxiety.
Contamination OCD can greatly hinder a person’s ability to live their life freely. They can feel consumed by obsessions and associated compulsions and have difficulty focusing on tasks, completing necessary work, or engaging in enjoyable activities. When symptoms are severe, a person may experience difficulty leaving the house as they believe contaminators are everywhere – the doorknob being a common object of anxiety that is feared to be dirty.
While compulsions, such as excessive hand washing, may temporarily decrease distress, the more a person engages in these behaviors, the stronger the anxiety becomes over time and the more they believe they need to engage in the behavior. In other words, hand washing leads to more hand washing over time. A temporary decrease in anxiety is followed by an increase, and can cause a person to become trapped in an OCD cycle.
This article from the International OCD Foundation provides an overview of contamination OCD.
Treating Contamination OCD Effectively Through Exposure and Response Prevention (ERP)
Cognitive behavior therapy (CBT) is a very effective treatment for OCD. More specifically, a type of CBT called Exposure and Response Prevention (ERP), which counts as one of the most effective treatments for OCD. ERP involves exposure to, or confronting the thoughts, images, or situations that cause anxiety and provoke obsessive thoughts; response prevention on the other hand, focuses on not engaging in a compulsive behavior once anxiety is triggered.
Generally, a person with contamination OCD feels anxiety because they view an obsessive thought – “I am contaminated and will get a serious illness” – as a threat, and by gradually exposing themselves to the anxiety-provoking situation and not engaging in compulsions, they can teach their brain that the threat does not actually exist. Exposure aims to reduce anxiety through habituation. Habituation is a natural learning process where the nervous system gets used to a certain stimulus through repeated, prolonged contact with it.
For instance, a person may practice exposure by repeatedly touching a garbage can they believe is contaminated and fear that touching the can will lead them to get an illness. After exposing themselves to this perceived threat, they will then practice not washing their hands. The purpose of response prevention – i.e. not washing their hands – is to decrease the frequency of compulsions, and with repeated exposure practice, they will learn that they will not contract an illness and their anxiety decreases.
In other words, being confronted with a fearful situation without anything bad happening, you learn that your anxiety alarm is misfiring and there is no actual threat present – nothing bad has happened, your thoughts are just thoughts. You also learn that you can cope with anxiety and distress without relying on compulsive behaviors, and that the anxiety will pass too.
Exposure, Habituation, Extinction: Working Through the Steps
Along with habituation, extinction is another principle of learning that forms the basis of ERP. Consequences shape behavior. Positive consequences such as praise and attention can increase behavior and negative consequences such as punishment or criticism can decrease behavior. Another word for a positive consequence is a reinforcer. Reinforcers facilitate feelings of pleasure or contentment or decreasing unpleasant feelings such as anxiety.
Extinction is what happens when a reinforcer no longer creates feelings of pleasure or no longer reduces discomfort. When a reinforcer is no longer reinforcing, you typically stop engaging in the behavior. In the case of contamination OCD, compulsive behaviors such as hand washing strengthen or reinforce obsessive worries and fears by decreasing the discomfort caused by the obsessions. In ERP, blocking compulsions with response prevention means obsessions are not being reinforced and will eventually decrease.
If you are (or believe a loved one to be) ready to start taking the steps towards living a life free of contamination OCD, don’t hesitate to reach out to learn more about evidence-based treatments at CBT Denver.