Contamination OCD Fears and Recovery

Contamination OCD is a common subtype of OCD where a person experiences unwanted obsessive thoughts and fears of being contaminated, contaminating others, or contracting and spreading an illness. They can spend hours a day preoccupied with these fears. 

These obsessions can manifest in several ways, including a strong fixation with dirt or germs, worry that something is incomplete, thoughts about violence, or extreme concern with order, symmetry, and precision. 

In response to these fears, a person with Contamination OCD will attempt to repress their unwanted thoughts, or neutralize them, through ritualistic and repetitive behaviors known as compulsions.

Examples of contamination OCD compulsions include showering for hours, avoiding crowded spaces, or hand-washing until their skin becomes raw.

Contamination OCD is one of the more common and well-known subtypes of OCD. Research suggests that it can affect up to 46% of people with OCD.

How do I know if I have contamination OCD?

Symptoms of contamination OCD manifest differently in each sufferer; however, there are common thoughts and behaviors that may indicate someone is suffering from this type of OCD. Below is a list of common obsessions and compulsions associated with contamination OCD. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the handbook used by healthcare professionals worldwide to guide their diagnosis of mental disorders.

According to the DSM-5, in order to be diagnosed with OCD, you must fit the following criteria:

  • You experience obsessions, compulsions, or both.
  • You have obsessions or compulsions that take up at least an hour of your day
  • You experience obsessions or compulsions that cause significant distress or affect your social, occupational, or other important areas of functioning.

Common Contamination OCD Obsessions

  • Fear of contracting STIs, developing cancer, or becoming ill
  • Fear of becoming personally contaminated after coming into contact with certain objects or people
  • Fear of spreading illnesses and contaminants to others
  • Fear of bodily fluids including blood, saliva, blood, sweat, and semen
  • Fear of germs, toxins, radiation, dust, and dirt
  • Fear of becoming contaminated by germs from touching certain types of substances or objects in particular places
  • Fear of more magical or illogical forms of contamination such as through unlucky numbers or another person’s negative emotions, breath, or bad luck

Common Contamination OCD Compulsions

  • Repeatedly and excessively washing one’s hands, showering, or cleaning
  • Separating contaminated items from non-contaminated items
  • Discarding of items deemed contaminated
  • Changing your clothes multiple times per day
  • Excessively and repeatedly sterilizing objects in one’s space
  • Using harsh chemicals or sanitizers on one’s skin to stay clean
  • Scraping off skin one thinks might be contaminated
  • Spending hours researching germs, illnesses, and diseases, and how to prevent contamination
  • Avoiding certain people, places, and things who they think might be contaminated
  • Seeking continual reassurance from others for confirmation that something is not contaminated
  • Performing certain rituals like praying, knocking, repeating or thinking certain thoughts

How Does Contamination OCD Affect a Person’s Daily Life?

The obsessive thoughts and compulsions associated with Contamination OCD can greatly impact a person’s daily life and functioning. Contamination OCD can be incredibly time-consuming, disruptive, and draining.

Obsessive thoughts and compulsive behaviors can consume hours of one’s day and feel impossible to stop.

For example, people with a hand-washing compulsion can spend multiple hours in a single day washing their hands, leaving their skin red, wounded, and irritated.

Additionally, individuals with this type of OCD tend to feel great anxiety about being in public spaces, which may lead them to not leave their own home or severely restrict their travel to public places. 

As with all types of OCD, the more a person engages in the obsession-compulsion cycle, the stronger the Contamination OCD can become. The more they wash their hands and avoid leaving their home, the more the fear of contamination grows.

Compulsive behaviors only provide small amounts of short-term relief, increasing the fear and obsessions in the long run and eventually taking over a person’s life completely. The condition can make it challenging to hold down a job, maintain a relationship, or simply leave the house.

Is Contamination OCD Treatable?

Although there is no “cure” for OCD, it can be treated and controlled effectively. You can learn to manage how your symptoms affect your daily life through medication, therapy, mindfulness, or a combination of treatments.

At least half of the patients who seek treatment for OCD will show symptomatic remission over the long term and experience an increased quality of life and improved functioning.

The best outcomes occur in individuals who are diagnosed early and start an intense treatment program right away. Depending on the severity of OCD, some people may need longer-term or more intensive treatment.

Cognitive Behavioral Therapy for Contamination-Related Fears 

Cognitive Behavioral Therapy (CBT) is one of the most common and effective treatments for individuals dealing with all types of OCD, including Contamination OCD.

During CBT, your therapist will help you decrease your anxiety by identifying the thought patterns that are distorting your view of reality and leading to these obsessive thoughts. They will then help you restructure these thoughts in productive ways. 

Exposure with Response Prevention (ERP) and Mindfulness-Based Cognitive Therapy (MBCT) are two approaches to CBT that have proven to be particularly beneficial for the treatment of Contamination OCD.

Exposure and Response Prevention for Contamination-Related Fears

Exposure and Response Prevention (ERP), a type of CBT, is considered the first-line psychotherapy for OCD. In ERP, patients work with a therapist to identify both external and internal triggers that cause them stress and make them want to behave compulsively.

ERP is designed to gradually reduce the anxiety that feeds the obsessions and compulsions through a process called habituation. The goal of habituation is to purposely invoke anxiety in attempts to disrupt the neural circuit between the processing and action parts of the brain.

For example, an ERP therapist might encourage a patient with a fear of touching doorknobs to intentionally touch doorknobs without covering their hands, washing their hands immediately after, or engaging in other compulsions.

By staying in a feared situation and leaning into the discomfort and uncertainty,  patients learn that they don’t need their compulsions to cope and their fearful thoughts are just thoughts and nothing else.

While ERP can feel very difficult and time-consuming, overtime patients learn that they can cope with their thoughts without relying on ritualistic behaviors.

Mindfulness-Based Cognitive Therapy for Contamination-Related Fears

Mindfulness-Based CBT (MBCT) is a type of psychotherapy that combines the ideas of cognitive therapy, meditative practices, and the cultivation of mindfulness.

In contrast to ERP, MBCT encourages patients to observe their unpleasant experiences or thoughts as they arise and label them simply as thoughts, feelings or bodily experiences. Patients are taught to refrain from judging these thoughts and from acting on them compulsively and to approach their experiences with non-judgmental awareness and acceptance.

Through MBCT, OCD sufferers learn that their intrusive thoughts have no power over them and that by responding to their thoughts with compulsive behaviors, they are only giving them more strength and credibility.

MBCT has been shown to change the relationship between OCD patients and their symptoms by allowing patients to better recognize and accept that unwanted thoughts, feelings, sensations and urges are a normal part of human life.

Other References:

American Psychiatric Association, DSM-5 The Diagnostic and Statistical Manual of Mental Disorders. 5 ed, ed. D. Kupfer: American Psychiatric Association

Coughtrey, A. E., Shafran, R., Lee, M., & Rachman, S. (2013). The treatment of mental contamination: A case series. Cognitive and Behavioral Practice20(2), 221-231.

Coughtrey, A. E., Shafran, R., & Rachman, S. J. (2014). The spread of mental contamination. Journal of Behavior Therapy and Experimental Psychiatry45(1), 33-38.

Olivia Guy-Evans

BSc (Hons), Psychology, MSc, Psychology of Education

Associate Editor for Simply Psychology

Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.

Julia Simkus

Research Assistant at Princeton University

Undergraduate at Princeton University

Julia Simkus is a Psychology student at Princeton University. She will graduate in May of 2023 and go on to pursue her doctorate in Clinical Psychology.