Contamination OCD is a subtype of Obsessive Compulsive Disorder that focuses on cleanliness, emotional safety, and feeling “just right.”
If there were ever a “flagship” subtype of Obsessive Compulsive Disorder (OCD), Contamination OCD would, without a doubt, be it. Contamination OCD is by far the most commonly portrayed OCD subtype in text books and popular culture, and is the manifestation most closely associated with Obsessive-Compulsive Disorder.
Like all other sub-names for OCD (like HOCD, Harm OCD, Scrupulosity, etc.), the term “Contamination OCD” is a colloquial title used as shorthand for the general themes and compulsions that make up someone’s symptoms. While these names can be helpful to the OCD community for discussing and web-searching their particular symptoms, they still miss some finer nuances.
Disease and Illness– focus on catching an illness from a particular contaminant and suffering and/ or spreading an illness to a loved one. Can involve food, mold, and bodily fluids, just to name a few.
Disgust– aversion to contamination is focused solely on the uncomfortable feeling one gets when encountering, or even thinking about, a contaminant. This can be both sensory or emotional disgust.
Environmental– excessive concern with real or perceived chemicals and toxins one encounters in the course of living life.
Magical-Thinking– superstitious beliefs about colors, numbers, actions, people, or words.
Contamination OCD Symptoms
Contamination OCD can take on many forms, but follows the same anxiety cycle as all other manifestations of anxiety and OCD. That said, the feared story (obsession) associated with contamination can vary from person to person and have a wide range of perceived consequence and resulting compulsions.
Contamination OCD Obsessions Can Include:
- “If I don’t wash my hands enough, then I could get sick.”
- “What if I touch something dirty and get my child sick?”
- “What if the chemicals in my food can cause cancer or hurt me?”
- “If anything makes me sick, then I won’t be able to do my job or live the life I want.”
- “What if I become my room mate?”
- “I can’t be around anything blue or I’ll catch malaria.”
- “I might die if I catch the flu.”
- “I feel dirty when I’m around fat people.”
- “Touching garbage cans are gross.”
- “I can’t stand it when my hands feel yucky and sticky.”
Contamination OCD compulsions can include:
- Excessively using hand sanitizer
- Repeatedly washing hands
- Mentally monitor all the touched surfaces
- Keep track of things that have been “cross contaminated”
- Ritualistic house cleaning
- Rigid showering and changing clothes routines
- Avoiding public places
- Avoiding making direct contact with handles (doors, gas station pumps, hand rails, etc).
- Scrutinizing the cleanliness of seats before sitting
- Using napkin or paper towel to open doors
- Avoidance of certain people, items, colors, number, etc.
- Avoidance of items perceived to contain “chemicals” or “toxins”
- Excessive research on product ingredients
- Requiring loved ones to follow rigid cleaning rituals
- Avoiding “contaminated” items or locations
- Disposing of items perceived to be dirty or contaminated
Typical or Excessive?
Many people have the question about whether their concerns about contamination are typical , or whether they are excessive and beyond that of the average person. At the time I am writing this article (late March of 2020), the world’s attention is fixated on the Coronavirus pandemic, which is leading many to search for information on “Coronavirus symptoms”, “How to wash your hands”, and “Am I safe from COVID-19.” These searches, as well as the hysteria with buying surgical masks, toilet paper, and hand sanitizer is being done, in the overwhelming majority of cases, by people who do not have a diagnosable contamination obsessions. In other words, “normal people.”
People, not just people with OCD, are concerned about their health and the health of their loved ones. All people want to be healthy and be sure that their family will be healthy. Therefore, we must conclude that to a certain degree the concern about whether you have been exposed to a contaminant that could affect your health will draw your attention. Furthermore, and the argument I hear most often from my clients, “why not be safe than sorry?”
As with all OCD subtypes, the primary determining factor in whether your concern with contamination and cleanliness tips the scales into a diagnosable concern is whether the obsession or response causes you emotional pain, negatively impacts your social life, gets in the way of your ability to do your job, or is otherwise beyond what you would like it to be. When we become overwhelmed by our thoughts and feelings, and feel that we have to clean, wash, avoid, or check beyond what we want to do or rationally see as appropriate, then a typical desire for cleanliness and safety has become excessive and should be addressed with therapy.
Contamination Treatment in the COVID-19 Pandemic
The goal of OCD treatment is for clients to develop a more sustainable way to interact with the world while taking the same reasonable risks as the average person. This of course takes into account the level of risk in a given environment. If someone is afraid of drinking tap water due to a fear of potential contaminants, the reasonableness of this concern greatly depends on whether they are in Los Angeles, Detroit, or a third world country. In other words, treatment takes genuine risk into account. Since COVID-19 appeared on the world stage, we understand that we are no longer living in a 2019 world. Therefore, new precautions must be considered.
