Contamination OCD

Contamination OCD is one of the more common subtypes of OCD, and there are many different symptoms any individual person can experience. They could either fear contracting a specific disease or illness (e.g., botulism) or fear contamination in general. Some physical compulsions include excessive hand-washing or showering, avoiding crowded spaces, using hand sanitizer excessively, or frequently changing one’s clothes. Excessive research is another compulsion, and a person may spend hours online looking up disease, bacteria, and how to prevent contamination. For example, they may spend an entire night researching the potential of getting food poisoning and become convinced their last meal will make them sick, despite no physical symptoms. Sufferers may avoid situations or people. They might leave garbage in their home due to fear of becoming contaminated while disposing of it, or spend hours making a mental list of what is clean and what is dirty. (e.g., I let my friend use my pen, and I touched the pen when she gave it back to me, and now everything I touched is dirty). People with contamination OCD may also experience fears of emotional contamination. For example, a person may fear that thinking or speaking about an illness will contaminate them. They may avoid talking about someone they know is sick because they are afraid any mention of this person will contaminate others. They might fear watching a movie or reading a book about someone ill will make them sick.

People with contamination OCD are driven to know whether something is contaminated with 100% certainty. As long as even a tiny fraction of doubt remains, the obsessions and compulsions will continue. Even when it seems a compulsion has effectively relieved their anxiety (e.g., I just washed my hands 10 times, so now I finally know I’m clean), it’s only a matter of time before more obsessive thoughts arise.

Contamination OCD ERP therapy

The best course of treatment for contamination OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. The idea behind ERP is that repeated exposure to obsessive thoughts, without engaging in compulsions, is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety.   ERP is considered the gold standard for OCD treatment and has been found to be effective for 80% of OCD patients. The majority of patients experience results within 12-20 sessions. As part of ERP therapy, you will track your obsessions and compulsions and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective, and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.

Examples of contamination OCD ERP exposure  

Let’s say you struggle with contamination OCD and feel that you cannot allow anyone to enter your living room for fear that a guest will contaminate the space. This compulsion has become painfully isolating, and it prevents you from hosting friends and feeling close to the people in your life. You may truly want to host a friend, but the fear of contamination prevents you from being able to.  With a therapist, you’ll work toward overcoming the compulsion to keep your living room off-limits so that you’re able to host people in your space again. At first, you might think, “I can’t have anyone over. That’s impossible. I’ll do anything but that.” If an exposure feels too overwhelming to start with, you’ll work with the therapist to find the right intensity for you. Perhaps inviting a friend is too scary to start, but bringing an object you deem to be contaminated into your living room is still more manageable.   Once you choose a plan, you’ll work with your therapist on the emotions that come up during the exposures. They may bring up many of the fears you’ve been trying to alleviate with your compulsions (e.g., What if I bring an object into my space and my whole living room becomes contaminated?). However, when you realize your worst fears aren’t actualized through these actions, you’ll start to become more comfortable with the uncertainty and anxiety driving your compulsive behaviors. With practice, you’ll find the intense need to engage in your compulsion will wane and you reach a point where you can invite friends over without fear.

How to get help  

Contamination OCD may be tricky to diagnose because oftentimes the symptoms are not visible to an outside observer. For example, a person may engage in mental compulsions around contamination (like repeating statements to themselves) as opposed to physical compulsions. However, a mental health professional who specializes in OCD will be able to make an accurate diagnosis. If you’re interested in learning about contamination OCD and how it’s treated with ERP, you can schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live face-to-face video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment.