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  • Unlocking the Fear of Germs and Compulsive Hand-washing: All about Contamination OCD

    Contamination OCD is one form of Obsessive Compulsive Disorder in which people suffer from excessive worries about infectious germs and microbes, and may wash their hands or disinfect in a very extreme or specific way.

    This has been portrayed before in films like As good as it gets (above), and The Aviator (below).

    Many known figures have spoken openly about suffering from this form of anxiety, including Howie Mandel, Cameron Diaz, and even Frank Sinatra.

    Contamination OCD can be incredibly distressing, and can lead to habits such as:

    • Washing to the point of dry, cracked, or even bleeding skin on one’s hands
    • Washing up past one’s hands, wrists, or elbows
    • Washing rituals for an arbitrary amount of times (e.g. 17 seconds, or multiples of 3, etc.)
    • Washing while counting to a specific number
    • Opening doorknobs or touching light switches with one’s elbow, foot, or using another object
    • Wiping or cleaning surfaces in one’s environment (e.g. door knobs, light switches, handles, keys, etc) with excessive frequency
    • Excessive purchasing and use of cleaning products (e.g. disinfectant sprays and wipes)
    • Avoiding shaking hands with other people

    You might hear the term “Germophobe” used as a colloquial term sometimes poking fun at people who are very concerned with cleanliness, or who may avoid touching certain surfaces or objects. However, people suffering from Contamination OCD may be avoiding and/or disinfecting to such a degree that it is deeply impairing their day to day functioning. The cost of time, mental energy, and even money (e.g. on cleaning products) can be deeply debilitating.

    With people suffering with Contamination OCD, it can be helpful to identify what the specific core fear is for the sufferer. The core fear is an underlying theme or feared possibility that the sufferer is hoping to prevent or avoid by their extreme manner of washing,

    Core fears with contamination OCD might include:

    • Getting horribly sick and/or dying
    • Getting sick with a disease and passing it on to others
    • Getting sick, resulting in vomit (aka Emetophobia)
    • Being unable to tolerate feelings of disgust

    As with other forms of OCD, Exposure with Response Prevention (ERP) is a well established treatment of choice.

    Examples of Exposure exercises for treatment of Contamination fears may include:

    • Touching avoided surfaces eg doorknobs, light switches counters, etc.
    • “Spreading” contamination by then touching other “clean” areas and places in one’s environment

    Response prevention strategies may look like:

    • Refraining from or delaying washing one’s hands after contact with objects perceived to be contaminated
    • Refraining from or delaying disinfecting of surfaces perceived to be contaminated
    • Reducing the frequency and/or amount of time spent washing or disinfecting

    As always, ERP is meant to be proactive (rather than passive or just experienced in the normal course of one’s day), methodical and step by step (e.g. not immediately jumping to confront one’s most feared situation).  In other words, while we encourage our clients to stretch their comfort zone, new clients are never required to immediately confront one’s most feared situation. Progress happens at a different pace for each person.

    With repetition, Contamination OCD sufferers will learn by direct personal experience that their fears of contamination are disproved and that they can tolerate increasingly uncomfortable situations. As a result, the grip of OCD on the sufferers life shrinks and the person is more and more free to live their life on their own terms .

    In the era of the COVID pandemic, we have all been extra attentive to germs, contact with others, and disinfecting hands and surfaces. Some Contamination OCD sufferers report that the pandemic increased their already high levels of anxiety. At the same time, others state that they felt well prepared for the pandemic, as they have already been in the habit of cautiousness about the spread of germs and disease. 

    While adhering to the guidelines of CDC recommended precautions, the principles of confronting fears (Exposure) and reducing unnecessary cleaning and washing (Response Prevention) remain effective for addressing Contamination OCD. Also, as per the Inference-Based CBT approach to OCD, compulsive washing arises purely from doubt, whereas an appropriate amount of washing is based on facts and senses.

    If you’d like to discuss treatment for OCD related to themes like Contamination fears, please contact us to see how we can help.

    Martin Hsia, Psy.D. is the Clinical Director of CBT SoCal, and specializes in helping people with OCD, Anxiety, and Insomnia in Glendale, CA.