Approximately 3-5% of the population evidence a diagnosis of Obsessive-Compulsive Disorder (OCD). Although there are many subtypes of OCD, one of the most common involves obsessional fears related to contamination.

Those with this form of OCD have intrusive thoughts and images of becoming contaminated by certain chemicals, germs, dirt, other people, environmental pollutants, and several other sources.

Every form of OCD is associated with some type of catastrophic fear. In the case of contamination OCD, the obvious fear is illness and death.

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However, it’s interesting to note that some individuals with this diagnosis do not fear their own death, but instead fear that once contaminated, they will inadvertently contaminate others, resulting in an illness that will lead to that person’s death.

Regardless of the feared source of contamination, the default response to one’s obsessional fears is to avoid whatever objects or situations are believed to have the potential to cause harm to self or others.

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AVOIDANCE STRATEGIES

Avoidance behaviors are seen in all anxiety disorders. For example, those with Panic Disorder will avoid activities that may bring about physical changes which mimic a panic attack, such as physical exercise, sitting in a sauna, etc.

They will also avoid entering environments which do not have easily obtainable “escape routes” — seen as necessary should a panic attack occur.

Individuals with a diagnosis of contamination OCD engage in two different forms of avoidance — passive and active avoidance strategies.

Passive Avoidance

This form of avoidance involves completely avoiding, if possible, the feared object, situation, etc. For example, consider someone who fears public restrooms as the primary source of their contamination fears.

The individual defines public restrooms as ANY bathroom other than the one in their own home. Clearly, this definition would make it nearly impossible to use this form of avoidance.

Therefore, in a situation such as this the person would be forced to use an “active” avoidance strategy.

Active Avoidance

This type of avoidance behavior involves interacting with the feared source of contamination, but only in a ritualistic manner, using several self-imposed rules of engagement.

For example, rather than touching the bathroom door in order to open it, the person would wait for another individual to open the door, and then immediately follow him or her into the restroom.

In addition, when needing to touch any object in the restroom, such as what is needed to flush the toilet, the hot or cold water faucets for washing one’s hands, etc., special gloves, sanitized small towels, etc. would be used — all of which were packed ahead of time, to be used as a means of protecting oneself when needing to use any bathroom outside of the person’s own home.

Once these items are used, the person would then leave them behind in the trash, due to the belief that they now contain the contaminants which originated in the restroom.

WASHING RITUALS

Although active avoidance helps to lower anxiety levels experienced by an individual with contamination OCD who has come into contact with items believed to contain certain types of contaminants, the person is still left in a state of uncertainty.

Their “what if” thinking starts to take over. “What if” part of my hand accidentally touched the water faucet, and certain contaminants are still on my hand?

This person is seeking 100% certainty (which never exists) that they have not been contaminated. Thus, following the use of active avoidance, a compulsive washing ritual will take place, of which there are several different formats.

Consider Janet, a senior in college, who has been suffering from contamination OCD for more than 10 years. Janet’s obsessions are concerned with the possibility that she will inadvertently come into contact with something or someone (there is no specific object, nor person) that would result in her skin being contaminated.

Her most catastrophic fear is that she will somehow spread her contamination onto others, causing them to become fatally ill. When she arrives back to her apartment at the end of each day of classes, Janet performs the following ritual:

Use several bars of soap, antiseptic wipes, disinfectants, and bleaches to wash her face, arms, hands, and legs;

These body parts are always washed in the same order — from top to bottom;

Repeatedly soap and rinse these body parts for no less than 1 hour;

Take 2 showers each day AFTER arriving home from school—each shower takes at least 90 minutes; and

Shower using scolding water, granulated soaps and scrub brushes, even though they cause skin lesions (which could elicit infection).

In Part 2 of this series, we’ll discuss the most common factors that trigger compulsive washing.

Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxietytreatmentinclinevillage.com to learn more.