What Is Contamination OCD?

Obsessive-compulsive disorder is a mental health condition that results in obsessive behavior that negatively impacts your life. One of the stereotypes of OCD is excessive hand washing.

Fear of contamination or germs is a symptom of OCD, although it doesn’t affect everyone with the condition. Contamination OCD or contamination-related OCD is one of the most common obsessive "themes," accounting for about a quarter of OCD patients in the US. Understanding it can help you better manage your condition or support a loved one with OCD.

What are the symptoms of contamination OCD?

Obsessive hand washing is what most people think of as a symptom. However, the key feature of contamination OCD is an extreme, maladaptive fear of disease or illness caused by environmental factors. Some examples of how contamination OCD might manifest include:

• Avoiding consuming or handling substances that "may cause cancer"

• Not wanting to enter a building that might have asbestos in its construction, despite knowing that it is only a problem if it is compromised and produces dust

• Refusing to touch things others have touched, such as door handles, elevator buttons, and money. This can lead to an overall avoidance of public spaces or insisting on wearing disposable gloves.

• Rapidly cleaning up any spill that resembles blood

• Avoiding sticky or greasy substances

• Being afraid of touching animals

• Refusing to eat at restaurants or from buffets because of a fear of food poisoning

This can lead to compulsions which include:

• Excessively cleaning objects

• Excessive and ritualized hand washing, including using towels only once

• Frequently changing clothes and changing clothes immediately if they are soiled

• Not allowing others in their "clean" areas

• Throwing things away unnecessarily

• Avoiding certain places or things

• Asking others for reassurance that they are clean or to look at parts they can't see

If you have OCD, you might construct complex, unlikely scenarios to explain your fear. For example, you might fear that a mosquito biting you had recently bitten somebody with AIDS.

In most cases, contamination OCD expresses itself as extreme hygiene or avoidance of situations. While the activity concerned might carry a tiny risk (such as eating at a restaurant), this risk looms much larger if you have OCD.

Another form is "magical" or emotional contamination, where you may avoid a place or person you dislike to extreme degrees. For example, a child who dislikes a classmate might refuse to sit at a desk they know they sat at or touch a library book they borrowed.

Why do certain people get contamination OCD?

OCD appears to be caused by genetic factors and life experiences. The initial trigger that causes OCD symptoms likely affects the symptoms that develop.

Situations that involve disease or dirt may trigger contamination OCD. Disgust propensity¹ (DP) is one theory, and it’s a stable personality trait. Essentially, it’s how easily you are disgusted by things such as mud on your hands and insects landing on you. 

Scientists typically consider a high level of disgust propensity a risk factor for contamination OCD. However, having contamination OCD can also increase your level of DP. 

A recent issue is a worsening or increase in contamination-related OCD² cases directly related to the COVID-19 pandemic. Restricted access to therapy and treatment caused some of these issues. If you were already prone to contamination OCD, the extreme measures that some experts recommended in the second and third quarters of 2020 might have validated your fears. 

For example, experts recommended frequent hand washing, showering every time you come home, and disinfecting groceries. Somebody with a propensity towards OCD could have seized on these behaviors and ritualized them to protect themselves.

However, the root causes of OCD remain poorly understood, and we need much more research.

How is contamination OCD treated?

OCD is often challenging to treat. Typically, treatment is a combination of medication and psychotherapy.

Cognitive behavior therapy

Cognitive behavior therapy³ is part of the mainstay of OCD treatment. Therapists typically use a combination of some form of exposure and response prevention (ERP) treatments.

Exposure therapy involves controlled exposure to what you fear until your brain understands that the activity, person, or place is safe. People with OCD tend to exaggerate the likelihood and severity of bad things. 

For example, someone with OCD might believe that touching an elevator button without gloves will give them a cold and that the cold will put them in the hospital. They tend to require evidence that something is safe, while most people assume something is safe until proven otherwise.

Exposure therapy might take place in real life—”in vivo.” In vivo exposure therapy starts with short durations and minor triggers. For example, if you fear using a public restroom, your therapist might start by having you touch the door, then open the door, etc.

Ritual prevention involves abstaining from rituals you developed to prevent the feared disaster. This teaches your brain that the disaster won't happen even if you don't do the rituals.

A processing phase follows where you discuss your emotions and what you learned.

Scientists consider this therapy a breakthrough as traditional CBT does not work well for OCD. It is considered superior to meditation, relaxation, and anxiety management training, and your gains are typically long-term.

Usually, you’ll continue therapy for 12-16 weeks, after which you’ll have the tools to continue on your own, with occasional check-ins with your therapist.

Medication

Unfortunately, medication typically only reduces OCD symptoms rather than eliminating them. However, it can improve your quality of life, and pharmacological treatment⁴ is standard practice.

