Do I have contamination OCD or something else?

If you’re neat and organized that’s one thing. But if you’re disgusted by the thought of touching a stranger and avoid public restrooms, that could be something else. It could be contamination OCD. 

Contamination OCD is a subtype of obsessive-compulsive disorder or OCD that causes extreme fear and disgust, intrusive thoughts and images, and compulsive urges around contamination and dirtiness. It’s also one of the most common and well-known presentations of OCD.

Here, we offer a guide to contamination OCD, including its symptoms, causes, treatments, how to tell the difference between it and similar conditions, and how to find help.

What is contamination OCD?

OCD is a serious mental health condition that’s characterized by obsessions, or intrusive thoughts and urges, and compulsions, or repetitive or ritualistic behaviors. 

Contamination OCD refers to a subtype of OCD that causes people to have excessive worries about germs, dirt, blood and other bodily wastes and fluids, garbage, household chemicals, and more. These worries often involve fears of physical contamination or dirtiness. But some people with contamination also have fears of emotional or spiritual contamination. 

Contamination OCD is the most common presentation of OCD, and studies show that up to 46% of people diagnosed with OCD experience fear of contamination.

It’s important to note that contamination OCD, and any other type of OCD, including real event OCD, false memory OCD, and relationship OCD, are not separate disorders from OCD itself. Subtypes of OCD are common themes, identified by experts, that OCD symptoms tend to revolve around. The same methods are used to diagnose and treat contamination OCD and other subtypes of OCD.

What are the symptoms of contamination OCD?

Just like everyone with any subtype of OCD, contamination OCD sufferers experience 2 core symptoms: obsessions and compulsions.

Obsessions are intrusive and unwanted thoughts, images, or urges that cause intense distress. They can revolve around any theme. Most people with OCD experience obsessions about 1 or 2 specific topics. 

Compulsions are repetitive or ritualistic behaviors that the person feels an overwhelming drive to perform to either try to make the obsession-related distress go away or to try to prevent feared events.

Contamination OCD obsessions

Obsessions can be thoughts, feelings, urges, or images. Some common obsessions that someone with contamination OCD might have include:

• All-consuming preoccupation with germs on hands.
• The fear of contracting a life-threatening illness from touching contaminated surfaces.
• Excessive concern about bodily fluids (for example, saliva, sweat, or urine).
• An intrusive image of bacteria or viruses covering surfaces.
• The fear of becoming sick after exposure to public restrooms or shared facilities.
• A fear of inhaling airborne pathogens in crowded or enclosed spaces.
• The fear of being unable to adequately clean or disinfect certain items or surfaces.
• Intense urges to isolate oneself to prevent contamination.
• Intrusive mental images of contamination spreading from one person to another through objects.

Some specific obsessive thoughts that someone with contamination OCD can have include:

• “What if I accidentally spread germs to my loved ones and make them sick?”
• “What if I get a sexually transmitted infection from using that public toilet?”
• “If I touch that, I’ll never feel clean again.”
• “What if the few germs that weren’t killed by my antibacterial soap have now spread out over my skin?”
• “My dog was bleeding when I took him to the vet. What if I caught a blood-borne disease from him?”
• “The word cancer just popped into my brain. What if I gave myself cancer by thinking this impure thought?”

Contamination OCD compulsions

The compulsions of contamination OCD, like obsessions, can be physical or mental. Physical compulsive behaviors are visible to others while others only happen in someone’s mind. 

People with contamination OCD do these compulsions to try to help themselves feel less anxious or to prevent their contamination fears from coming true. However, compulsions only bring temporary relief. They find themselves needing to do compulsions over and over again until they’re 100% sure they’re safe and clean, but this certainty never comes. This creates a vicious cycle, and many people with contamination OCD lose hours a day to their compulsions.

Some common compulsions that affect people with contamination OCD include:

• Washing hands repeatedly, often to the point of skin damage
• Showering or washing clothes multiple times a day
• Excessively cleaning and disinfecting surfaces
• Excessive use of protective gear like masks or gloves
• Having ritualized behaviors while cleaning and grooming, such as brushing teeth in a very specific way or having a strict order in the shower
• Seeking reassurance from others that things are “clean,” such as asking others to examine their hands for any signs of dirt
• Mentally reviewing past memories; for example, one might retrace their steps to remember everything they touched that day
• Mental rituals, such as repeating certain words, phrases, or prayers
• Compulsive avoidance of objects and people that may be contaminated
• Compulsive research, or spending hours online checking 

What does contamination OCD look like?

