Fears about drinking water

What is OCD related to the fear of drinking water?

A person with OCD centered on fears related to drinking water may be concerned that any water they drink could hold harmful contaminants. Feared contaminants could be anything, including metals, toxins, pollutants, chemicals, or waste that is improperly filtered. In OCD, these worries and fears cause distress and anxiety, often involving rumination on the worst-case scenario of ingesting contaminated or impure water. Someone with this form of OCD may go to great lengths in an attempt to avoid drinking water, especially tap water or water that they feel may not meet the strict standards they attempt to follow.  These intrusive thoughts, images, or fears about drinking water are called obsessions. In response, people with OCD will perform compulsions, which can be mental or physical acts that serve to neutralize uncertainty or worry about the water they drink, or serve to prevent a feared outcome associated with drinking water.  People with this form of OCD may frequently research potential contaminants found in water and excessively check the levels of various chemicals in their tap/drinking water. They may also worry about unintentionally swallowing small amounts of pool or lake water and experiencing harmful effects as a result.  On the other hand, someone experiencing fears of drinking too much or too little water may be experiencing health-themed OCD. They would likely be concerned about the negative effects of drinking too much or too little water, and how under-hydration or over-hydration could impact their health.

Fear of drinking water – Common obsessions

• What if I am not drinking enough water?
• What if I am drinking too much water?
• How do I know if I am hydrating properly?
• What if I drink too much and die?
• What if I drink too little and get sick?

Common triggers

People with fears about drinking water that may be contaminated may be triggered by situations involving drinking water from unknown sources, such as at a restaurant or a friend’s house. They may avoid drinking water served from anything unfamiliar, or avoid anything other than bottled water. They may carry their own water bottles with them wherever they go. They may refuse to drink from a tap. They may avoid swimming in lakes or pools so that they do not unintentionally digest any unclean water.

Triggers for people who are afraid of drinking tap water or other water may include:

• Drinking water from restaurants
• Drinking tap water
• Swimming in a pool/lake
• Drinking tap water
• Seeing impurities or particulates in water
• Drinking water from a glass that may be unclean
• Hearing about contaminated water
• Hearing about communicable disease

Individuals who have concerns that they may be drinking too much or too little water may be triggered by:

• Feeling dehydrated or overly hydrated
• Feeling like they are full or have drunk too much water
• Hearing about health effects of over-hydration or under-hydration
• Hearing about the negative effects of dehydration
• Noticing the color of their urine

How can I tell if my fears are a sign of OCD, or if they’re healthy levels of caution and health concern?

This is an excellent question. To know if you may be suffering from OCD, you need to learn to recognize the OCD cycle.

The OCD cycle is composed of: 1) intrusive thoughts, feelings, images, or urges; 2) anxiety or distress that comes as a result; 3) compulsions performed to relieve distress and anxiety. Understanding this cycle can help you distinguish OCD from other conditions. Something to keep in mind is that if you are feeling an intense urgency to know something immediately and with certainty, yet you cannot feel lasting certainty, that is a red flag that OCD may be at work.

Intrusive thoughts or doubts about cleanliness and contamination can and do happen to everyone. Most people who do not have OCD feel these doubts only in response to specific reasons (like seeing visible impurities in water), are able to brush these thoughts off rather easily, or trust in their own decisions and intentions. However, people with OCD struggle to do this, believing that they cannot tolerate the slightest uncertainty about the safety of the water they are ingesting. They may also worry about the health implications associated with too much or too little water intake. 

This is where OCD holds its power—100% certainty about water purity or perfect hydration levels is impossible to achieve. People with OCD focused on a fear of drinking water can get better by learning that they can tolerate uncertainty about the water they drink, just as they do in other areas of their lives. The same is true for people who worry about drinking too much or too little water—they can learn to tolerate distress associated with these fears, and live more comfortably with their doubts.

Common compulsions

When people with fears of drinking contaminated water experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in compulsions, which are physical or mental acts done to alleviate the distress and discomfort caused by intrusive thoughts or fears. Compulsions may provide temporary relief, but do nothing to keep obsessions from returning again and again, with an even stronger urge to perform compulsions. Performing compulsions inadvertently strengthens obsessions and fears, reinforcing the idea that obsessions posed an actual threat or danger.

Compulsions performed mentally or physically by people with fears of drinking contaminated water may include:

• Avoiding drinking from sources of water they are not in control of
• Excessively researching their particular community’s water safety
• Seeking reassurance from others, particularly health professionals
• Drinking only from a particular brand of water that they feel is safe
• Excessively checking labels on water bottles
• Excessively filtering all sources of drinking water
• Disposing of water that has been out for short periods of time
• Covering all cups or glasses between drinks

When people have fears of drinking too much or too little water, they may engage in some of the following compulsions:

• Keeping rigid schedules or lists surrounding water intake
• Keeping track of the amount of water in various food items as well as drinks
• Excessively calculating their water intake
• Research online health impacts of water intake
• Scanning body for any sense of unwellness

How to treat fear of drinking water

Fears of drinking water that could be impure or drinking too much or too little water can be debilitating, but these fears are highly treatable. By doing exposure and response prevention (ERP) therapy with an OCD specialist, you can find freedom from the OCD cycle. 

ERP is the gold standard of treatment for OCD and many other anxiety disorders. It is backed by decades of clinical research proving its effectiveness and shows promising results within 12-25 sessions on average. By doing ERP, you can learn effective ways to accept uncertainty and sit with anxiety and discomfort.

In ERP, you’re gradually and safely exposed to the thoughts and situations that are likely to trigger your fears about drinking water. With your therapist’s guidance and support, you will resist the urge to respond with compulsions like avoidance, washing, and checking. By doing this continually over time, you learn that you are able to tolerate anxiety, and you will feel more confident in your ability to sit with uncertainty and discomfort. In time, anxiety about drinking water, as well as the compulsions you do as a result, will interfere with your life and choices less and less.

Examples of possible exposures done to treat a fear of drinking water that could be contaminated may include:

• Drinking from the tap
• Drinking from the same glass twice in a row
• Reading or hearing about people who have drunk contaminated water
• Writing a script about the worst-case scenario of ingesting contaminated water 
• Watching movies involving contaminated water, like Erin Brockovich

Examples of possible exposures done to treat a fear of drinking too much or too little water may include:

• Writing a script about the worst-case scenario of ingesting too much or too little water 
• Reading about dehydration
• Going throughout the day not keeping track of water intake
• Hearing about cases where someone did drink too much water
• Drinking one “too many” or “too few” glasses of water

If you’re struggling with OCD, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. 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.

We look forward to working with you.