That said, OCD treatment, at its core, has not changed. Treatment for Contamination OCD still involves taking risk. These risks address the perceived risk of resisting compulsive behavior. For example, if in a world with no specific or immediate health threat (like most of the world pre-COVID-19) someone with Contamination OCD may typically wash their hands 30 times per day for 2 minutes each as compulsion. Treatment for this would likely involve working toward touching door knobs, water tap handles, and trashcans without washing their hands at all. However, given the current Coronavirus threat, treatment would involve following the CDC health guidelines as prescribed and resisting excessive washing above the recommended amount. Currently, people are being advised to wash for 30 seconds after touching common surfaces. So, the focus of treatment is on tolerating and resisting the urge to wash more than the recommended amount.
Once a vaccination is developed and the CDC changes their recommendation, treatment will likely be readjusted. However, despite the presence of COVID-19, the aim of treatment has not wavered; resist excessive and unnecessary urges to wash, clean, seek reassurances, and/or avoid.
Contamination OCD Therapy
Treatment for Contamination OCD will involve the use of Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and Mindfulness-based approaches like Acceptance and Commitment Therapy (ACT). Together, these approaches help clients challenge their exaggerated and often irrational interpretations of safety and health. Through continued exposure to their fears, along with resistance to unnecessary cleaning or reassurance seeking behavior, the feeling of anxiety slowly reduces and the client begins to develop greater comfort and confidence with a new relationship to the world around them.
CBT for Contamination OCD
Cognitive Behavioral Therapy is the core approach used to treat all manifestations of OCD and anxiety. Simply put, CBT works by addressing the interaction between our thoughts (cognitions) and our actions (behaviors). Thoughts influence action, and if the thoughts are catastrophic, bazaar, or twisted, then the resulting actions will be similarly hyperbolic. The first step in treatment is to consider the truthfulness of the feared story and whether the fear is based in a generally accepted and supported rationale. Often, it is not. Instead it is based in over-blown or highly improbable logic. Once the fear can be challenged, and a grounding in more rational thinking can be established, then the client and therapist work together to face the fear through exposure therapy.
ERP for Contamination OCD
Exposure and Response Prevention (ERP) is a behavioral technique that provides a structure to facing fear. There is no other method as effective as ERP to help reduce anxiety in the long run. As clients face their fear, their Sympathetic Nervous System (fight, flight, or freeze response) kicks in as a way to protect them from a perceived danger. However, if the tiger they are responding to is actually a tabby cat, then the feared response is unwarranted.
After developing a list of fears and compulsive responses, the therapist and client work together to develop exercises in which the client practices facing their fear without engaging in their compulsive cleaning ritual, avoidances, or reassurance seeking behavior. While they will initially feel anxious thanks to their fight, flight, or freeze response, their brain will eventually see that no danger is coming and the level of anxious response and compulsive behavior is excessive.
At this point, a two things may happen: 1) the Parasympathetic Nervous System kicks in to bring the level of emotional distress back down to normal and/ or 2) the client learns that the feared outcome likely won’t happen and they can therefore pay less attention to their feared thought. Either way, through repeated exposures, clients stop following through on their compulsive urges and start living their life.
ACT for Contamination OCD
Throughout treatment, mindfulness-based techniques found in Acceptance and Commitment Therapy help clients develop the understanding and confidence that their life does not need to be ruled by fear, and that they can accept the presence of unwanted thoughts and non-ideal circumstances. In short, we can accept that we have unwanted internal experiences (thoughts, feelings, etc) and unwanted external experiences (chemicals, germs, etc) as part of life. Unfortunately, it’s wrapped up in the human experience. But, we can decide how much power those things will have over how we live our lives because we are not the content of our thoughts and feelings.
Client’s never say “I love my washing and cleaning regimen! Showering for 3 hours and periodically soaking my hands in bleach is the joy of my life!” The Commitment piece of ACT is aimed at helping clients recognize that compulsions are not part of their ideal life, but is a compromise for short term comfort. ACT helps clients begin to take steps toward their most ideal and preferred life, which generally excludes compulsive behaviors.
For more information about Contamination OCD, or would like to schedule a session, please contact me.
The California OCD and Anxiety Treatment Center offers specialized therapy for Contamination OCD in its Fullerton offices. In addition to serving North Orange County, Los Angeles, and the Inland Empire, CalOCD offers online therapy, group therapy, and Intensive Out-Patient treatment.