Contamination OCD sufferers worry excessively about becoming dirty or contaminated, either physically or mentally. They have fears of being contaminated themselves as well as spreading germs or contamination to others. They may fear emotional contamination as well. They become so consumed with this fear that it becomes an obsession, and it can take over their lives.

People with contamination OCD aren’t just “neat freaks.” Contamination OCD isn’t about desiring your environment to be clean or your thoughts to be pure. It’s also not about taking reasonable measures to avoid illness (like wearing a mask in crowded spaces) or impure thoughts. Contamination OCD is an all-consuming, irrational fear of contamination — an obsession — as well as compulsive behaviors — compulsions — and rituals to try to protect from or rid oneself of contamination.

Here are some examples of what contamination OCD can look like.

Example 1: Alex

Alex is constantly preoccupied with the fear of germs and contaminants; no matter where he goes, he’s consumed with the thought, “What if this is dirty?” He has an especially strong fear of blood-borne diseases, including sexually transmitted infections. If Alex even sees blood or other bodily fluids, he becomes consumed with worries that he’s become infected.

Alex frequently washes his hands, often for extended periods multiple times a day. He often uses scalding hot water and excessive amounts of soap. Every time he touches a “dirty” object that may have touched body fluids, he feels the strong need to wash his hands exactly 3 times. After the third time, he feels some relief. But after a while, he feels contaminated again, leading to further compulsive washing. 

Alex’s fear of contamination is so intense that he refuses to hug or shake hands with loved ones, and he’s often late to work because of his hand-washing. His relationships and work life suffer as a result.

Example 2: Leticia

Leticia is a deeply religious individual who holds strict beliefs about purity. She becomes overwhelmed by the intrusive fear that her mind has been contaminated every time she sees, hears, or thinks something that she believes is “impure.” For example, whenever she has feelings of sexual attraction for someone, which she feels are impure, they trigger intense feelings of guilt, shame, and fear of punishment from a higher power. 

In an attempt to alleviate her distress and maintain a sense of purity, Leticia engages in various mental rituals and compulsions. For example, she has a list of “pure” words that she repeats to herself whenever she has impure thoughts. She counts repeatedly to a number she considers “holy.” Despite her efforts to purify her mind and spirit, Leticia finds herself trapped in a cycle of obsessive thoughts and compulsive behaviors that interfere with her ability to function and enjoy life.

What causes contamination OCD?

Like other mental health conditions, there’s no single cause of any type of OCD, including contamination OCD. Research suggests that OCD is caused by a combination of genetic, neurobiological, and environmental factors.

Some risk factors that may contribute to contamination OCD include:

• Genetics and family history of OCD.
• Neurobiology — researchers have found significant brain differences between the brains of people with OCD and those without it. 
• Disgust sensitivity, which is having a personality that’s highly prone to feeling disgust.
• Childhood trauma, including child abuse, and other stressful life events.

How is contamination OCD treated?

The main treatments for contamination OCD are psychiatric OCD medications and a type of cognitive-behavioral therapy (CBT) for OCD called exposure therapy, also called exposure response prevention (ERP).

Selective serotonin reuptake inhibitors (SSRI) are a type of antidepressant medication that’s been found effective for treating OCD. Specific types of SSRIs used for OCD include Luvox, Zoloft, Prozac, and Lexapro.

Although medication can be helpful, exposure therapy is the most effective cognitive behavioral therapy treatment for OCD and is considered the gold standard. ERP helps people with OCD break the cycle between obsessions and compulsions. 

In ERP,  your therapist will help you make a hierarchy of all of your contamination OCD fears and expose yourself to them one at a time. For example, possible exposures for contamination OCD include touching potentially dirty surfaces like a doorknob, shaking hands with a stranger, or looking at pictures of blood. 

As you expose yourself to these fears one at a time and intentionally trigger feelings of fear and disgust, your therapist will help you resist the urge to perform compulsions. For example, you may have to touch a doorknob without washing your hands afterward. This can be scary and uncomfortable, but it’s the only way to break the OCD cycle.

