Contamination OCD: Symptoms and Treatment

Josh Kaplan, MSW, LCSW

Josh Kaplan, MSW, LCSW

August 17, 2020

Contamination OCD is a common OCD subtype in which a person obsesses over contracting an illness or spreading germs. These intrusive thoughts cause the person serious anxiety and distress, which they try to relieve with compulsive behavior, like excessive washing or avoiding crowded spaces.

Here are two examples of what Contamination OCD can look like:

Example 1: A woman struggles to use a public bathroom.

Sandra is shopping at the grocery store and has to use the bathroom. The realization that she will need to use the public restroom triggers an onslaught of obsessive thoughts about germs and illness. She feels intense fear and dread upon entering the restroom. 

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 the thorough wash, Sandra struggles to cope with the uncertainty that her hands may remain contaminated. She returns to the sink and washes once more this time up to her elbows. Upon leaving the restroom she still feels uncertain that her hands are completely clean. In order to relieve the doubt, Sandra ends up washing and sanitizing periodically for the next hour. Her hands appear chapped and sore, and a quick shopping trip has turned into a long ordeal.

Example 2: Frank is overwhelmed by fears of contracting AIDS.

Frank is drinking coffee at his local cafe. He notices a small red-colored stain on the table he is sitting at. 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 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.

Fear of Germs

What are the Symptoms of Contamination OCD?

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. 

People with Contamination OCD become preoccupied with fears of illness, germs, and dirt. They can spend hours dwelling on these fears on a daily basis. Common 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, semen;
  • Fear of germs, toxins, radiation, dust, dirt;
  • Fear of getting contaminated by germs or getting sick;
  • Fear of more magical or illogical forms of contamination such as another person’s negative emotions, breath, or bad luck.

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 of items deemed contaminated;
  • Repeatedly changing clothes;
  • Using harsh chemical cleaners on one’s skin;
  • Scraping off skin the person thinks might be contaminated.;
  • Excessive researching of germs, illnesses, and ailments;
  • Magical rituals such as praying, knocking, repeating, or thinking certain thoughts.

Compulsions can also take the form of avoidance and reassurance-seeking in an attempt to reduce fear and suffering. A person 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.

How Does Contamination OCD Affect a Person’s Life?

OCD is often mistakenly used as an adjective to describe someone who is simply clean, neat, and tidy.  

This is a misconception because it misses several key elements that make Contamination OCD a chronic, debilitating condition – not a character trait. 

The fears and thoughts of a person with Contamination OCD tend to be illogical and irrational. Minor risks may seem like imminent disasters. 

Because of this disproportionate thinking, that person engages in intense compulsive behavior aimed at reducing the perceived risk. For example, they may fear that touching a doorknob will result in contracting a deadly disease. In order to avoid touching doorknobs, therefore, they may avoid leaving their house altogether. Even then, they may begin engaging in excessive washing even while staying home. Irrational fears lead to excessive routines and actions.

The fear of contamination does not simply go away once the person has carried out appropriate washing or prevention. As with all OCD themes, the compulsive attempts to reduce anxiety are not effective long term solutions. These obsessive thoughts are recurrent, coming back over and over.  

In fact, 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 a person with Contamination OCD. The condition may lead to difficulty holding down jobs, maintaining relationships, and even simply leaving the house.

Excessive washing and cleansing can also result in health concerns and actually increase the risk of illness and infection. In more severe cases, an individual may no longer leave their home at all. 

A happy woman after getting treated from Contamination OCD

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 over 80% of patients respond favorably to ERP therapy. 

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. 

In the case of Contamination OCD, ERP therapy might focus on gradually exposing patients to the “contaminant” they fear while assisting them in resisting the urge to perform compulsions, like excessive washing. 

Throughout this process, the patient’s obsessions and compulsions decrease, their anxiety improves, and the patient returns to a healthier level of living. In addition, the patient learns to accept the uncertainty and inherent risks of everyday life. 

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 get more informed. 

You can get started with personalized, face-to-face ERP therapy by scheduling a free phone call with the NOCD team.

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