Everyone has a bit of health anxiety from time to time—like when they’re riding a crowded bus and everyone around them is coughing. But if you regularly fear becoming contaminated after coming into contact with certain objects or people, or worry that you’ll carry illness or germs to other people and get them sick, those are some tell-tale signs of contamination OCD, a common form of of obsessive-compulsive disorder (OCD).
Contamination OCD is a mental health condition—not a personality quirk. But while it can lead to feelings of helplessness and despair, the reality is that it’s a highly treatable condition. Let’s take a deeper look at what this condition is, common symptoms, and steps to overcome it.
What is contamination OCD?
Contamination OCD is a subtype of OCD marked by intrusive thoughts about becoming contaminated or contaminating others. Like all types of OCD, contamination OCD is characterized by the presence of obsessions and compulsions. Obsessions are unwanted thoughts, feelings, urges, or images that cause anxiety or distress, while compulsions are behaviors or mental actions you do to try to relieve the discomfort that obsessions bring.
In the case of contamination OCD, sufferers’ obsessions—and the resulting compulsions—center specifically around germs, dirt, and uncleanliness. The constant fear about being contaminated, and behaviors that are done in order to cope with or neutralize the distress, can feel all-consuming. In OCD, obsessions and compulsions take up at least an hour of your day, and interfere with many facets of your life. “As you can imagine, this can take up quite a large chunk of your mental energy,” says Catherine Schuler, Psy.D, a staff psychologist at the Center for Anxiety & Behavior Therapy in Bryn Mawr, PA.
Interestingly, not all contamination triggers are the same. Some are rooted in fear (“I’ll become seriously ill by coming into contact with germs!”), while others are rooted in disgust (“I’ll never get to a place where I feel clean enough!”). “Disgust-based contamination OCD is not really about getting sick or getting anybody else sick. It’s just a pure sense of disgust if you feel contaminated,” says April Kilduff, MA, LCPC, LMHC.
What’s more, the focus of obsessions in contamination OCD can be physical, mental, or emotional:
- Physical contamination is when you come into contact with something or someone you believe has the ability to contaminate you.
- Mental contamination is when you feel internally “dirty” even though you didn’t have any physical contact with anything that you perceive to be contaminated. It can be triggered by a thought, a memory, or a feeling.
- Emotional contamination is when you worry about being contaminated by negative personality traits or energies of others, or by an object or space that you believe has a negative association.
Common obsessions in contamination OCD
- What if I get cancer?
- What if I magically get a disease just by talking about it?
- What if I spread an illness to someone else and they die?
- What if I inadvertently spark the next global pandemic?
- What if I hug someone with a noncontagious condition, and it somehow transfers to me?
- Could this food be contaminated?
- Someone just coughed near me; what if I get sick and die?
- My partner and I have tested negative for sexually transmitted infections, but what if I still get one and it’s incurable?
- I feel dirty and disgusting even though I’ve already showered.
- If I touch that doorknob, I’ll never feel clean again.
- If I make eye contact with that person, or sit in the same seat where they were, I might be contaminated with some of their negative traits.
It’s important to note that people without OCD can share many of the above concerns. The difference is that for people with OCD, these thoughts are highly distressing, constant, and may become downright irrational. “It can feel like the world is attacking you,” says Kilduff.
Common compulsions in contamination OCD
- Excessive hand washing, showering, and cleaning
- Separating “contaminated” items from “non-contaminated” items
- Throwing away “contaminated” items
- Repeatedly changing clothes
- Using harsh cleaners on your skin
- Doing excessive research on germs, illnesses, and ailments
- Sanitizing items unnecessarily
- Tracking items that have been touched by anyone else so you can avoid or clean them
- Limiting the foods you eat due to irrational fears of contamination
- Using gloves or sanitizer excessively
- Seeking reassurance—say, that you’re not contaminated, or that you won’t make other people sick
- Engaging in rituals such as excessive praying, knocking, repeating, or thinking specific thoughts
- Avoiding the use of public bathrooms
- Avoiding streets with cemeteries, because you think they’ll infect you with “death germs”
Engaging in a compulsion might bring relief for a little while, but the downside is that it only works for a short time. The more you engage in these behaviors and rituals, the more you feed the OCD. So, for example, the more you wash your hands, the more you need to keep washing. That’s the OCD cycle in action.
How contamination OCD can affect your life
You may end up doing compulsions for hours every day, and it can seriously affect your work, relationships, and other aspects of your daily life.
What’s more, OCD loves to latch onto the areas of an OCD sufferer’s life that they value most. It’s not surprising that contamination OCD is so common, Schuler says, because good health is important to most people. But the great irony of OCD is that the compulsions you do to try to protect your well-being usually make it worse, warns Kilduff.
We’ve seen people who wash and sanitize so much that their skin gets dry and cracked and bleeds, which actually makes you more susceptible to contamination.
“We’ve seen people who wash and sanitize so much that their skin gets dry and cracked and bleeds, which actually makes you more susceptible to contamination,” says Kilduff. “I’ve also heard of people who would wash themselves with bleach, and I’ve seen clients drop an unhealthy amount of weight because they were so afraid their food was contaminated that they stopped eating.”
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All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Getting help for contamination OCD
It’s vital to seek treatment from a provider who specializes in OCD therapy. That’s because many treatments that work well for other disorders—such as talk therapy or general cognitive behavioral therapy (CBT)—can actually make OCD worse, not better.
Exposure and response prevention (ERP) therapy is considered the gold-standard treatment for all forms of OCD, including contamination OCD. In ERP, you’re exposed to your triggers and taught how to resist your compulsions. This is a gradual process—meaning that you’ll begin with exposures that only elicit a small amount of fear, and work up from there.
Over time, you’ll learn that the distress passes on its own, without the need for compulsive behaviors. You also realize that your intrusive thoughts never posed the threat you believed that they were—which takes the power away from your OCD. “My confidence grew every time I felt my anxiety drop. Thoughts that once took over my life were now drifting behind me,” NOCD member Ashley Marie Berry says of her ERP journey for contamination OCD.
What might ERP look like? Well, suppose you developed a debilitating fear of germs after the COVID-19 pandemic began, and you compulsively avoid having any guests enter your home. “The goal is to take the compulsions down to the point where you’re just doing what’s recommended for every average person, and nothing more,” says Kilduff. To start, you might work with your therapist to bring an object from another location into your living room, without sanitizing it first. Then you gradually build up to more challenging exposures, until you can finally have, for instance, loved ones over to visit.
For some people with OCD, ERP therapy is most effective when accompanied by medication. This may be due to the severity of symptoms, a person’s unique psychology and neurobiology, or other conditions that occur alongside OCD, such as major depressive disorder. In such cases, a treatment plan combining therapy with medication can provide the best chance at long-term recovery.