This is the one variant of OCD that receives the most publicity, and optimistically, it is also among the most ‘treatable’ forms of OCD.
Most of the early studies on treatment for OCD focused on people struggling with contamination fears. Despite this early focus in the research literature, some continue to struggle following treatment, or fail to respond altogether. It has been my experience that there are some factors that weigh heavily in whether one successfully recovers from contamination OC. Among these factors are: 1) extent that others assume ‘responsibility’ for cleanliness, 2) extent of overvalued ideas, and 3) ability to engage in treatment related exercises. These areas will be considered later in this article.
Contamination OC may be defined as a pervasive sense of having some undesirable object(s) still on one’s body, even after washing. Many sufferers from contamination OC report a ‘radioactivity effect’ such that mere exposure or incidental contacts with an identified contaminant results in total contamination. This creates a vicious spiral where the sufferer becomes increasingly concerned over being clean, and is incapable of satisfactorily ridding themselves of the contaminant.
This form of OCD frequently manifests itself along a few major themes. These are as follows:
- Contamination results in harm to self or others
- Simple awareness that a contaminant is ‘just there.’
- Bugs, and concerns over bug related contamination (which is different from phobias related to insects).
- Washing rituals as efforts to remove undesirable thoughts or ideas.
The purpose of this article is to consider each of these forms of contamination fears and how they manifest. Then, some general concerns relating to the assessment of symptoms is discussed. Finally, the methods of treatment are covered, with special attention given to treatments that are commonly offered, but also generally ineffective.
Symptoms of Contamination OCD
Although I have outlined four major ways in which contamination fears may present, there are two dominant overall concerns for people with contamination OC. One is a pervasive and unrelenting sense of doubt that they are clean enough. Imagine washing your hands in the dark, and there is low water pressure. After washing, you may wonder if you have completely washed your hands. Now, imagine that you or your child’s life depends on your hands being completely clean after washing in the dark with low water pressure. This is the kind of uncertainty and perception of necessity that people with contamination OC struggle with everyday while trying to cope with their fears. As people with this condition continue to engage in washing routines to alleviate the doubt about being clean, they typically suffer greater damage, as symptoms frequently worsen until it is as though they simply cannot get away from the sink. Essentially, as you wash and give in to the urge to assume perfect cleanliness, there is greater validation given to your brain’s concern over the necessity of being clean. What follows from this is a greater degree of vigilance for contaminants, and it becomes increasingly difficult to become as clean as necessary. As one person with this form of OCD once told me,
“It was simply horrible. I knew I was clean, but couldn’t help think that I might not be completely clean, and continued to wash. It would go on for about one hour. Then if I accidentally touched something I thought was dirty, I had to begin again. It seemed the possibilities for inadvertent contact were limitless.”
After a while, this person was no longer satisfied by using soap, but instead found that only using a disinfectant cleaner could bring comfort. She is no longer suffering to this degree, and only requires about one minute to wash, and does so only three times a day. This idea seemed impossible to her, and when I suggested that this might be possible when we started working together, she laughed and said she would probably prove me wrong. Fortunately, we collaborated to solve her problem and her condition has been improved to this degree for over three years.