Contamination OCD: Obsessions, Compulsions, & Treatments

What Is Contamination OCD?

Contamination OCD is a subtype of OCD that creates obsessions and compulsions around avoiding sickness and germs. Contamination obsessions are persistent and unwanted thoughts, feelings, images, or sensations that elicit distress or anxiety.

Decontamination compulsions are what someone does in response to these obsessions to try to neutralize, decontaminate, or get rid of the thoughts. To meet clinical criteria, the symptoms must interfere with important activities or cause significant distress.³

“Obsessive-compulsive disorder (OCD) is a debilitating mental illness that consists of unwanted intrusive thoughts that cause high levels of anxiety followed by compulsive behaviors performed in an attempt to temporarily relieve the anxiety. An example of a contamination related obsessive-compulsive behavior consists of an individual deeming an item contaminated and having an intrusive thought or feeling that something bad will happen (e.g. death, making a loved one sick, feeling gross) if they do not clean themselves thoroughly after coming in contact with the item, or they may avoid touching the item all together.” – Cali Werner, therapist at the McLean OCD Institute 

Contamination OCD can take many forms, but the most common presentation focuses on diseases and potential poisons. The spreadability of these contaminants can be overwhelming, causing the person to experience extreme distress when leaving the home. Compulsions often start subtly, but quickly grow to an unmanageable degree. Those with contamination OCD may develop hours of compulsive rituals before they realize how far the disorder has grown.

Contamination OCD Vs. Fear of Germs

Contamination OCD is not simply a fear of germs. A fear of potential contaminants, diseases, or “germs” can be a part of the presentation – but it is more complex than that. Contamination fears can also include things like household chemicals, paint fumes, spoiled food, sticky substances, pets, garbage, bodily fluids, and more. Contamination OCD causes daily disruptions in every phase of life, while someone with a fear of germs can typically manage and live normally.

Mental & Emotional Contamination OCD

Contamination OCD can also present as emotional or magical contamination. Emotional contamination is the fear of a person, place, or word contaminating or endangering the sufferer.⁴ This can be a “type” of person (such as someone with a feared disease, or a missing limb) or a specific person (like a parent or sibling who the OCD has latched onto).

Contamination OCD Symptoms

All types of OCD involve obsessions and compulsions. For someone with contamination OCD, the obsessions will revolve around not wanting to contract or spread germs or illness, and their corresponding compulsions might include washing their hands or showering excessively, spending an inordinate amount of time disinfecting their home, or even completing mental compulsions to try to “ward off” the contamination.

Common Contamination OCD Obsessions

Obsessions in contamination OCD, as with other subtypes of OCD, are intrusive and unwanted. They can present as recurring thoughts or questions, and elicit enough distress to warrant a response, or compulsion.

Common contamination OCD obsessions include:

• What if I spread an illness to my child (or any loved one)?
• What if I touch something contaminated, and don’t realize it?
• What if I eat something spoiled and need to go to the hospital?
• What if I get sick and can’t handle the symptoms?
• What if I spread a disease to a random stranger?
• What if my entire home becomes contaminated, and I can’t escape it?
• What if I become disabled through thinking of someone in a wheelchair?
• What if I am so uncomfortable I can’t handle it?
• What if I’m so disgusted I can’t handle it?
• What if I get bad luck by seeing/thinking of that individual?

Common Contamination OCD Compulsions

Compulsions in contamination OCD are what an individual does in response to their obsession with avoiding disease. They are often overwhelming and frustrating for the individual. It is important for loved ones not to blame someone with contamination OCD for ritualizing, as this promotes feelings of shame. Instead, work to support them in response prevention if they are open to help.

Common contamination OCD compulsions include:

• Repetitive hand washing
• Repetitive showering
• Repetitive asking for others to decontaminate themselves or objects
• Excessive laundry
• Wiping down groceries, cell phones, door knobs, and other contaminated items
• Excessive use of hand sanitizer
• Avoiding certain areas or things (this could be where a contaminated person sat, airplanes, elevators, public restrooms)
• Keeping one area of the home pristine, often the bed
• Mental compulsions (praying, counting, or picturing images after seeing a contaminated person/item)
• Researching effects of contaminants (cleaning supplies, mold, pollution etc.)
• Seeking reassurance from loved ones (you didn’t touch that, did you? Did you wash your hands?)
• Excessive researching (online or with professionals)

Outward Signs of Contamination OCD

Contamination OCD will look different for each person dealing with it. But, there are common OCD symptoms one can look out for in order to know when to get treatment. Both physical and emotional aspects of contamination OCD involve the fear of coming into contact with the real or perceived contaminant. Contamination OCD often involves family accommodation. Put simply, this would be anything a loved one does for a person with contamination OCD to put them at ease.

Common signs of contamination OCD include:

• Excessive hand washing: A person with contamination OCD may wash multiple times with a specific routine (lengthy or structured), or even asking others to wash their hands (family members, partners).
• Excessive shower routine: This can involve frequent showers to decontaminate, and fear of getting contaminated post-shower.
• Excessive laundry routine: This can involve washing clothing or bedding once or more per day.
• Excessive fear of illness: This can involve reassurance seeking from others, researching, seeing multiple doctors, avoiding crowded spaces, etc.
• Avoiding shared items:  Those with contamination OCD may not share dishes, drinks, or food items with loved ones due to fear of being contaminated.
• Use of barriers: Those with contamination OCD will avoid touching items without a barrier (paper towel, tissue), avoiding touching door handles, remotes, communal books, car doors, and more.

