Contamination OCD

Of the most common types of OCD is contamination. When it comes to creating a program to help with OCD suffers that have a contamination issue, it’s fairly straight forward. We start by using an assessment to gather information, this is followed by cognitive restructuring and then an introduction to exposure.

Assessment of Contamination OCD:

We introduce you to the concepts and attempt to gather more information about what you would like to accomplish from our sessions. This will help determine if in fact it would be a good fit for the both of us. We would also ask specific questions about your OCD to help understand if it’s manifesting in other ways. At the end of the session, you would be asked to complete a questionnaire to help with identifying where to begin in your treatment. We will try to identify how much time you spend on your compulsions, how does it get in the way of your day to day functioning, how upset you would get if you were to let go of some of your safety behaviours, how difficult it is to try to fight off your compulsions, and what you are avoiding in your life because of your OCD. Other questions will be asked to help develop the treatment plan. Every case is unique and it may take 1-2 sessions to complete the assessment.  

Cognitive Component of Contamination OCD

What we do at our clinic is prepare our clients with techniques and skills that help them challenge their thoughts. This includes looking at situations where they are ‘breaking’ their own rules and not considering the exception. This may look like having patients see that their feared consequence of getting sick can happen and their rules aren’t exactly ‘air tight’ or fully protecting them from everything.  For instance, people with contamination issues may wash their hands religiously in the bathroom, but still touch the door knob on the way out of the restaurant. The door knob may have been touched by those who haven’t washed their hands after using the washroom.  The cognitive component is very important in the treatment of OCD. Clients would then work side-by-side with the psychologist on challenging themselves on accepting their feared consequence and living with uncertainty.

We will teach you about how to recognize your anxious thoughts and how they are influenced by specific cognitive distortions unique to OCD patients. The cognitive distortions keep you stuck and see things in a way that may not be completely true. Identifying each cognitive distortion will help you challenge some of your rigid OCD thinking and eventually challenge your rituals. Many people with contamination OCD think they may not be able to handle getting sick, but millions of people around the world manage and cope with illness. Anxiety serves to help protect you from danger, we want to be able to make sure that it’s actually serving a healthy purpose. This may mean challenging the thoughts that bring on those anxious feelings and identifying how accurate they actually are.

Habituation is a word used to describe what happens when you ‘get used’ to a situation. You may have noticed that your body getting slightly cold when entering into a pool. The feeling is something your body becomes used to as time passes. This process is also known as habituation. Similarly, people who experience difficulties with contamination anxiety, they too can get used to the feeling and their anxiety will dissipate. We do this through the use of exposure.  

Exposure and Response Prevention with Contamination OCD

We will then work on designing an exposure schedule based on feared situations. This is done collaboratively and done so with compassion and kindness. We recognize that challenging your fear is difficult, but we want to make sure that we are there to support you on every step of your journey. We will even participate in the exposure with you. Remember, exposure can also happen in your imagination, it doesn’t necessarily have to begin with live exposure.

Very carefully, slowly, and when ready, we introduce some exposure exercises of feared situations. With contamination OCD we work very slowly to move through the list of items created and challenge each one.  We make sure that we are walking carefully through each exposure exercise with the patient. Ideally, we would like the anxiety to go down to zero. We also encourage our patients not to participate in any activities that will reduce their anxiety during the exposure. This may mean, not using tissue paper when touching the door knob. For this to be effective, OCD patients are required to practice exposure 1 hour per day.

Contamination in Obsessive Compulsive Disorder

 Fears of contamination features prominently in obsessive compulsive disorder. Contamination fears are typically the force that compels individuals to wash their hands repeatedly and keep themselves clean. Cleaning compulsions are also a form of obsessive compulsive disorder and is the second most common form of the condition. The cleaning compulsions are usually described as out of control and bizarre. Overtime the cleaning can become stereotypical or robotic in some way. Many patients even describe having forgotten how to wash normally. Compulsive washing can be overwhelming for many patients. The compulsive behaviour is an attempt to rid oneself of a perceived contaminant in attempt to remove a threat to the body.

