Dirty on the Inside: Mental Contamination and OCD

Jane is a young woman who is terrified of cheating on her partner. She had a friend, once, who had an affair, and Jane increasingly became afraid that having contact with this friend would influence her to the point where she would turn into the kind of person that would be unfaithful in a relationship. Jane cut off her relationship with this friend, but that wasn’t enough. She still felt dirty on the inside whenever she visited the place that her friend used to work, or whenever she ate her friend’s favorite food. Jane slowly started to avoid these places and things, too.

But Jane’s fear only grew. She felt dirty any time she met someone who shared the same name as her ex-friend. It felt wrong to watch any kind of infidelity in the media. Whenever she even saw the word “infidelity”, Jane would worry that she’d become a cheater.

Jane suffers from a rare subtype of OCD, called mental or emotional contamination – and it’s not hard to see how if she doesn’t get treatment soon, this disorder will ruin her life.

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What is Contamination OCD?

When you think of OCD, one of the first images that pops into your head is probably that of somebody compulsively washing their hands because they’re worried about germs. Although this picture of OCD is limiting (there are many, many other types of OCD, and many people who suffer from OCD don’t have any fears about cleanliness at all), it’s true that the contamination subtype of OCD is one of the most common.

Typically, people with contamination OCD worry excessively that the things they come into contact with have given them germs or a disease. These are the people most of the world imagines when they think of what OCD looks like: washing their hands, obsessive about cleanliness, and constantly worrying about whether or not they’re dirty or sick.

Obsessions and Compulsions of Contamination OCD

OCD is a disorder that’s defined by the presence of obsessions and compulsions. Naturally, this applies to contamination OCD as well; many people can be uptight about cleanliness, but they don’t have OCD unless they experience obsessions and compulsions that severely affect their daily lives and functioning.

Obsessions are persistent, intrusive, and unwanted thoughts that cause someone severe anxiety, distress, and fear. The person experiencing the obsessions does anything they can to push these thoughts away, but they keep coming back.

People who suffer from the contamination subtype of OCD likely experience obsessions like: “What if that doorknob had germs on it?”; “What if I didn’t wash my hands correctly or for long enough?”; or “That person I just shook hands with may have been sick.” People with these OCD fears often obsess about things other than just dirt or germs, including bodily fluids like sweat, blood, or urine. With no rational basis, they fear contracting diseases like cancer or HIV.

Compulsions are what the person with OCD does to try to mitigate the anxiety or escape the danger that their obsessions convince them are true. Of course, none of us like anxiety, and it’s natural to try to do something to feel less anxious. What differentiates a compulsion is that it’s repetitive and ritualistic, and it doesn’t actually relieve the anxiety for more than a few minutes. In the end, the person gets caught in the compulsive behavior, and it does more harm to them than good.

A common compulsion for people with contamination OCD is hand-washing. Washing our hands is an important hygiene practice, but people with OCD may wash their hands over and over, even until they crack and bleed. They may have rituals associated with their hand-washing practices, for example washing their hands for exactly 99 seconds or having to wash their hands each time another person enters the room.

Hand-washing is far from the only compulsion people with contamination OCD engage in, though. Other people may shower compulsively, change their clothing frequently during the day, or excessively sanitize their surroundings. Avoidance can become compulsive as well; some people may avoid coming into contact with anything that they think of as “contaminated”.

What Causes Contamination OCD?

Anybody, regardless of sex, gender, race, ethnicity, sexual orientation, or any other demographic factor can develop OCD. The exact cause of this disorder isn’t fully understood yet, but there are certain things that are thought to be risk factors.

The development of OCD almost certainly has a genetic component; although it’s not a finality that you’ll develop OCD if it runs in your family, it does put you at a higher risk. Environmental factors are likely to play a role, too; a traumatic and dangerous event, for example, might heighten your obsessive fears about a specific topic.

For example, if you or a loved one contracted a serious disease that could have been prevented with better hygiene practices, that may make you more inclined to have obsessions and compulsions related to germs and contamination. Many people with contamination OCD, though, have had no such experience, and the obsessions seem to rise up out of nowhere.

A Different Kind of ‘Dirty’: Mental Contamination OCD

Although in general, contamination OCD is one of the disorder’s most common subtypes, there is a smaller group of people within the subtype who face a different type of obsessions and compulsions: mental or emotional contamination.

People with this theme of OCD have excessive fears that they are contaminated, but not on the outside. They may worry that because of some contact they had with something they consider dirty, wrong, or bad luck, that they are contaminated, dirty, or evil on the inside. This feeling of being mentally or emotionally dirty follows them around and, if left unaddressed, can start to severely affect their lives.

How Does Mental Contamination Differ From Contact Contamination?

Like we explained earlier, people with OCD who experience fears about contamination worry excessively that they’ve become contaminated with germs or disease by physically touching something they consider to be dirty.

People who face mental contamination obsessions, on the other hand, worry that they’ve had some sort of contact – speaking to a specific individual or having a specific word come into their minds, for example – with something they consider to be internally dirty, bad, or wrong. They may fear that whatever bad quality that they’ve projected onto the “dirty” person or thing may somehow transfer over onto themselves.

People who face this subtype of OCD may not worry about their bodies being contaminated by disease, but they worry excessively that they’ve somehow been contaminated in their minds or their hearts – even their souls. They have a constant feeling of being uncomfortable or corrupted.

