What Is Contamination OCD?

When it comes to obsessive-compulsive disorder (OCD), preoccupations differ from person to person: one person might have obsessions around car accidents, another might have obsessions around fires or natural disasters, while others might have obsessions about germs and cleanliness. These are called OCD “themes.”

OCD that focuses on germs and cleanliness is called contamination OCD. Because bathrooms are often thought to be dirty, many people with contamination OCD develop anxiety around bathrooms, whether public or private.

Many people also develop OCD around bowel movements or urination. This can also be called “bathroom OCD.” This can involve fearing that you’ll urinate or have diarrhea in public. It can also entail fearing that you need to poop but having nowhere to use the restroom.

OCD involves obsessions, which are unwanted, upsetting, intrusive thoughts and images, and compulsions, which are behaviors and rituals used to get rid of the obsessions or neutralize the anxiety (temporarily).

Not everybody with contamination OCD will have the same obsessions and compulsions. However, a common obsession is the idea that germs will infiltrate your immune system and make you ill. A common compulsion is to wash your hands excessively to avoid spreading germs.

Contamination OCD often focuses on the bathroom because bathrooms are an area where you can easily be exposed to others’ bodily fluids. People often call this issue “bathroom OCD.”

“Bathroom OCD” can also refer to an obsession with pooping. For example, you might experience intrusive thoughts about having diarrhea in public. The compulsion might be to avoid going out in public for too long or to locate a bathroom as soon as you get to a public space.

All kinds of OCD, including contamination OCD, are categorized as the same disorder as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

According to the DSM-5, you need to fit the following criteria to receive an OCD diagnosis:

• You experience obsessions, compulsions, or both.
• Your obsessions and compulsions cause significant distress and impact your day-to-day life.
• The obsessions and compulsions usually take up an hour or more of your day.

The nature of these obsessions and compulsions can differ from person to person. With contamination OCD, the symptoms can look like:

• spending a significant proportion of your day cleaning
• washing your hands or showering in excess
• worrying excessively about illness, germs, or dirt
• experiencing intrusive thoughts about becoming ill or getting dirty
• throwing away items that you think are contaminated or dirty
• engaging in specific washing rituals (e.g. not feeling clean unless you wash your hands a certain number of times)
• constantly asking others to reassure you that you’re not dirty/contaminated
• avoiding “dirty” areas, like public bathrooms
• feeling anxiety around pooping

Can OCD cause bowel problems?

Possibly. A 2021 study looked at the link between irritable bowel syndrome (IBS) and OCD. It found that OCD was prevalent among people with IBS. Studies conducted in 2018 and 2019 reached the same conclusion.

It’s not clear why this is the case. It might be that anxiety and stress can affect your digestive system because stress prompts your body to enter “flight or fight mode,” during which your body doesn’t prioritize digestion. As a result, stress can cause digestive issues.

However, it might be more complex than that. A 2022 study found that people with OCD were more likely to have an imbalanced microbial biosystem in the gut, which can affect digestion. A 2020 study also found that OCD was associated with more inflammation in the gut.

When someone you love has contamination OCD, your instinct might be to help them avoid dirt and germs so that they don’t feel distressed. However, this actually enables their OCD, which makes it worse.

If you help them carry out their compulsions, it reinforces the idea that everything needs to be clean in order for them to feel safe. While you might want to help them clean their house excessively or reassure them that they won’t get sick, they need to learn to cope without engaging in those compulsions.

Instead, try the following:

• Encourage them to seek therapy.
• Encourage them to try support groups and self-care strategies.
• Give them space to talk about their feelings.
• Attend family therapy with them, if it’s an option.

If your loved one lives with OCD, remember to take care of yourself, too. Watching someone close to you in distress can cause you distress, too. Take time to decompress and reach out for help if you need it.

You could also join a support group for the loved ones of people with OCD – try the IOCDF OCD in-person support groups list or the IOCDF online or telephone support groups list.

As with other kinds of OCD, contamination OCD is treatable. Talk therapy is one of the most common and effective treatments for OCD.

Although a few different kinds of therapy can be used to treat OCD, a kind of cognitive-behavioral therapy (CBT), called exposure and response prevention (ERP), is particularly effective.

With ERP, you’ll be exposed to the things that trigger your obsessions without being allowed to engage in your compulsions. For example, your therapist might challenge you to touch a dirty shoe and resist the urge to wash your hand immediately. These triggers can gradually become more challenging. Eventually, your anxiety will decrease.

Beyond therapy, you also might benefit from prescription medications such as selective serotonin reuptake inhibitors (SSRIs). SSRIs would have to be prescribed by a doctor or psychiatrist. Not everyone with OCD needs SSRIs in order to improve, though.

Additionally, the following might help:

• attending support groups, such as those on the IOCDF OCD support groups list
• finding healthy ways to relieve stress, such as journaling or exercise
• engaging in enjoyable activities and hobbies
• cultivating relationships with loved ones
• trying an OCD app
• taking care of your basic needs by sleeping enough, eating good food, and staying hydrated

You could also try to use an OCD workbook, such as Getting Over OCD: A 10- Step Workbook for Taking Back Your Life or The Mindfulness Workbook for OCD.

Many people with OCD have obsessions with germs and dirt. This is called contamination OCD. You might also have obsessions around bowel movements and bathrooms, public or private. This is sometimes called “bathroom OCD”.

Contamination OCD, as with other forms of OCD, is treatable. Your first port-of-call is to find a therapist with experience treating OCD. You can find a therapist by searching in the IOCDF resource directory.