Key takeaways:
Contamination obsessive-compulsive disorder (OCD) is a common type of OCD in which obsessions and compulsions revolve around dirtiness and contamination.
People with contamination OCD may fear getting diseases, touching bodily fluids, spreading germs, and more. To deal with these fears, they spend excessive time on rituals or compulsions — such as repeated handwashing or changing clothing.
Contamination OCD won’t go away on its own. But there are effective and evidence-based treatment options that can help, such as exposure and response prevention therapy.
You might have heard someone who likes cleanliness make a joke that they’re “so OCD.” But contamination OCD is no joke.
Contamination OCD (obsessive-compulsive disorder) is a common type of OCD that may affect almost half of all people living with OCD. It can be debilitating, and people who live with it often lose hours of their time performing compulsions like excessive handwashing.
Luckily, there are several treatment methods proven to help people with all types of OCD — including contamination OCD — find relief from their symptoms.
What is contamination OCD?
Contamination OCD refers to a common OCD theme (or type) that revolves around dirtiness and being infected or tainted. It’s one of the most common and well-known subtypes of OCD.
To be clear, contamination OCD isn’t its own disorder, and there is no separate diagnosis for it. All people with OCD, no matter what theme or type they experience, are simply diagnosed with OCD. Naming common OCD themes just helps you and your providers better understand your symptoms.
Although there are more common themes, OCD can present itself in hundreds of different ways. And no two people with any theme, including contamination OCD, are alike.
Signs and symptoms of contamination OCD
People who have contamination OCD, like everyone with OCD, experience two key symptoms:
Obsessions (also called intrusive thoughts)
Compulsions
Contamination OCD obsessions
Obsessions are intrusive and unwanted thoughts that cause a great deal of anxiety and distress. Most people get intrusive thoughts. But people with OCD can’t let these thoughts go. OCD has been called “the doubting disease” because people with OCD need to know, with 100% certainty, that their obsessions (or fears) are untrue.
People with the contamination subtype of OCD could have obsessions like:
What if I touch that doorknob and contract a disease?
What if my favorite coffee shop has been using dirty water to make my drinks?
I know I just washed my hands, but how can I be sure I got all the germs?
What if I have a severely contagious disease, and I’ve accidentally spread it to my family?
I heard the word “cancer” on the radio this morning, and now I’ve been contaminated.
What if I got a sexually transmitted infection (STI) by hugging my promiscuous friend?
I don't know why, but I just feel dirty.
That person sneezed, and now the whole room is filled with their mucus.
Is that bleach I smell? Bleach is going to make me sick.
People with contamination OCD aren’t only afraid of germs and dirt. According to the International OCD Foundation, they also may have a fear of:
Blood
Mucus
Saliva
Dead animals
Lead or asbestos
Garbage
Semen
Bleach and other cleaning chemicals
Urine
Broken glass
Contamination OCD compulsions
Compulsions are the second key feature of OCD. Compulsions are an effort to try to reduce the anxiety and distress caused by obsessions.
People with OCD don't perform compulsions because they want to; they do them because they feel they need to in order to prevent their frightening obsessions from coming true. Any type of repetitive or ritualistic behavior can be a compulsion, whether it’s a physical or a mental action.
For example, someone with contamination OCD might have the obsession, “What if I touch that doorknob and get a disease?” In response, they might perform compulsions like:
Avoiding the doorknob altogether
Only touching the doorknob through a handkerchief
Washing their hands repeatedly after touching the doorknob
Other common compulsions for contamination OCD include:
Excessive and repetitive handwashing, often to the point where the skin becomes cracked and raw
Ritualized showering or handwashing
Throwing away items believed to be “contaminated”
Changing clothes frequently
Creating “clean zones” at home or in the office that are off-limits to others
Disinfecting or sterilizing items
Avoiding places, people, objects, or even words
Scraping off skin that feels contaminated
Seeking reassurance from others that they aren’t sick or dirty
Excessively researching (the symptoms of a disease, for example)
Mentally reviewing (all the items they touched during a day, for example)
Contamination OCD compulsions are very different from simply being a neat person who likes cleanliness. People with OCD lose hours of time performing compulsions, and this is part of what makes OCD such a debilitating disease.
What causes contamination OCD?
We aren’t sure what causes OCD. However, several factors can raise your risk of developing OCD, including:
Genetics and family history
Brain chemistry
Environmental stressors, like childhood trauma
Research has also found a link between disgust sensitivity and contamination OCD specifically. Disgust sensitivity refers to being more likely to feel disgusted compared to other people. For example, one study found that people who had a higher disgust sensitivity were also more likely to have contamination fears.
What are the treatment options for contamination OCD?
Just like all other types of OCD, contamination OCD isn't likely to go away on its own. OCD is a serious mental health condition that requires treatment. Luckily, there are evidence-based treatment methods for OCD that are very effective.
Therapy
Most OCD experts consider exposure and response prevention (ERP) therapy to be the best OCD treatment. In clinical studies, up to 60% of people with OCD experienced an improvement in symptoms with ERP.
During ERP therapy, you intentionally expose yourself to distressing obsessions (exposure) while resisting the urge to perform compulsions (response prevention). The idea is to help you realize you can tolerate anxiety around your obsessions as well as lessen your distress.
With ERP, you will start slow and gradually work up to your bigger fears. Your ERP therapist will be there to support you along the way.
Other types of therapy can also be helpful for treating OCD. In addition to ERP, you can consider the following options:
Cognitive-behavioral therapy (CBT) focuses on how your thoughts, behaviors, and emotions influence each other and how to change them to reduce your symptoms.
Acceptance and commitment therapy (ACT) helps you define and use your life goals and values to address distressing symptoms.
Medication
Many people with OCD also take medications to help treat their symptoms. Research shows that the right medication can help around 70% of people with OCD.
Types of medication used for treating OCD include:
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Fluvoxamine (Luvox)
Clomipramine (Anafranil)
If these treatments aren’t effective for you, then a non-invasive brain stimulation therapy called transcranial magnetic stimulation (TMS) is also FDA-approved for treating OCD. TMS is a device that uses magnets to target areas of your brain associated with OCD symptoms.
You can find a treatment provider on the International OCD Foundation’s directory page.
The bottom line
Contamination OCD is much more serious and debilitating than simply wanting things to be clean. People with contamination OCD have extremely anxiety-provoking obsessions revolving around contamination and contagion fears. They often lose hours of their time performing compulsions to try to ease their anxiety.
But performing compulsions don’t make the obsessions go away. The only way to address contamination OCD is by getting treatment. There are several treatment options that have been proven to work, and a qualified mental health professional can help you decide on the treatment option that would work best for you.
Why trust our experts?
References
Jalal, B., et al. (2020). Obsessive-compulsive disorder—contamination fears, features, and treatment: Novel smartphone therapies in light of global mental health and pandemics (COVID-19). Cambridge University Press Public Health Emergency Collection.
Law, C., et al. (2019). Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives. Psychology Research and Behavior Management.
MedlinePlus. (2021). Obsessive-compulsive disorder.
Olatunji, B. O., et al. (2004). Disgust domains in the prediction of contamination fear. Behaviour Research and Therapy.
Penzel, F. (2000). OCD and contamination. International OCD Foundation.
Penzel, F. (2010). Obsessive compulsive contamination fears. International OCD Foundation.
Pittenger, C., et al. (2014). Pharmacological treatment of obsessive-compulsive disorder. Psychiatric Clinics of North America.
Society of Clinical Psychology. (n.d.). Psychological treatments.
