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Fear of Dirt and Germs/ Moral Contamination

Fear of Dirt and Germs/ Moral Contamination

People with contamination OCD report a wide range of obsessions, including intrusive thoughts about being dirty or poisoned, coming into contact with viruses or other germs, contracting an illness or giving one to another person, or becoming morally contaminated.

People with this type of OCD fear contamination for a variety of reasons. Many dread the negative health or social consequences of viruses such as herpes or AIDS. Others’ obsessions are focused on the feelings of disgust or discomfort that arise from contact with dirt. Those with this type of obsession often report that they do not fear illness but instead the how intensely distracting feeling dirty is.

Individuals can also fear emotional or moral contamination. In such cases, the person with OCD may obsess about contamination from any number of sources, such as hearing foul language, seeing disturbing images, or being near a person who has undesirable characteristics. In such cases, a person may need to shower, clean their ears, and even wash their face, eyes and mouth if they hear a triggering word or if they encounter a person having characteristics they find aversive. Other individuals with this type of OCD will engage in mental rituals that neutralize the threat of contamination.

Example 1

Jason is a 26-year-old businessman who has had OCD since age 15. Jason is afraid of coming into contact with or being in the presence of anything he associates with feces, urine or bodily fluids. These things make him feel “unbearably disgusting and gross” even though he is not afraid that he will become sick or diseased as a result of such contamination. Jason feels disgusted by coming into contact with animal or human feces, urine, or vomit, or anything he imagines might have been touched by these (e.g., a stained sidewalk or public bathroom). Even pictures or videos of feces, urine or vomit or hearing someone mention these or related words (e.g., bathroom, dog walker) will make him feel dirty; he then feels the urge to wash. Jason washes his hands at least 20 times per day, with each episode taking him up to 10 minutes depending on how dirty he feels. He also showers for an hour in the morning and evening, during which time he follows an elaborate ritual of cleaning his mouth, nose, and body of all perceived contamination until he feels clean.

Jason also has a fear of being morally contaminated by gambling. His brother had a gambling problem and lost a significant amount of money. Since that time, Jason has been afraid to be near his brother, anyone who looks like or reminds him of his brother, or places like casinos or even games that might involve gambling for fear of becoming contaminated by gambling. He reports feeling anxious and dirty when he encounters these cues and he must go through his usual washing rituals as well as repeating several prayers at the same time to feel “cleansed of the contamination”. As a result of his compulsions, Jason has been late to work and for meetings on several occasions, which has jeopardized his job. These obsessions have also interfered with his social life, to the extent that he has no romantic relationships. He was also unable to be around his brother or any other family member or close family friend, since he felt they were all contaminated by his brother.

Another  common theme of contamination is fear of disease (e.g., hepatitis or HIV) as a result of coming into contact with contaminants and becoming sick and even dying. Another common fear is becoming contaminated with chemicals such as household cleaners, poison, or other types of toxic materials.

Example 2

Dana is a 34 year-old accountant who is married and has two young children. She is afraid of getting a life threatening disease as the result of touching things that she fears may have become contaminated with a deadly bacteria (especially staphylococcus and tuberculosis) or virus (herpes). As a result, she is no longer able to go into crowded public places and spends a significant portion of her day washing and using hand sanitizer, which is causing her to fall behind in her work.

She is also afraid of becoming poisoned by household cleaners (bleach, ammonia, drain cleaner) or environmental contaminants (asbestos, lead, toxic dust) for fear these will cause her to contract cancer or a neurological disorder such as dementia. She goes out of her way to avoid construction sites, congested streets, gas stations, and supermarket isles with household cleaners. She also avoids places that smell of cleaning products and anything on the street that looks to her like it could be spilled chemicals. An overarching fear is that she will become too sick to care for her family and they will be left alone. She is also afraid that her children may become contaminated or poisoned.

Treatment

Exposure and response prevention treatment for contamination-related fears involves creating a hierarchy of situations and activities that will activate fears of contamination while refraining from cleaning compulsions. Treatment begins with the person entering and remaining in somewhat distressing situations. As the person gains confidence and has mastered those challenges, s/he works with the therapist to take on more anxiety-provoking situations.  These gradual exposures to threatening situations without ritual or escape serve to extinguish the fears and reduce the estimation of threat, subsequently reducing the anxiety and distress associated with them.   Ultimately the fear reaction is reduced to be more commiserate with the actual level of threat.

For Jason, exposure begins by saying words like “vomit” and “feces” without washing and then by looking at images of these things. He moved on to more challenging exposure work, knowing that his fear was most intense at first, but always improved over time. By attending treatment twice weekly and practicing exposures daily, Jason’s excessive washing and bathing routines were eliminated over the course of 10 weeks. He was also able to start dating, his work performance improved. He was also able to see his family again and eventually re-established his relationship with his brother.

For Dana, intensive daily treatment over five weeks involved going into increasingly crowded places without washing, eating with her hands in a mall, and going into places associated with disease such as hospitals. She also walked down store cleaning product aisles and she bought drain cleaner and carried it around with her as part of her therapy. By practicing exposure and response prevention in this way, Dana was able to do things she had avoided for years such as going to the movies and into busy stores with her family; she was also able to buy and use household cleaners again. Her productivity at work improved and she was able to enjoy time with her children and husband again without the constant fear of contamination.