Nearly everyone has heard somebody exclaiming that they’re “so OCD” because they like a tidy house, or because they wash their hands before every meal. But as a doctor who treats Obsessive-Compulsive Disorder (OCD), I can tell you that a preference for organized closets and frequent hand-washing doesn’t necessarily add up to a clinical diagnosis. While some of these stereotypical symptoms may actually be involved in some people’s experience with OCD, they tend to be quite distressing—not innocuous or quirky—and they’re far from the whole story.
First, let’s define Contamination OCD. Contamination OCD is a common OCD subtype in which a person obsesses over contracting an illness or spreading germs. Intrusive thoughts, fears, or images related to these topics cause the person serious anxiety and distress, which they try to relieve with compulsive behavior, like excessive washing or avoiding crowded spaces.
While there are many ways that Contamination OCD can manifest, here are two examples of what it can look like:
Example 1: Sandra struggles to use a public bathroom.
Sandra is shopping at the grocery store and has to use the bathroom. Realizing that she’ll need to use a public restroom triggers a flood of obsessive thoughts about germs and illness. She feels intense fear and dread upon entering the bathroom.
In an attempt to reduce her anxiety and prevent contamination, she carefully avoids contact with the door handle, toilet, and sink. After using the bathroom, she washes her hands aggressively for several minutes until she “feels clean.”
Despite all this, Sandra struggles to cope with the uncertainty that her hands may still be contaminated. She returns to the sink and washes again, this time up to her elbows. Upon leaving the restroom, she still feels uncertain that her hands are completely clean. To relieve her doubt, Sandra ends up washing and sanitizing periodically for the next hour. Her hands appear chapped and sore, and a quick shopping trip has become a long ordeal.
Frank is drinking coffee at his local cafe. Suddenly, he looks at his table and is struck by fear when he notices a small blood stain—or maybe it’s only wine or jelly. Frank suddenly feels intense anxiety and starts to worry about contracting a disease. He thinks to himself, “Is that blood? Did it get in my coffee? Did it get on the mug? Is it on my hands now? Is it on me? Am I going to get sick? Will I get HIV?”
Frank quickly leaves the coffee shop feeling overwhelmed. He returns home and begins to engage in several compulsions.
First, he removes his clothes and places them in a plastic bag. Rather than risk spreading the contamination by washing the clothes, Frank decides that it’s safer to just dispose of them altogether.
He then showers and aggressively washes his body. Once he feels clean, he puts on new clothes. Frank then begins to worry that the bottoms of his shoes may have somehow been contaminated with blood as well. He attempts to retrace his steps washing the floor where he had walked.
Frank spends the next several hours researching HIV online and can’t stop obsessing that he just might have gotten blood on him and will eventually contract the disease.
What are the Symptoms of Contamination OCD?
Now that you have an idea of how Contamination OCD can show up in someone’s life, you may be wondering what the symptoms of Contamination OCD look like.
All types of OCD include obsessions and compulsions. Obsessions can come in the form of unwanted and intrusive thoughts, feelings, urges, and doubts, while compulsions are repetitive physical or mental actions connected to those obsessions.
Common Obsessions in Contamination OCD:
People with Contamination OCD become preoccupied with fears of illness, germs, and dirt. They can spend hours dwelling on their contamination fears on a daily basis. Common contamination obsessions include:
- Fear of contracting STIs, developing cancer, or otherwise becoming ill;
- Fear of spreading illnesses and contaminants to others;
- Fear of bodily fluids, including blood, saliva, and semen;
- Fear of germs, toxins, radiation, dust, and dirt;
- Fear of getting contaminated by germs or getting sick;
- Fear of more magical or emotional contamination, such as someone else’s negative emotions, eye contact, or bad luck.
Common Compulsions in Contamination OCD:
In response to these fears, people with OCD engage in various compulsions in the hope of reducing anxiety and cleansing themselves of any contaminants. People with Contamination OCD may engage in compulsions for hours every day. Common compulsions include:
- Excessive and repetitive hand washing, showering, and cleaning;
- Separating contaminated items from non-contaminated items;
- Discarding items deemed contaminated;
- Repeatedly changing clothes;
- Using harsh chemical cleaners on one’s skin;
- Scraping off skin the person thinks might be contaminated;
- Conducting excessive research on germs, illnesses, and ailments;
- Employing magical rituals such as praying, knocking, repeating, or thinking specific thoughts.