Signs of Emotional Contamination OCD

Emotional contamination OCD will also look different for each person, but may look like:

• Avoiding saying the word “cancer” or “AIDS” in fear of increasing risk of disease through magical means
• Avoiding being near the emotionally contaminated person (this could be anyone that the OCD latches onto)
• Avoiding touching the contaminated person’s items
• Performing rituals after being triggered by emotional contaminant

Examples of Contamination OCD

Contamination OCD may be one of the easiest OCD forms to identify. Oftentimes, the behaviors are clearly excessive and focused on constant cleaning and disinfecting.

Here are some examples of what contamination OCD can look like:

• Someone who decontaminates all of their mail or groceries before bringing them into the home
• Someone who will throw away expensive items because they touched something “unclean”
• A person who avoids social interactions because it could involving contact with dirt and germs
• Someone who will avoid cooking or eating fresh foods due to fears of food-borne diseases

Causes of Contamination OCD

The cause of obsessive compulsive disorder is not definitively known. But, research suggests that a strong biological component is present.⁵ Studies show prevalence rates of 7-15% in first-degree relatives with OCD.⁶ OCD is a neurobiological disorder, with specific structures in the brain that are affected. Despite common misconceptions, OCD is not caused by trauma or stress.⁷

Understanding the biological component of OCD is crucial as it cultivates compassion and understanding, rather than shame and blame. From a place of understanding, sufferers and families can take thoughtful action toward recovery.

Do I Have Contamination OCD?

If you think you might have contamination OCD, ask yourself these questions:

• Do I avoid crowded environments due to germs?
• Do I wash my hands so often I have dry skin or discomfort?
• Do I have an extreme fear of being sick or getting sick?
• Do I need to wash something right away for fear of contamination?
• Do I avoid any kind of body fluid?
• Do I become unreasonably uncomfortable about things in my space that are sticky or greasy?
• Do I think about whether something is getting cross contaminated?

Regardless of how you answer any of these questions, if you are in distress you should consider reaching out for help from a therapist or your PCP.

How Contamination OCD Can Impact Someone’s Life

There can be a lot of impacts of contamination OCD on someone’s life, such as:

• Cutting yourself off from loved ones and important experiences due to fear of being around someone sick
• Fear of using public restrooms therefore limiting your time in public
• Avoiding helping someone injured due to fear of their blood
• Avoiding public places due to fear of germs
• Socially isolating due to fear of getting sick

Treatment of Contamination OCD

The most effective treatment for OCD is exposure and response prevention (ERP) and/or medication.² The International OCD Foundation confirms that about 70% of those with OCD benefit from ERP and/or medication.² This effective treatment gives agency and hope to those suffering with OCD.

Werner says, “A combined treatment of ERP and medication management of Selective Serotonin Reuptake Inhibitors (SSRIs) has been proven to have the greatest outcome for overall OCD symptom reduction.”

Exposure and Response Prevention (ERP)

When working with an OCD therapist, people can expect to be treated with exposure and response prevention (ERP). The goal with ERP is to build skills to handle the presence of unwanted thoughts or feelings without engaging in compulsions. These skills develop through exposures, where the individual gradually exposes themselves to feared stimuli while resisting compulsions. When completing ERP therapy for OCD, the individual often uses a hierarchy and gradually builds tolerance for more challenging exposures.

With contamination OCD, the person will gradually expose themselves to feared contaminants while resisting rituals, like doing laundry while resisting hand washing, touching the counter then eating a snack, opening a car door without a barrier, or sitting on your bed with street clothes. Individual treatments will look different based on what their contamination OCD tells them to avoid.

Examples of ERP Exposures for Contamination OCD

Contamination ERP will usually involve asking people to expose themselves to something deemed “unclean” without compulsing afterwards.

Potential ERP exposures for contamination OCD could include:

• Touching a toilet
• Going to the bathroom without washing their hands
• Shaking hands with someone
• Touching a doorknob
• Eating food that fell on the floor

Medication

OCD medication alongside therapy has been shown to be effective.⁸ The class of medications that are front-line treatment for OCD are selective serotonin reuptake inhibitors (SSRIs). For cases that do not fully respond to the SSRIs, other categories of medications will be tried or added.

Medications that may be commonly used to treat OCD include:⁸

• fluvoxamine (Luvox)
• sertraline (Zoloft)
• citalopram (Celexa)
• fluoxetine (Prozac)
• paroxetine (Paxil)
• clomipramine (Anafranil)
• escitalopram (Lexapro)

As with all medications, there are possible side effects and risks. A physician or psychiatrist will work with a patient to discuss options.

How to Get Help for OCD

Getting help from a therapist and a psychiatrist is a great way to find ways to manage and cope with OCD. You can use an online therapist directory to find the right therapist near you who specializes in OCD, or ask your primary care doctor for a referral.

When looking for an OCD specialist, don’t be afraid to ask questions, such as:

• What techniques do you use to treat OCD?
• How much of your caseload is OCD?
• Do you use exposure and response prevention to treat OCD? (If the answer is no, please consider looking elsewhere)
• What is your training and background in OCD?

Final Thoughts on Contamination OCD

OCD can be debilitating and overwhelming. If you or someone you love is struggling with OCD, know you are not alone. Reaching out to a trusted friend or OCD specialist can be a scary, but powerful, first step.