Contamination OCD: Obsessions, Compulsions, & Treatments

What Is Contamination OCD?

Contamination OCD is a subtype of OCD that involves 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 for OCD, the symptoms must interfere with important activities or cause significant distress.³

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 contamination. Emotional contamination is the fear of a person, place, or word contaminating or endangering the sufferer, and is based in magical thinking.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 whom the OCD has latched onto).

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

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.

Contamination OCD Obsessions

Obsessions in contamination OCD are intrusive and unwanted. They can present as recurring thoughts or questions about germs and any uncleanliness, 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?

Contamination OCD Compulsions

Compulsions in contamination OCD are what someone with COD does in response to their obsession with avoiding disease. They are often overwhelming and frustrating for the person. 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)

The specific nature of these types of compulsions can range in severity and frequency. For example, in more serious cases, someone might shower for several hours at a time and hurt their skin with caustic cleaning chemicals or other dangerous decontamination rituals. Or they might spend several hours washing and re-washing laundry, which can cause them to neglect other important responsibilities.

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

What Causes 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, meaning there is a genetic component to 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.

Risk Factors for Developing Contamination OCD

Experts have not identified a single factor that causes OCD. Instead, they have pinpointed various risk factors that may increase someone’s likelihood of developing this condition. It’s also important to note that OCD symptoms can fluctuate over the lifespan. However, it’s possible to develop contamination-based symptoms at any point in time.

Potential risk factors that can influence the development of OCD include:⁸

• Family history of OCD
• A temperament that leans toward experiencing negative emotions
• History of childhood trauma
• History of medical issues
• Co-occurring anxiety disorders 

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 have a fear of pooping?
• 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

Contamination OCD Treatment Options

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.

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 for OCD is to build skills to handle the presence of unwanted thoughts or feelings without engaging in compulsions. These skills develop through exposures, where the person gradually exposes themselves to feared stimuli while resisting compulsions. 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 Potential OCD Contamination Exposures

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 for OCD

OCD medication alongside therapy has been shown to be effective.⁹ 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:⁹

• 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. You can also use an online OCD resource, like NOCD, to find specialized treatment.

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?

Deep TMS

TMS is short for transcranial magnetic stimulation, and it’s a newer OCD treatment option. It’s an outpatient treatment that is typically advised if people are struggling with symptoms after receiving ERP or medication. TMS for OCD entails stimulating brain activity using magnetic fields. Research shows that about 45% of people with OCD experience a symptom reduction at one month following TMS.¹⁰

Mindfulness Training

Mindfulness training can be an integral part of OCD treatment. Mindfulness is generally a part of ERP, and it includes practicing acceptance for distress and staying in the “here and now” as much as possible. People with contamination OCD will likely need to engage in mindfulness to reduce or avoid engaging in their usual compulsions.

How to Get Over Contamination OCD

There’s no doubt that seeking treatment is one of the most crucial steps to overcoming any form of OCD, including contamination OCD. However, it’s also important to implement your own lifestyle changes, and that includes being mindful of your triggers, engaging in new OCD coping skills when you feel anxious, and seeking positive peer support.

Here are more ways you can help yourself get over contamination OCD:

• Maintain structure throughout your day
• Get enough sleep
• Stay busy by doing tasks that are unrelated to your obsessions or compulsions
• Journal or engage in creative expression
• Practice mindfulness meditation
• Acknowledge any progress, no matter how small
• Aim to be self-compassionate with yourself throughout the journey

How to Help Someone With Contamination OCD

Loved ones may feel frustrated, upset, or scared when it comes to managing OCD symptoms. Many of them also aren’t sure what to say or do. They often want to be helpful, but they’re worried about making things worse. Remember you can’t fix someone’s OCD, but you can be a supportive ally to them.

Here are some ways to help someone with contamination OCD:

• Be aware of their triggers
• Avoid shaming
• Remember that progress is rarely linear and setbacks are common
• Avoid trying to convince your loved one they’re overreacting or that nothing is wrong
• Support treatment efforts
• Be mindful of accommodation behaviors (i.e. giving constant reassurance)
• Practice your own self-care