Compulsions can also take the form of avoidance behavior and reassurance-seeking in an attempt to reduce fear and suffering.
How Can Contamination OCD Affect Your Life?
Despite the way some people talk about “being a little OCD,” the reality is that OCD is a chronic, debilitating condition—not a personality trait. As such, Contamination OCD can impact many areas of your life.
Since the fears and thoughts of someone with Contamination OCD tend to be illogical and not based in reality, there’s no such thing as a “minor risk.” Instead, life revolves around avoiding what is perceived to be a potential imminent disaster.
Take something like fear of touching a “dirty” doorknob, for instance. If you think you might catch a deadly disease simply by putting your hands on a contaminated door, you might avoid leaving your house. Even if you stay home, you may engage in excessive hand-washing. In other words, there can be a tickle effect, where irrational fears less to excessive (and often debilitating) routines and behaviors. Remember that the fear of contamination does not simply go away once the person has carried out “appropriate” washing or prevention. As with all types of OCD, compulsive attempts to reduce anxiety are ineffective long-term solutions. These obsessive thoughts are recurrent, coming back over and over.
Someone with Contamination OCD might avoid specific people, places, and things they think might be contaminated. In more severe cases, they may even avoid spouses, family, and friends. People with Contamination OCD often seek the reassurance of others, repeatedly asking for confirmation that something has been cleaned properly.
The more a person engages in the obsession-compulsion cycle, the stronger the Contamination OCD can become. The more they wash and avoid, the more the fear of contamination grows. The more they wash, the more they need to keep washing. The more they avoid, the more they must keep avoiding. OCD plays a tricky game, enticing the person with only small amounts of relief, only to then increase the fear and obsessions in the long run. This downward spiral can eventually take over the life of someone with Contamination OCD. The condition may lead to difficulty holding jobs, maintaining relationships, and even leaving the house.
Is Contamination OCD Treatable?
The bright side to this painful form of OCD is that effective treatment is available. A specific form of Cognitive Behavioral Therapy called Exposure and Response Prevention (ERP) therapy is the recommended treatment available for all forms of OCD. Research shows that ERP results in significant results for most people with OCD.
ERP involves exposing a person with OCD to something that will trigger their obsessive thoughts and then encouraging the person to resist performing their familiar compulsions. This allows the person to learn that their anxiety will come down on its own and that the compulsive behaviors are not necessary.
Treatment Exercise Examples for Contamination OCD
Suppose someone developed a debilitating fear of germs entering into their living space after the COVID-19 pandemic began. It’s gotten to the point that they haven’t had a guest in their home—even a family member—in over a year. Their compulsive avoidance keeps them increasingly isolated from their loved ones and the outside world. They would really like to have more social contact in their home, but they feel ruled by their fears.
Working closely with their therapist, they come up with a plan to gradually but directly face their compulsions. At the beginning they feel that having others in their space right away will be simply too distressing, so that’s not where their plan starts. Instead, they work with their therapist to bring an object from another location—like a friend’s home—into their living room, without sanitizing it first.
The next crucial part of the process involves working with their therapist to deal with the emotions that come up during the exposures. Acting directly against the compulsions that they did in an attempt to stay safe is distressing and scary, so their therapist helps to guide them through these intense emotional responses as they gradually pass-which they always do. In sitting with these feelings as they eventually dissipate, they find that they can get through the experience, that their extreme fears haven’t overtaken them, and over time, they become more comfortable with the uncertainty and anxiety that come with incrementally expanding their isolated world.
Eventually, weeks or even months later, they feel capable of inviting friends and family over while asking that they remove their shoes and wash their hands. In this way, they can free themselves from being controlled by their compulsions, feeling both in control of their safety and capable of interacting with their loved ones according to their hopes and values.
You Can Overcome Contamination OCD
From my personal experience treating OCD, people are shocked at how quickly they experience relief from symptoms once they start ERP therapy. If you or someone you know is dealing with any form of OCD, I encourage you to take steps to become better informed.
You can get started with personalized, face-to-face ERP therapy by scheduling a free phone call with the NOCD team. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. You can also join our Contamination OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.