Contaminants fall into four classes:

1.     Disease and Dirt

2.     Pollution

3.     Harmful Substances

4.     Mental Contaminants.

In addition to the contaminants listed above, some OCD suffers also describe difficulties with contact contamination, which is caused by touching waste products, blood, bandages, rotten food and herbicides. Another form of obsessive compulsive disorder is mental contamination. Those who experience these difficulties often worry about their mind being contaminated either psychologically or through physical violation.

In most cases of contact contamination, the feelings of becoming contaminated are acquired rapidly. Usually a patient will complain of having touched an object of substance of a contaminated person or object. Thoughts begin to spiral in a direction of potentially being sick and ill.  

The difficulties that many patients describe when it comes to contact contamination is that they typically don’t come in for treatment until their world has significantly ‘shrunk.’ They become extremely vigilant and precautionary. Their behaviour supports this as they begin not to be able to keep pace with the spreading contamination. Their fear compels them to avoid more places, people and things. They begin to believe that there is no spontaneous braking mechanism to prevent the spread of contamination.  

What causes the fear of contamination obsessive compulsive disorder?

There is no reason to believe that the fear of contamination is different than any other fear. One theory that helps provide clarity regarding the development of human fears is the three pathways of theory of fear acquisition (Rachman 1978). According to the theory, we are conditioned to responses through the transmission of fear-inducing information. This means that if we see it, experience it, and feel it as dangerous we will likely recall it as such later on, thus creating a conditioned response to the stimulus.

For example, a female who learned of someone who died after drinking from a bottle that contained anti-freeze. She then became hyper aware of substances being contaminated from bottled items.  

The case illustrates how through conditioning, learning through observation and absorbing negative information can all lead to the development of a feared response.  

The consequences of a fear of contamination

The consequences of having such a fear can influence a patient on many levels, including: socially, occupationally, cognitively, perceptually, and behaviourally. Affected individuals perceive the world and themselves in a changed way. They become overly sensitive to perceived threats in their environment. As a result, they generally become hypervigilant. On top of the environmental cues that bring on an increased awareness, suffers also are highly attentive of their internal cues. These scans could include internal dialogue such as: “am I now entirely safe and clean? Does my body feel absolutely clean? If I visit a relative in the hospital, will I get contaminated?”

A fear of contact contamination obsessive compulsive disorder can lead to bouts of social anxiety and avoidance behaviour. People who have the fear of their own bodily influences, become sensitive of others and how their body can bring them sickness. They often dread how people will react to their condition and often anticipate rejection.

People spend a great deal of time attempting to avoid or escape situations and things. According to a study by Salkovskies (2005) as fear increased so did their perception of disgust, but as disgust increased fear remained stable. They argue that disgust reactions are magnified by fear, but fear is not magnified by disgust. Much clinical evidence suggests that both disgust and contamination-fear generate compulsive cleaning.

Further Information:

Memory

Most people with contact contamination have an enhanced memory for contaminated substances. These cues and events are retained in a precisely in their memory. Often then can recall the exact nature and whereabouts of contaminated material. Some patients are able to recall cues from 20 years ago. One individual described seeing a band-aid in a parking lot from many years ago and has avoided the tainted area since.

Normal and Abnormal Feelings of Contamination

Often times feelings of contamination are not excessive and irrational. Contamination with material that is deemed disgusting or dangerous is common and universally experienced. However, the sense of contamination does not come about until the person reaches a certain age in childhood that facilitates an awareness of disgusting or dangerous material. Young children often attempt to touch things or even eat objects that could potentially be harmful to them. Naturally, they are ignorant to possible harm. They do not avoid infectious people or contact with excrement. Further to that notion, people are generally more tolerant of their own bodily products and that of their infants as well, but are disgusted of bodily products of others. As a general rule, people believe that anything that the body excretes must not be allowed back into the body.