Contamination OCD

1. Have you ever felt gross or dirty after touching something or being near someone?

2. Do you ever feel like you need to wash yourself or your hands a lot because you're worried about getting sick or spreading germs?

3. Have you ever felt anxious about being in a specific place, like a public restroom, because you're worried about germs?

4. Do you find yourself constantly cleaning things or changing your clothes because you're scared of contamination?

5. Have you ever felt like you had to follow a strict routine, like always showering after using the bathroom, because you're worried about being contaminated?

6. Do you avoid certain people, objects, or places because you're afraid of getting contaminated?

If you responded “yes” to the above questions, and these thoughts and behaviors upset you, take up hours of your day and interfere with your life, you may have OCD. The following article talks about one of the most common types of OCD, which I will call “contamination OCD”. This OCD revolves around a fear of being infected. Individuals with this type of OCD often strive to maintain immaculate cleanliness, going to great extents to avoid contaminants. When avoidance is impossible, they resort to elaborate and time-consuming cleaning rituals.

Symptoms of Obsessive Compulsive Disorder (OCD) with the theme of ‘contamination’

OCD is a condition where a person spends a lot of time doing things (compulsions) to manage their worries (their obsession). When a person’s obsessions revolve around contamination, they tend to have an intense fear of germs, dirt, getting sick or contaminating others (the obsession). This leads them to excessive cleaning, washing, and avoiding places that they think may contaminate them (the compulsion). 

Contamination OCD is one of the most common types of OCD, and is the one that most people think of when they think of OCD. However, the condition is misunderstood by many. Google analytics, for example, shows that many people may think that contamination OCD is “ocd cleaning disorder”, “cleanliness ocd”, “obsessive cleanliness disorder”, “cleaning obsession disorder”, or “over cleanliness disease”. These terms aren’t really used by mental health professionals though. We refer to the condition as ‘contamination OCD’, or usually just ‘OCD’.

Intrusive thoughts 

Everybody has intrusive thoughts from time to time. These are thoughts that just pop into our mind. Sometimes they're pleasant, sometimes they're not. Ironically, OCD intrusive thoughts are no different to the intrusive thoughts that everyone else has. The only difference is that, in OCD, a person takes these intrusive thoughts seriously.

If I had a thought that “I might get AIDS from that door knob in this public toilet” I'm likely to just dismiss it and get on with my day. This is because I am not committed to getting a 100% guarantee that I won't get AIDS (and I know that the likelihood of getting aids in such an example is pretty slim). In OCD however, a person is usually striving to be perfectly clean and to be 100% safe. For this reason, when they have the thought about the AIDS that may be on the door knob, they panic. They want a 100% guarantee that they won't get AIDS from the doorknob. Such a guarantee is sadly impossible, as there are no guarantees in life. 

The above example features a core fear around aids. In reality, a person’s obsessive thoughts can revolve around anything that may harm themselves. For example, during COVID, a person’s fears may relate to that. Not everyone with OCD fears AIDS, in other words, and because everyone’s OCD is unique to them, their triggers can be unique as well.

Triggers

With contamination OCD triggers can include:

• Public spaces (e.g., door handles, public toilets, seats, handrails, elevator buttons)

• Cleaning objects (e.g., bins, cleaning supplies)

• Items touched by others (e.g., money, clothes, pens, pencils, cutlery)

• Physical contact with others (e.g., handshakes, hugs)

• Being near people you think are objectionable (e.g. people who have broken laws, sinned, or acted immorally)

• Foods (e.g., unpackaged food)

• Animals (e.g., pets, bird poo, wild animals)

This above is not an exhaustive list. A person's OCD triggers are usually unique to them. They may not be triggered by anything on this list, for example. However, there will tend to be a theme of contamination, whereby they are concerned about getting infected or spreading infection by ‘something’. For some people they may fear what is known as metaphysical contamination…

OCD and stress

Stress plays a major role in a person’s OCD. Not only is OCD a stressful thing to live with, stress itself can trigger OCD symptoms. In the case of contamination OCD, this can trigger compulsive cleaning.

OCD and cleaning

Google analytics shows several hundred searches for “OCD cleaning disorder” / “cleaning obsession disorder” in 2023. This suggests that many people associate cleaning with OCD. This may be because cleaning is probably the most obvious sign of OCD in those concerned with contamination. The fact is that there is a lot more going behind the scenes. 

The movie ‘The Aviator’ chronicles the life of Howard Hughes (played by Leonardo Dicaprio) and his struggles with OCD. It is a tragic portrayal of what OCD can do to a person’s life if left untreated. Hughes’ struggles throughout the film with contamination OCD (among others), with cleaning and washing compulsions being central to his condition.

From the outside, contamination OCD can look like a person obsessed with cleanliness. This is partly because cleaning and washing is a central feature. We might see a person excessively cleaning themselves (e.g., excessively washing hands, using sanitizer gels, showering) or cleaning objects (e.g., excessively washing clothes, bed sheets or other household items). We might also see them using barriers to avoid contamination (e.g., wearing gloves, using tissues to pick things up, asking others to handle things for you) or avoiding triggering places altogether.

A person's obsession with cleanliness in this type of OCD is more driven by fear and perfectionism, than a love of cleaning. The person usually doesn’t like cleaning, they just feel driven to do it to gain a sense of being perfectly clean or free of contaminants.

Is health anxiety OCD?

Contamination OCD and Health Anxiety are similar in that they both can relate to a person’s health. They are two different conditions though. People with health anxiety fear they may have a terrible disease - whereas in OCD a person is more focused on avoiding getting infected by something. To learn more, read a blog post dedicated to the similarities and differences between ocd and health anxiety.

OCD treatment

The treatment for contamination OCD is the same as for all types of OCD: Cognitive Behavioural Therapy (CBT) with Exposure and Response Prevention (ERP). It is the best treatment we have, and most people who do it properly either recover from OCD or drastically reduce their symptoms.

The main message to take from this article is the symptoms of contamination OCD are well understood, and excellent treatments are available.