Contamination OCD

What is contamination OCD?

Obsessive-compulsive disorder (OCD) is a mental health condition that causes uncontrollable and distressing thoughts or obsessions that result in compensatory or compulsive behaviors ^[1].

Although OCD is listed in the DSM-5 as a single condition, people with the disorder can experience a wide range of symptoms ^[2]. As such, it may be common for two people with OCD to have entirely different presentations.

Because of this range in symptom presentation, many consider OCD to be comprised of various subtypes that may occur alone or in combination with one another. Some of the subtypes of OCD include contamination OCD, symmetry and arranging, doubt and checking, and taboo thoughts ^[3][4].

Contamination OCD is characterized by intense and extreme obsessions with cleanliness, dirt, or contamination, which leads to repeated cleaning behaviors or rituals. It is believed to be the most common subtype of OCD, affecting around half of those with the condition ^[4][5].

Contamination OCD symptoms

OCD causes obsessions, which may occur in the form of thoughts, images, or impulses. Obsessions tend to feel uncontrollable and cause significant distress. A person suffering from OCD turns to compulsions, which may be overt (physical) or covert (mental) rituals and behaviors, used as a solution or safety mechanism to reduce the distress caused by obsessions ^[6].

For people with OCD, obsessions and compulsive behaviors cause significant impairments in daily, professional, and social functioning. It can also cause intense anxiety, fear, disgust, discomfort, and guilt ^[7].

Obsessions related to contamination OCD can include ^[4][5][7]:

• Persistent and excessive fear of becoming contaminated.
• Severe anxiety about dirt, germs, or illness.
• Fear of contaminating others.
• Fear of touching contaminated items, which can include floors, door handles, any item in a public place, bodily fluids and excretions, trash, sticky surfaces, animals, people, and even cleaning products.
• Overwhelming and uncontrollable belief that things, people, or places are contaminated.
• Brief relief from anxiety immediately following compulsive behavior that returns quickly when believed to be contaminated again.
• Belief that a whole room, person, or area is contaminated by a single drop of a substance or brief exposure to a contaminated item.
• Belief that contamination can spread between items, such as a spoon resting on a table being used to stir a cup of coffee, and therefore, the coffee becomes contaminated.
• Increasing fear and anxiety when encountering thoughts, images, or others speaking about dirt or illness.

Common compulsions related to contamination OCD can include ^[5][7][8]:

• Avoiding touching people or objects that are believed to be contaminated.
• Excessive and repeated cleaning rituals.
• Repeatedly disinfecting and sterilizing surfaces and objects.
• Repeated or prolonged handwashing and showering, which can occur numerous times per day, take several hours, and may even result in damage to the skin from excessive scrubbing.
• Throwing away clothes and objects that are contaminated.
• Regularly changing clothing.
• Asking others for reassurance or to check for dirt or contamination.
• Using gloves or paper towels to avoid touching things with bare skin.
• Avoiding people or places that are considered contaminated, or even avoiding leaving the house altogether.
• Creating an area that is ‘clean’ and an area that is ‘dirty’, refusing others access to the clean area. Contaminated clothing, people, and objects are allowed in the dirty area and must not enter the clean area.
• Rituals that include ‘magical’ ideas to ensure cleanliness, such as repeating words and phrases, counting or doing actions a specific number of times, or performing actions in reverse.

What causes contamination OCD?

There is no specific cause of OCD. The condition is believed to develop due to a combination of several causes and risk factors, which can also influence the development of specific symptoms or subtypes ^[3].

Causes may include genetics, environmental factors, childhood experiences, life stressors, gender differences, and brain functioning. It is also believed that many of these factors influence each other to impact the risk of OCD ^[6].

Genetics

Studies show that the likelihood of developing OCD is significantly increased in individuals with a direct relative with the condition, such as a parent or sibling. This risk is believed to increase further if the relative developed OCD at a young age ^[1].

Research suggests that there are multiple genes involved in the development of OCD. This research has contributed to the belief that a specific combination of genes may cause different symptoms and subtypes of OCD. However, this link is unclear and requires further research and clarification ^[3].

