Fears about Harmful Contamination

Harmful contamination themes in OCD include features of subtypes like Harm OCD, Contamination OCD, and Scrupulosity. People with this presentation of OCD have excessive and irrational fears about causing harm to others by exposing them to various contaminants, which may or may not be intrinsically harmful. These substances can range from bodily fluids such as fecal matter, urine, saliva, or semen, to bacteria that may be present in raw meat, poultry, or fish, or spoiled food, to chemical contaminants. People who suffer with fears of harmful contamination may also be afraid of becoming contaminated themselves. However, a distinguishing feature of this theme in OCD is the fear of contaminating others. An element of scrupulosity may be present, with an exaggerated sense of responsibility for accidental contamination.

People with harmful contamination obsessions are typically hyper-focused on tracking the objects or surfaces they have touched so that they are aware of any and all possible sources of contamination. This often involves meticulous mental tracking of things they have touched and in what sequence things were touched, followed by a rigorous cleansing/sanitizing routine. People with this subtype often have well-developed ideas about clean vs. dirty objects and areas. Because contaminants are often not seen or readily detected, one’s imagination can create the perception of contaminants that are either nonexistent or greatly exaggerated in their potential for harm.

People may report having lost touch with what they used to do before they developed OCD and wonder what others do in similar circumstances. People who suffer with harmful contamination fears in OCD often become very isolated as they seek to avoid contaminating others. The COVID 19 pandemic was a common catalyst for people to develop contamination OCD because many feared contracting the virus and infecting vulnerable loved ones with it.

Fear of contaminating others with bodily fluids, such as saliva, urine, feces, blood, or semen
Fear of contaminating others with undercooked meat, poultry, or fish
Fear of contaminating others with chemical agents
Fear that one might be responsible for making others sick or causing them to die by contaminating them

Common Triggers

People with harmful contamination fears in OCD may be triggered by a wide variety of situations that could cause contamination or the transmission of a contaminant to others. Activities that would involve contact with other people could be very triggering. These might include schools, workplaces, stores, church services, concerts, or movie theaters.

Triggers for people with harmful contamination OCD include contaminants and places where they could be picked up or spread:

Contaminants:

Bodily fluids
Raw or spoiled foods
Garbage
Cleaning agents
Pets

Means by which contaminants might be spread:

Schools
Workplaces
Stores
Shopping carts
Door handles in public places
Elevator buttons
Churches
Theaters or other entertainment venues
Restaurant menus

How can I tell if it’s harmful contamination obsessions in OCD, and not simply conscientiousness and safety?

OCD is distinct from a typical level of concern for responsible behavior in that it consists of a cycle: intrusive, fearful thoughts, called obsessions; persistent anxiety that comes as a result; and compulsions, which are attempts to neutralize the thoughts and reduce the anxiety or prevent a feared outcome.

The obsessive thoughts in OCD go far beyond what someone with a reasonable level of conscientiousness would experience. Obsessive thoughts are persistent and result in significant anxiety. A person with this subtype of OCD may feel they are being tormented by their thoughts and feelings of guilt. As with other forms of OCD, people feel driven by anxiety to resolve the perceived problem or threat, but any relief they gain is fleeting, as doubt and fear quickly returns.

Common Compulsions

When people with harmful contamination themes in OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may engage in a variety of compulsions, both mental and physical. As with Contamination OCD, they perform meticulous mental reviews of their actions to detect whether they have contacted a contaminant and how they might have spread it to surfaces that others might touch. Rigorously maintaining ‘clean’ zones in their homes is common. It may also be perceived as safer and is much easier to stay in one’s home than to venture out into the world where one might cause others to be contaminated.

Common compulsions performed mentally or physically by people with harmful contamination OCD include:

Meticulously tracking chains of transmission of contaminants
Avoiding any contact with real or imagined contaminants
Excessive cleaning/sanitizing procedures
Avoiding contact with others when one is worried that they are contaminated
Avoiding activities or places where contamination might occur
Excessive online researching about potential contaminants and modes of transmission
Seeking reassurance from others about the activities that might result in others being contaminated
Saying prayers, phrases, or words in a ritualized way that is aimed at preventing harm to others
Changing clothes frequently

How to treat fear of harmful contamination

Harmful contamination themes in OCD can be debilitating, but all forms of OCD are treatable. By doing exposure and response prevention (ERP) therapy with a trained therapist, anyone can overcome the debilitating cycle of OCD. With the guidance of their therapist, they will engage in exposures, or planned activities that trigger their fearful thoughts and anxiety. The purpose of doing exposures is to purposefully resist engaging in compulsions. When compulsions are resisted consistently over a period of time, one can learn that although unpleasant, anxiety can be tolerated. Usually, in time, a person’s anxiety in response to previous triggers is reduced to a more manageable level.

ERP therapy would involve violating the rules a person has made about touching possible contaminants and places where they might be spread. Examples of possible exposures done to treat harmful contamination OCD include reducing or eliminating specific cleansing routines, intentionally touching feared contaminants, and going to places that were previously avoided. Exposures never involve any activity that would pose a risk to anyone’s wellbeing, but challenge a person’s fearful beliefs about the dangers posed by everyday circumstances.

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.