The other dominant concern for people with contamination OC involves an intolerance of uncertainty. This is different from doubting in the following way. Again, if we were to think of washing in the dark, and still feel that there was in incomplete hand washing, most people without contamination OC would be relatively unconcerned. This is not so for those with contamination OC. The circumstances surrounding a less than perfect probability of being clean is frequently difficult to tolerate for people with contamination OC. In this case, the problem is quite frightening where one cannot help but feel that because they are ‘only 99% clean’ that the 1% left will be harmful, possibly fatal. Even when one can state that they feel this level of cleanliness is likely adequate, there is still a persistent fear that this time the remaining unclean portions will be harmful.
Reasons for Contamination OCD
People with contamination OC consistently cite a few distinct reasons for their concerns with dirt and germs, as listed earlier. One involves vulnerability to personal harm. That is, if they are not clean enough, then they will harm themselves somehow and be unable to cope with the consequences. This is the one that is most commonly associated with OCD. Indeed, in the movie As Good As It Gets, the screenwriters were depicting a character with a classic symptom of OCD (although the character portrayed by Jack Nicholson did not have the personality typical of people with contamination OC). Another reason cited is that they will inadvertently harm someone else by infecting others with a contaminant. This is also referred to as responsibility OC (See Guilt Beyond A Reasonable Doubt). Someone I recently treated, who had this form of contamination fear, reflected on his difficulties this way,
“I was always terrified that I would be responsible for someone becoming ill. I used to wash for 20 minutes, and in a special pattern designed to ensure that I was clean. I was reluctant even then to shake hands, but if I had not washed, I thought someone might get ill from being near my hands. I also had to shower a special way, in a pattern, beginning with my head and systematically working down to my feet. This took an hour. But at the time, it was worth it because I couldn’t cope with the idea that I would be responsible for someone else becoming sick.”
An important theme emerged for this person, that he would be responsible for others becoming sick. When someone has this form of contamination OC, the typical concern centers on responsibility and the ability to cope with feeling guilt (even if unlikely accurate) due to events due to their actions (or in the case of washing, incomplete action). If we were to depict this as a sequence, it would appear as follows:
- Feeling dirty
- Hand washing
- Doubt about cleanliness
- Increased washing
- Responsibility alleviated
People who have this form of contamination OC are frequently concerned that they will be ‘carriers’ of an illness. That is, they will not necessarily become sick with physical symptoms, but rampantly spread the disease. This problem has been exacerbated for some by the media attention given to air-borne bacteria and germs present on surfaces in the public. For example, products currently available to kill germs following contact with public areas have contributed to some with contamination OC finding their symptoms worsen. One well-known celebrity (with a talk show) has openly expressed his affinity for these products out of a concern with contracting an illness.
Among the illnesses most commonly feared by some sufferers include AIDS, Hepatitis, Sexually Transmitted Diseases (such as Herpes), the Ebola Virus, and even colds and flu. Areas most feared for people with contamination OC include hospitals, subways, public restrooms, drug stores and pharmacies, and any public place where there is a risk of encountering people with illnesses. This would encompass the concern that the contaminant is ‘just there,’ and therefore intolerable.
Another variety involves a concern over insects. However, people with this concern who have contamination OC are not worried about bug bites as much as they are worried that the insect has some contaminant that will result in harm to themselves or others. This is one way of distinguishing this problem from problems of other phobics (such as spider phobics, who primarily fear being bitten). In this case, all insects may be a source of extreme fear and worry over possible harm from developing an insect-borne illness.
Finally, people with contamination OC sometimes engage in washing rituals for contaminants that are actually thoughts. The “washing of ones’ sins” would be part of this concern. This is also a part of pure-obsessions, where most of the problem centers on forbidden thoughts or ideas. For example, I had treated a man who washed whenever he thought a blasphemous thought, or witnessed someone engaged in an activity that was not in keeping with certain superstitions. So someone failing to close an umbrella before entering a house would result in a washing ritual. Or if someone said ‘Nostrodamus was a fool.’ He used to compile a mental list through the day of each blasphemous thought or superstition violation, and wash for each one at the end of the day, sometimes lasting until the early morning hours.