Environment

Environmental factors can also influence the risk of developing OCD and may be linked to genetic factors in some cases.

For example, someone displaying OCD thoughts and behaviors may influence others in the home. If a parent excessively cleans the house and frequently references contamination, this could contribute to their child learning these behaviors and attitudes and developing similar OCD symptoms ^[3][6].

Experiences

Other childhood experiences can also impact the risk of developing OCD. For example, childhood exposure to traumatic experiences is believed to increase the risk of developing compulsive behaviors to help manage emotional distress, thus contributing to OCD symptoms ^[6].

Additionally, research has found that people who experience a streptococcal infection (such as strep throat) in childhood are more likely to develop OCD. However, this link is unclear, and why this occurs is not known ^[1].

Recent experiences may also trigger or exacerbate symptoms of OCD, such as stressors relating to work, relationships, or finances ^[6].

Gender

Some studies indicate that gender differences may impact the development of OCD and influence the occurrence of specific symptoms. For example, females are more likely to experience symptoms of contamination OCD. It is thought that this may be linked to societal gender roles and hormonal differences, although further research is required to clarify this ^[3][9].

Brain

Research suggests that brain functioning may impact the development of OCD. For example, it is thought that levels of neurotransmitters, such as serotonin, are reduced in those with OCD. Similarly, some studies show abnormal volumes and activity in specific areas of the brain in individuals with OCD. However, these links are unclear, and research into this area is ongoing ^[1][3][5].

Contamination OCD treatment

Currently, there are no evidence-based treatments specifically for contamination OCD or other subtypes. However, it is recognized that subtype-specific treatments need to be researched further to provide effective treatment for specific symptoms ^[3].

Treatment for OCD typically involves medication, therapy, or both. Although these treatments are effective for some, others do not respond well to these treatments and require additional or alternative options ^[10].

Therapy

Typically, OCD is treated with cognitive behavioral therapy (CBT). A specific type of CBT, called exposure and response prevention (ERP), is often the most effective treatment for OCD and can be applied to the various subtypes ^[3][5].

ERP involves gradual exposure to the feared stimulus without the use of compulsive behaviors, thereby desensitizing the individual to this fear. For people with contamination OCD, this may involve touching items perceived as contaminated while increasing the time between this exposure and compulsive behaviors such as excessive washing.

While it is likely that the individual will experience anxiety during exposure therapy, by facing the feared stimulus and recognizing that no harm will come to them, they will gradually increase their tolerance of these situations. Eventually, they will be able to touch items previously thought to be contaminated without experiencing any anxiety and needing to wash their hands ^[10][11].

Because of the potential for distress and the complex nature of the condition, this type of therapy requires a trained mental health professional to support and guide the individual through the exposure process.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medication typically used to treat OCD. They can be very effective at helping to manage emotional distress associated with the condition and reducing OCD symptoms.

SSRIs can take several weeks to be completely effective and may initially cause some unpleasant side effects. Medication must be taken exactly as prescribed, and any persistent or concerning side effects should be reported to the prescribing doctor ^[1][10].  

Self-care

OCD symptoms can be improved with the use of various self-care techniques, such as ^[6][10]:

• Talking to others: Speaking with friends and family about anxieties and concerns can help reduce emotional distress and provide support and reassurance.
• Learning more about the condition: Some people find it helpful to learn more about OCD and find that this reduces the impact of their symptoms while increasing their understanding of the condition and treatment options.
• Attending support groups: Support groups can provide a space to discuss experiences and share advice relating to the symptoms and management of the condition.
• Relaxation exercises: Utilizing relaxation techniques can help to reduce anxiety and stress associated with OCD and may reduce the impact of symptoms.
• Mindfulness: Similarly, mindfulness can help to reduce anxiety and stress while improving awareness of thoughts and sensations in the body.
• General well-being: Taking care of physical and mental health can improve anxiety, depression, and emotional distress, helping reduce the impact of OCD symptoms. Getting plenty of sleep, eating a healthy diet, and engaging in regular exercise can significantly improve well-being and resilience to stress.