How to deal with contamination OCD at home?

Contamination OCD is a serious health condition that requires professional treatment. You can’t treat contamination OCD on your own. It’s important to seek a licensed mental health provider’s support.

After you’ve started working with a therapist or psychiatrist, there are things you’ll do between sessions to maintain your progress, including:

• Challenge yourself to complete exposures between sessions.
• Whenever your OCD fears are triggered, resist the urge to do compulsions. If you can’t resist entirely, then work on delaying the compulsion for some time.
• Take all medications as prescribed.
• Seek the support of loved ones and ask them to help you stick to your treatment plan. For example, you might request that they refrain from reassuring you about your compulsions when asked.

Is it something else? Other types of OCD and anxiety disorders

There are other mental health conditions, including other subtypes of OCD as well as anxiety disorders, that can look like contamination OCD, including:

• False memory OCD: False memory OCD causes people to compulsively review past memories for accuracy or potential consequences. People with false memory OCD fear that they may not be remembering things correctly. False memory OCD and contamination OCD can overlap when someone reviews their memories for occasions when they contaminated themselves.
• Scrupulosity OCD: Mental contamination OCD has many overlaps with religious or moral scrupulosity OCD, which is a subtype of OCD that causes people to have excessive worries about being “good” or doing the “right” thing. 
• Somatic OCD: Somatic OCD involves obsessive concerns and intrusive thoughts about bodily sensations, symptoms, or perceived abnormalities, often leading to compulsive checking, reassurance-seeking, or avoidance behaviors. This can overlap with contamination OCD when people become fixated on bodily sensations or health concerns related to perceived contamination.
• Generalized anxiety disorder: Anxiety and OCD often get confused, but they’re distinct conditions. Someone with generalized anxiety may have some worries about getting sick, but they likely also have worries about other areas of life. Their worries aren’t obsessive and don’t lead to compulsive behaviors.
• Illness anxiety disorder (hypochondriasis): Illness anxiety disorder has overlaps with contamination OCD. Both can cause people to worry about illnesses. But people with illness anxiety disorder experience worries that are focused on the possibility of illness (even in the absence of any symptoms). People with contamination OCD worry about becoming contaminated, whether with germs or another perceived contaminant. In addition, people with contamination OCD experience compulsions while people with illness anxiety don’t.
• Specific phobia of germs (mysophobia): People who have a phobia of germs, or mysophobia, can be so frightened of germs that they avoid touching potentially contaminated surfaces, just like people with contamination OCD. However, people with mysophobia don’t engage in compulsive behaviors. In addition, people with contamination OCD often have more insight that their fears are irrational (although this doesn’t decrease their obsessions).

Remember that the assessment and treatment process is the same for all types of OCD; these aren’t different conditions, but different ways in which OCD symptoms present themselves. It isn’t critical to differentiate if you have contamination OCD or another type of OCD, and you may have OCD symptoms of different subtypes.

It is important to distinguish between OCD vs anxiety disorders (including generalized anxiety, specific phobia, and illness anxiety disorder). Anxiety and OCD are unique conditions that require different treatments. You and your therapist need to know which diagnosis you have to determine the best treatment option for you. Only a licensed mental health provider can give you the right diagnosis.

Does contamination OCD ever go away?

Contamination OCD is a chronic condition, which means that no treatment will cure it or make it go away. However, OCD treatment is highly effective; exposure and response prevention is helpful for up to 80% of children and adults with OCD.

Many people with contamination and other types of OCD receive treatment and go on to live happy and fulfilling lives free of obsessive fears and resulting compulsive behaviors. You may still have some fear of germs and contamination after treatment, but your fears should be less intense. You’ll be able to trust that your fears are just thoughts and can’t hurt you. You’ll also learn how to not respond to fears with compulsions, which means you’ll get your time and life back.

Find a provider on Klarity Health for OCD treatment

It may feel like OCD is controlling your life, it doesn’t have to stay that way. OCD treatment is highly effective. On Klarity Health, quickly connect with a licensed psychologist or therapist who offers OCD therapy or medication management.

Find a provider on Klarity Health today and take back your life.