Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fear of toilets

7 min read
Melaine Dideriksen, LPC, CAADC

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What is OCD fear of toilets?

OCD focused on a fear of toilets falls within the Contamination OCD subtype and involves fears about anything associated with using a toilet.  A person with Contamination OCD related to fear of toilets may avoid using public bathrooms, or even bathrooms in their own homes.  Some people may engage in rituals around using the restroom that involve excessive cleaning like washing the toilet before each use and multiple hand washing events before and after. They may even struggle with seeing a toilet for fear that simply looking at the toilet could in some way cause contamination that will lead to sickness or harm to oneself or others. Let’s take a look at an example to illustrate this fear.

Example
Jesse has been struggling with Contamination OCD for the past three years. She worries that she will touch things that will make her sick and in turn make other people sick as well. Over the past three years she has engaged in compulsive hand washing, washing clothing multiple times, vacuuming, excessive cleaning rituals that take multiple hours of the day, and during the past year, a fear of toilets has become prevalent as part of her Contamination OCD.

Up until a year ago Jesse was able to use public bathrooms and bathrooms in her home with handwashing, use of protective barriers while in public, and hand sanitizing. However, in the past year, her fear of toilets and all of the bacteria that they could hold has paralyzed her in many ways. She is no longer able to use public bathrooms at all. This keeps her from spending much time in public, and she restricts her fluid intake so she does not have to use a bathroom. She is unable to work in her office at this time and is fortunate to have the option to work from home. In her home Jesse has two bathrooms. There is one bathroom that her husband and four children use and her bathroom that only she uses. She is not able to go into her family bathroom and her husband has taken over all cleaning of the space. She often checks in with her husband to make sure that he has done the daily routine of cleaning the toilet as well as other bathroom surfaces.

In Jesse‘s own bathroom, only used by her, she keeps a very detailed routine around using the toilet. Each time she goes to use the toilet she pours bleach into the toilet bowl, uses a disposable toilet bowl cleaner brush, and cleans the bowl of the toilet. She usually repeats this process two or three times until she feels the inside of the toilet is bleached and all of the germs are gone. Jesse then takes her spray bottle of bleach water and sprays down the entire outside of the toilet. She takes a paper towel and wipes down all of the bleached areas of the toilet and throws that paper towel into the garbage. She then has to tie up the garbage and take that outside to the dumpster. When she comes back in, she sits on the toilet and feels intense anxiety, worrying that she may have missed a germ or a spot. When she is done using the toilet she wipes, washes her hands 3 or 4 times, and then repeats her cleaning ritual, throws away the disposable toilet bowl brushes, ties up the new garbage and takes that out to the dumpster. She returns to wash her hands 3 or 4 times and her bathroom ritual is complete.

Using the toilet for Jesse has become quite the process. Sometimes the preparation and cleaning before and after can take up to an hour. Jesse has suffered from dehydration from fluid restriction and also bladder infections from holding her urine and not using the toilet. She has gotten to the point where her doctor has told her if she cannot start using the toilet more regularly, she may need to go to an inpatient program at the hospital, because her health and well-being are severely affected by her fear of toilets.

Fear of toilets – Common obsessions

  • There are germs on this toilet that will cause me or others to become ill
  • How many people have used this toilet?
  • What if I get splashed by toilet water while using it?
  • What if the toilet has deadly bacteria on it?
  • What if I get an STD from using this toilet? 

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Common triggers

People with Contamination OCD related to fear of toilets may be triggered by any situation involving a toilet. They may try to avoid these situations in an attempt to avoid the discomfort caused by their obsessions. 

Common triggers for people with Contamination OCD focused on a fear of toilets may include:

  • Dirty toilets
  • Seeing a toilet overflow
  • Bad smells in a bathroom
  • Seeing people using a toilet stall without washing their hands after
  • Public restrooms
  • Seeing blood on a toilet or a tampon in the water
  • Feeling nauseated 
  • Any feeling of needing to use the restroom

How can I tell if it’s Contamination OCD focused on a fear of toilets and not healthy levels of cautiousness?

Here are some questions that could be helpful in assessing whether you may have OCD, specifically Contamination OCD centered on fear of toilets:

  • How persistent are your fears around contamination and toilets?  Are thoughts popping up anytime you use the bathroom? Are the thoughts about the contamination you may encounter on toilets distressing or disturbing? 
  • Are you trying to ignore the thoughts? Do you try to push the thoughts away? 
  • Do you engage in any behaviors in an attempt to neutralize those thoughts or fears, such as repetitive cleaning, seeking reassurance, avoidance, or checking?  
  • Do these worries or behaviors take up more than one hour of your day or interfere with your life?

If the answer to some or all of these questions is yes, you may be experiencing OCD. 

Common compulsions

When people with Contamination OCD focused on a fear of toilets experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in compulsions in an attempt to eliminate the fear and anxiety resulting from their intrusive thoughts. 

Compulsions performed mentally or physically by people with OCD focused on a fear of toilets may include:

  • Self reassurance: “I know this toilet is clean because I’m the first one to use it today”
  • Seeking reassurance from others: “Are you sure it’s impossible to get an STD from a toilet seat?”
  • Checking behaviors, such as monitoring all others who have used a toilet
  • Excessive cleaning behaviors
  • Excessive hand washing/sanitizing
  • Stacking several protective covers on the toilet seat 
  • Avoiding specific toilets or only using a select few toilets that feel “safe”

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How to treat OCD fear of toilets

Contamination OCD with a focus on fear of toilets can be debilitating for people who struggle with it, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with a trained ERP therapist, individuals can find relief from the cycle of OCD. ERP is the gold standard of treatment for OCD and is backed by decades of clinical research. 

People who struggle with a fear of toilets in Contamination OCD will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually an ERP therapist will start with an exposure that is predicted to bring about a low level of fear and anxiety and work up to the harder exposures as confidence is built. When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions. Over time, this allows you to tolerate anxiety about toilets and contamination, without relying on compulsions to feel better.

Examples of possible exposures done to treat Contamination OCD centered on a fear of toilets include:

  • Looking at pictures of dirty toilets
  • Reading about all the germs and bacteria/diseases found on toilets
  • Watching videos of toilets overflowing
  • Using a perceived dirty toilet
  • Eating while on the toilet or near the toilet
  • Using a public toilet
  • Allowing others to use a designated “safe” toilet 

I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment. 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.

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