Contamination OCD is a subtype of OCD that involves repetitive fear and worry about becoming contaminated, dirty, or sick due to certain behaviors or contact. One common focus of these fears is contracting illness by coming into contact with saliva or spit.
Fears about spit in OCD
Contamination OCD often involves intrusive thoughts concerning fears of becoming ill or getting someone else sick if the individual comes into contact with a particular bodily fluid such as blood, semen, or spit (saliva).
People diagnosed with OCD who have significant concerns about their health being impacted by contamination often experience frequent unwanted, intrusive thoughts that they are somehow responsible for spreading illness/infection to others and/or themselves. They might feel like it is their responsibility to ensure this does not occur, or agonize over the worst-case scenario if they were to become contaminated or sick.
With regard to specific concerns about saliva, people may experience worrisome thoughts that their spit can contaminate others and spread infection, or that they may get others’ spit on them and contract an illness. They may also experience intense discomfort associated with becoming contaminated or “dirty,” even without specific fears about illness.
The cause of Contamination OCD and other related disorders is unknown. It is likely a combination of environmental and genetic factors. In the case of Contamination OCD, individuals who struggle with these symptoms may have a history of health concerns themselves or within their family. They may also have observed the behavior of other trusted individuals at a young age and adopted these behaviors themselves, contributing to the development of OCD.
Common obsessions experienced by people with Contamination OCD involving fears about spit include:
- What if I come into contact with germs through spit?
- What if I contract an illness?
- What if I’m responsible for my family/friends/strangers becoming ill via my own spit?
- If I think too much or talk about sickness this might come true.
- What if I didn’t get all traces of saliva off of me?
- I might get seriously ill or get others ill because I wasn’t careful enough.
When participating in treatment for OCD, a specialist will help identify triggers that increase anxiety and that normally lead to intrusive thoughts and compulsive responses. These triggers are helpful in determining necessary exposure exercises throughout therapy.
Common triggers for fears about spit:
- Touching light switches, door knobs, elevator buttons, shopping carts, cash
- Being around anyone who might be sick
- Participating in activities where saliva may be expelled from the body: athletic activities, singing, eating in a restaurant
- Coughing, sneezing, or blowing the nose
- Hospitals, doctors
- Hearing about illness on the news or social media
- Coming into contact with eating utensils that other people have previously used
How do I know if I’m experiencing OCD involving fears about spit, rather than maintaining productive and healthy hygiene and safety?
To help you get a better sense of whether your fears and behaviors are a sign of OCD, it can be helpful to ask yourself the following questions, based on the criteria for OCD in the DSM-V:
- Are you experiencing obsessions, or recurrent and persistent thoughts, urges, or fears that are often unwanted and intrusive?
- Do these obsessions cause significant anxiety or distress?
- Do you attempt to ignore or suppress these thoughts, urges, or images, or attempt to neutralize them with another thought or action?
- Are you engaging in compulsions, or repetitive behaviors or mental actions in an attempt to reduce anxiety or prevent a feared outcome?
- Do obsessions and compulsions take a lot of time?
- Do obsessions and compulsions cause significant anxiety or distress?
- Do obsessions and compulsions cause impairment in your day-to-day life?
If the answer to one or more of these questions is yes, you may be struggling with OCD. Getting an assessment from an OCD specialist can determine if you have a diagnosis of OCD.
People who suffer from OCD involving fears about spit may respond to their obsessions and anxiety about spit by engaging in various compulsions in an attempt to reduce their anxiety about saliva and contamination, or to prevent coming into spit at all costs.
Here are some examples of common compulsions that people may perform in response to their fears about spit:
- Avoiding speaking with others
- Covering their mouth with their hand when speaking
- Excessively washing or sanitizing their hands and/or face
- Not eating or drinking in public
- Not using provided utensils and dishes in restaurants or others’ homes
- Wearing facemasks in great excess, such as while alone outdoors
How to overcome the fear of spit
Fortunately, symptoms of OCD, including obsessions about being responsible for contamination via saliva and associated compulsions, tend to decrease significantly when treated with exposure and response prevention (ERP) therapy. Backed by decades of clinical research, ERP is considered the gold standard in OCD treatment, allowing over 80% of people with OCD to live with significantly reduced suffering.
In ERP, a person who has persistent fears about saliva-related contamination may be guided in confronting feared scenarios, such as speaking with others or deliberately putting a small trace of their saliva on their hands. At every step, they will be guided in resisting the typical compulsive responses or behaviors they may be inclined to use in these situations. For example, when speaking with others, the person would be encouraged to not cover their mouth or turn away from other people.
Here are some other examples of exposure exercises that may be done to treat a fear of spit:
- Using provided utensils in a restaurant
- Applying some saliva to their hand
- Wearing only one face mask in public, instead of two
If you’re struggling with OCD and are interested in learning about ERP, you can schedule a free call with the NOCD Care Team to find out how 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.