Doctors typically prescribe these medications to manage OCD:

Selective serotonin reuptake inhibitors (SSRIs)

The front-line treatment for OCD³ includes the SSRIs escitalopram, fluvoxamine, fluoxetine, paroxetine, and sertraline. There is no statistical difference between them, but people may react differently to each one. Doctors typically don't switch OCD patients from one to another as it seems to show a lower response rate than switching to clomipramine. 

Because OCD is treatment-resistant, doctors typically prescribe higher doses than other anxiety disorders, and you must stay on the drugs for at least twelve months. About 40-60% of patients show no or partial symptom improvement.

Clomipramine

Clomipramine⁴ is a serotonin reuptake inhibitor (SRI), an antidepressant. It has a powerful binding mechanism and cannot be used in higher doses as there is a risk of heart problems.

While this drug works better, it has worse side effects: Weight gain, sedation, hypotension, dry mouth, and constipation. ECG monitoring may be necessary if you’re on a higher dosage.

Doctors use clomipramine when therapy with SSRIs fails. Some doctors have tried prescribing both, but there is sparse data. You should not combine clomipramine with fluvoxamine, as this can cause seizures and arrhythmia.

In most cases, your doctor will prescribe one of these two drug classes. However, they sometimes use adjunct therapy with other drugs. These include:

Typical or atypical antipsychotics

These are particularly useful if you also have a tic disorder. The most convincing evidence is for a low dosage of haloperidol and risperidone. 

Anti-glutamatergic modulators

These drugs reduce elevated glutamate levels, which researchers have found in the cerebrospinal fluid (the liquid around your brain and spinal cord) of unmedicated adults with OCD. Research has shown memantine benefits, for adults and children, with OCD. Scientists are studying memantine monotherapy. 

Researchers have tried glycine, but it is typically poorly tolerated. Sarcosine, a naturally occurring amino acid analog, produces a reduction in symptoms. However, scientists have not completed a full control trial.

Riluzole

Riluzole is another glutamate modulator, and some small trials have shown a distinct benefit in patients who are not responding to other treatments. It has a good long-term safety profile.

Researchers have also studied other drug treatments. However, the standard of care for OCD remains the combination of an SSRI with cognitive behavior therapy. These treatments are not entirely adequate, so scientists are working on discovering second-line therapies for patients who don't respond to SSRIs.

How can you manage contamination OCD?

People who have contamination OCD can greatly benefit from therapy. However, several self-help strategies can reduce your symptoms and improve your quality of life:

Learn to manage stress

Stress can worsen OCD symptoms, especially if stress is related to events that support your obsessions. For example, if a loved one gets a contagious disease, this is likely to worsen your symptoms related to germ avoidance. Therapy helps build a stress management toolkit.

Try to get enough sleep

Sleep deprivation is also likely to make your symptoms worse. Talk to your therapist or doctor if you repeatedly wake up with compulsions.

Do cardio

Regular aerobic⁵ exercise improves mood and reduces anxiety and compulsions. Talk to your therapist about focused treatment if you are afraid to exercise. You can also work with them or friends and family to find a way to exercise that doesn't trigger anxiety.

Avoid alcohol and drugs

People with OCD are at higher risk of developing a substance use disorder. Don't self-medicate with alcohol to try and deal with your symptoms.

Join a support group

Peer support can be helpful. Be careful with social media peer support groups. They can provide some benefits, but they might make you feel worse, afraid to seek further support, or aggravate your symptoms. Look for moderated groups.

The most important thing is to listen to your therapist and take all medication as directed.

How to help somebody with contamination OCD

If a loved one has contamination OCD, it can be frustrating, especially if it is your partner, child, or somebody else you live with. You may find that your partner is drawing you into their rituals and "rules." For example, they may insist that you take off your shoes the second you enter the house or be unable to perform certain household chores.

The first thing you can do is help them come to the understanding that they need therapy. Other than that, you should:⁶

• Not judge, show shock about, or laugh at their obsessive thoughts, no matter how ridiculous they seem. Remember that these are genuine fears to them.

• Educate yourself about OCD to understand they don't have a choice regarding their compulsions.

• Avoid accommodating their compulsions. Don’t help them carry out a ritual or reassure them about it. While refusing to help can increase their anxiety, helping them reinforces compulsions in the long term. Instead, help them challenge the compulsion or offer a hug

• Consider family therapy or have them talk to their therapist about a joint session. Therapy can help you work together to develop better techniques to control their OCD.

The lowdown

Contamination OCD is the most common type and most often portrayed in the media. It consists of extreme anxiety about being "dirty" or contaminated by germs, dirt, or even thoughts and emotions.

People with contamination OCD require therapy and medication, although managing the condition is challenging. It is also important to look after yourself and practice good self-care to manage your condition better.