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A comprehensive guide to Contamination OCD

Contamination OCD (also known as C-OCD) is a form of obsessive-compulsive disorder (OCD) where a person is excessively concerned about getting in contact with dirt, germs, or other contaminants (or perceived contaminants), and intrusive thoughts about potentially getting sick (or dying) as a result.

Any activity or situation that the individual thinks might contaminate them can cause significant distress or anxiety, because regardless of whether these perceived threats are genuinely hazardous or not, the brain will nevertheless generate intense fear that feels very real to the sufferer.

This condition ranges from being a slight preoccupation with cleanliness and hygiene, to being an utterly paralyzing fear of contact with any sort of surface. As a result, people with Contamination OCD may go to great lengths to avoid anything that they see as risky, and may have difficulty participating in everyday activities or socializing with others.

Contamination-related obsessions and compulsions are one of the most common symptoms for OCD-sufferers, affecting about 46% of all patients with an OCD diagnosis.

This guide to Contamination OCD will attempt to aid you in understanding this condition, including its symptoms, causes, and treatment options. 

How many people have Contamination OCD?

As 2 to 3% of people of the general population has some form of OCD, and since slightly less than half of them have contamination-related obsessions and compulsions, it can be reasonably assumed that roughly 1 in 100 people have some form of Contamination OCD. 

There is, of course, a wide range of severity in terms of how Contamination OCD impacts people’s lives, so keep in mind that not all people who have this condition will necessarily exhibit the same level of impairment or distraction.

What causes Contamination OCD?

The causes of Contamination OCD are still not yet fully understood, but the current evidence shows that a combination of environmental and genetic factors contribute to developing this condition. It is also known that OCD is associated with inflammation within the brain’s neurocircuitry, and a lack of functional connectivity in certain brain regions, such as the orbitofrontal cortex and the anterior cingulate cortex.

Examples of Contamination OCD

• Being worried about potentially getting sick from touching an object or a surface

• Avoiding contact with other people due to the fear of spreading (or receiving) germs

• Staying home from work or school due to a paralyzing fear of getting contaminated there

• Checking oneself for signs of contamination frequently

• Rituals that are done in order to reduce anxiety about being contaminated, such as excessive hand-washing or cleaning

• Concerns about being poisoned or contaminated by food that someone (or oneself) has (potentially) touched

How can Contamination OCD be treated?

CBT (cognitive behavioral therapy) been demonstrated to be one of the most effective treatments for OCD (especially Contamination OCD); in a 2004 study that involved 77 children and adolescents (75% of whom had contamination-related obsessions), 88% of them no longer met the criteria for an OCD diagnosis after finishing treatment with family-based CBT.

ERP (exposure and response prevention) is also a useful form of therapy, resulting in a significant improvement in about 50% of OCD patients, according to a 2006 study; ERP can be a difficult form of treatment for some people, which often results in them not finishing the treatment. However, as an example from this same study, about 80% of patients respond well to ERP if they remain in treatment.

One could also have a discussion with their psychiatrist about possibly trying certain medications, which can also be effective; for example, in one 1998 study, 42% of young patients with OCD responded well to the antidepressant sertraline (Zoloft) for treating their disorder.

Another treatment with significant potential is something known as Repetitive Transcranial Magnetic Stimulation (rTMS), which has a response rate of about 35% for treating OCD, according to a 2013 study from the Journal of Psychiatric Research. rTMS works by sending a magnetic pulse into specific parts of the brain to stimulate the nerve cells.

There is no one-size-fits-all answer to the question of how best to treat Contamination OCD, as the most effective treatment will vary depending on the individual. However, there is an ample amount of different evidence-based options and it is likely that at least one of them will be effective for any given person.

The difference between germaphobia and Contamination OCD

Contamination OCD should not be confused with germaphobia, which is defined as an irrational fear of germs. People with Contamination OCD may have some overlap in symptoms with germaphobia, but the two conditions are not identical.

The main difference lies in the fact that a phobia does not include ritual/repetitive behaviors meant to reduce anxiety, which is a key part of what defines Contamination OCD. Furthermore, germaphobia is not necessarily caused by intrusive thoughts.

Germaphobia is also sometimes referred to as germophobia, mysophobia, bacillophobia or bacteriophobia. There is no practical difference between any of these labels, as they describe the same condition.

Retrospective Contamination OCD

Some sufferers of this condition may also fear that they have already been contaminated in some way, and thus they might become nervous and fearful about potentially spreading a virus to others.

This sort of retrospective contamination fear is a relatively rare subtype of Contamination OCD, but it can be one of the most debilitating forms of it.

Sympathetic magic – what is it?

One major contributor to Contamination OCD symptoms is something called sympathetic magic, which is essentially a “magical” and irrational belief system about how the transmission of diseases, germs or other contaminants works.

One example of sympathetic magic in action would be the fact that a sterilized cockroach is still seen as being capable of spreading disease, because it is believed that the cockroach itself is always a carrier of contamination.

Another concept – Thought-Action Fusion (TAF)

People with Contamination OCD are often likely to engage in something called Thought-Action Fusion (TAF), which is a type of thinking error whereby a person thinks there is a connection between their (often irrational) thoughts and objective reality.

TAF is one of the fundamental reasons why some OCD symptoms (as well as many other mental health symptoms) persist and often worsen over time, due to the sufferer not examining whether their thoughts actually represent reality or not (e.g. whether something really is contaminated/hazardous and what the actual likelihood is that something bad might actually happen when touching it).

Mental contamination

One might also experience something called mental contamination, which is the feeling that you’ve had contact with something hazardous, despite not actually having had any contact with any contaminants at all.

Findings from one 2012 study suggested that about 10.2% of OCD-sufferers have symptoms of mental contamination, while having no symptoms of contact contamination at all, which means that their fears and compulsions are purely based on thoughts and images alone (without any physical contact).

Contamination OCD during the COVID-19 pandemic

The recent COVID-19 pandemic, due to the virus having a significant case fatality rate (CFR) among people of an older demographic (and those at extra risk because of other health conditions such as obesity, diabetes or asthma), has generated a lot of stress and anxiety for many people around the world – especially those with contamination-related OCD.

Since the beginning of the pandemic, there has been a growing demand for people to engage in proper hand-washing procedures (which can become ritualistic for some), as well as the usage of masks, hand sanitizers and other such items. Despite the importance of these behaviors during the pandemic, this has nonetheless served as a trigger for many people who suffer with Contamination OCD or even subclinical (minor and non-debilitating) forms of Contamination OCD.

According to a 2021 study of OCD during the COVID-19 pandemic (from the journal “Current Psychiatry Reports”), an average of 32% of patients in clinical studies reported that their OCD symptoms have worsened due to the pandemic; however, when looking at online samples, the percentage of people who reported an increase in OCD symptoms was averaged at an astounding 77%.

Read more about Contamination OCD – a few helpful resources

• The International OCD Foundation’s (IOCDF) fact sheet on OCD-related contamination fears

• A free booklet on managing OCD by the Berkshire Healthcare NHS Trust, which also touches upon Contamination OCD

• Oxford Health NHS Foundation Trust’s fact sheet on coronavirus-related OCD and contamination-related fears

Talk to other people about Contamination OCD

You can check out our community forum where we have a forum subcategory for Contamination OCD; here you can engage with other people and talk to them about experiences, treatments and so on!