Fears about urine

What is urine related OCD?

OCD with a focus on the fear of urine falls under the larger subtype of Contamination OCD. This theme is characterized by intrusive thoughts or worries about possibly coming into contact with urine and feeling or becoming contaminated. The fear may also involve a feeling of disgust or dirtiness, rather than a fear of becoming sick or other negative outcomes. A person with OCD centered on a fear of urine and contamination can experience a variety of fears related to coming into contact with urine. This can be triggered by seeing actual urine, being near areas or things that might contain or be near urine, or sometimes by seeing other liquids. People with this theme of OCD may feel unsure or unable to know what a substance is and worry that it could have urine. In OCD, these worries and fears cause distress and anxiety, often involving rumination on worst-case scenarios involving possible contact with urine.  The unwanted, intrusive thoughts, images, or fears about urine and the possibility of being contaminated are called obsessions. In response to the anxiety that comes from obsessions, people with OCD will perform compulsions, which can be mental or physical acts that serve to neutralize uncertainty or worry or prevent a feared outcome.  People with this form of OCD may frequently believe that any liquid substance could be or contain urine and experience obsessions around various types of liquids, or perform compulsions such as avoiding anything that looks yellow. They may be overly cautious about their own urine or others’ urine, or worry that yellow liquids in general may actually be urine or have traces of urine. OCD instills a sense of intense doubt, so it may be difficult for someone suffering from this theme of OCD to distinguish between safe situations and potential contamination risks.

Urine related OCD – Common obsessions

• How can I be sure that that isn’t urine on the floor?
• What if I walked in urine and spread it to my loved ones or throughout my home?
• How can I be sure that any yellow liquid isn’t actually urine?
• What if I accidentally got my own urine on me?
• What if I get my urine on other people?
• How can I know for sure that I won’t get sick if I come into contact with urine?
• How do I know that my underwear doesn’t have urine on it that I cannot see?
• How can I be sure that laundry doesn’t have urine on it?
• If I get urine on me, will I get sick? 
• If I spread uring to my loved one or pet, will they get sick?

Common triggers

People with fears about coming into contact with urine may be triggered by situations involving public restrooms, their own bathrooms, sinks, outhouses, dirty clothes, or any surface where they feel that there could potentially be urine. They may also be triggered by any yellow-colored liquid or any liquid in general, particularly in public places or restroom areas.

Triggers for people with fears of urine and contamination may include:

• Public bathrooms
• Personal bathrooms
• Yellow or clear liquids
• Sinks
• Floors that appear wet
• Toilet seats
• Giving a urine sample at the doctor’s office or hospital
• Underwear contact
• Laundry rooms
• Dirty laundry

How can I tell if I’m experiencing OCD focused on a fear of urine, or normal amounts of caution and cleanliness?

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 or prevent a feared outcome. Understanding this cycle can help you distinguish OCD from other conditions or unproblematic behavior. Something to keep in mind is that if you are feeling an intense urgency to know something immediately and with certainty, but you’re unable to find lasting certainty, that is a red flag that OCD may be at work.

Intrusive thoughts or doubts can and do happen to everyone, and most people are concerned about cleanliness and contamination to a degree. Most people who do not have OCD 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 or perceived risk relating to urine and contamination. This is where OCD holds its power. People with OCD focused on a fear of coming into possible contact with urine can get better by learning that they can tolerate uncertainty about contamination, just as they do in other areas of their lives.

Common compulsions

When people with fears surrounding urine 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 urine and contamination may include:

• Avoidance of public restrooms
• Avoidance of toilet seats
• Avoidance of bathroom sinks
• Wearing different shoes when out of the house versus in the house
• Specific cleaning rituals for bathroom use
• Holding urine for long periods of time to avoid using the restroom
• Excessive handwashing/body washing
• Seeking reassurance from others about what liquid contains
• Self-reassurance about what liquid contains
• Excessive checking for urine on toilet seats or floors, etc.
• Excessive disposal of liquids out of fear that they could contain urine
• Refusal to drink water in restaurants, others’ houses, etc.

How to treat fear of urine

OCD focused on a fear of urine can be debilitating for people who struggle with it, but it is 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 it shows promising results within 12-25 sessions on average. With ERP, you will learn effective ways to accept uncertainty about liquids and contamination, and will become increasingly able to sit with anxiety and discomfort relating to urine contamination.

In ERP, you’re gradually and safely exposed to the thoughts and situations that are likely to trigger your fears and resulting anxiety. With your therapist’s guidance and support, you will resist the urge to respond with compulsions, interrupting the vicious cycle of OCD. By doing this continually over time, you learn that you are able to tolerate anxiety, uncertainty, and uncomfortable feelings of dirtiness or contamination.

Examples of possible exposures done to treat fears of urine may include:

• Using public restrooms
• Touching bathroom sinks
• Touching yellow liquids
• Touching toilet seats
• Sitting on toilet seats
• Touching dirty laundry
• Watching videos about urine on surfaces (black light videos)
• Writing a worst-case scenario script about spreading contaminants through urine

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.