Someone can suffer from both physical contamination and mental or emotional contamination subtypes of OCD. However, they aren’t the same fear; someone who doesn’t give a second thought to physical or germ contamination could still worry excessively about becoming mentally, emotionally, or spiritually contaminated.

What Does Mental Contamination OCD Feel Like?

People have described mental contamination obsessions as a pervasive feeling that they are somehow “dirty”, “disgusting”, or “wrong”. Again, this isn’t a fear about their physical body being dirty – it’s more about their mind, or their spirit. It feels like they’ve made some huge mistake that’s impossible to correct, but keeps nagging at them just the same. Sometimes, people may not be able to identify what’s triggering their mental contamination thoughts – they just know they feel completely disgusted with themselves.

People who experience this subtype (or any other subtype) of OCD can’t get their minds off of this obsessive fear, no matter how much they try to push the thoughts away. Compulsive behaviors keep the obsessions at bay temporarily, but they always come back, and usually stronger than ever. They feel constantly wrong, disgusting, and contaminated, and they feel helpless in the face of this.

If left untreated, mental contamination OCD (again – or any other subtype of OCD) will rob the sufferer of their sleep, their well-being, their peace-of-mind, and their happiness. It starts to take over until the person with OCD can’t think about anything else.

Common Obsessions About Mental Contamination

Unlike contact contamination OCD, people who suffer from mental contamination OCD may not necessarily have obsessive fear about germs or dirt. Instead, they worry that they’re generally “dirty”, disgusting, or contaminated by being exposed to certain mental triggers. They may worry that they’re going to “take on” the perceived negative qualities of the people, thing, or place that they see as a contaminant.

Triggers are mostly words, feelings, thoughts, or symbols that the individual perceives as dangerous, bad, or unclean. It could be superstitious, or it could be related to past events that have harmed the individual. We can observe this clearly in Jane: she feels overwhelmed with fear that she will become contaminated if she comes into contact with anything related to cheating, including unfaithful people in public and in the media.

Sometimes, the obsessions latch themselves onto specific objects and people. For example, perhaps someone wore a specific shirt while they accidentally hurt their friend’s feelings. They may start to obsess and worry that this shirt is evil or contaminated, and that they will become evil when they put the shirt on.

Other times, people with mental contamination OCD obsess about a specific person. They might feel that having contact with “bad” people may pass on these evil or dirty qualities onto their own personalities. For example, Jane thinks that if she has a conversation with her former friend who cheated on their partner, then she will magically become the type of person to cheat on her partner, too.

Some specific mental contamination-related obsessions that people experience might be: “If I see that word somewhere, then I’ll become a terrible person.”; “If I touch an object that belonged to the person who hurt me, then those awful memories will come back and I’ll feel disgusting.”; or “If I see blood, I might become evil and start hurting people.”

Most people with OCD know that their way of thinking isn’t logical, which differentiates it from a psychotic disorder. Although intrusive OCD thoughts may seem delusional, they’re not delusions in that the person experiencing them almost always has at least some insight that the thoughts don’t make any sense. That doesn’t, though, make the thoughts feel less real or terrifying.

Mental Contamination Compulsions

Of course, as with every subtype of OCD, people with mental contamination obsessions experience compulsions, too – otherwise it wouldn’t be OCD.

Sometimes, the compulsions are physical – and can look very similar to the compulsions that people with contact (physical) contamination display. For example, someone might feel the compulsive need to wash their hands or shower every time they come into contact with a certain person, item, or even a specific word.

Avoidance is another common compulsion for those suffering from this subtype of OCD. Just like people with contact contamination OCD might avoid touching a surface that they think is dirty or has germs, a person with mental contamination OCD may avoid coming into contact with or even thinking about people, places, and things that make them feel anxious and wrong.

Sometimes, these avoided triggers may be people or things that have harmed the sufferer in some way. However, it’s just as common for the triggers to bring up memories or fears of the OCD sufferer harming someone else. Guilt and shame is a very common experience for everyone with OCD, not just this subtype.

Other people may have rituals to neutralize the “dirty” or “bad” feelings associated with their obsessive fears. For example, maybe Jane hears the word “cheater”, and it triggers the obsession that she will somehow actually become a cheater. She starts to feel ashamed and dirty. She might have a mental ritual in which she says an opposite word, loyal, over and over again in her mind to minimize the “harm” done by the offending word.

Just like their obsessions, people with OCD usually understand fairly well that their compulsions are illogical and are unlikely to protect them. But OCD is known as the “doubting disease” for a reason; people with OCD can’t deal with the “What if…” of severe consequences resulting from not performing the compulsion. They may know it’s unlikely to help – and the compulsion may not even be rationally linked to the obsession or fear – but still, they can’t help themselves.

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Magical thinking is a common symptom among OCD sufferers. When people experience magical thinking, their obsessions begin to take on a superstitious quality, to the point where it seems like the OCD sufferer believes they have some sort of magical powers. Their compulsions may become more and more removed from what’s realistically possible.

For example, someone with OCD who feels that by touching the doorknob exactly 3 times before leaving the house somehow protects them from intruders might be suffering from magical thinking. Clearly, the number of times that the person touches the doorknob has no bearing, in reality, on whether or not someone will break in. The person with OCD might even be aware that their actions are illogical – but somewhere in their brain, the urge feels real.

One specific manifestation of magical thinking is described as thought-action fusion, which is an accurately descriptive name for it; sometimes, when people experience magical thinking, they start to believe that by merely thinking something, they’ll cause it to happen.

An example of this is someone who fears that, since they had the intrusive thought “I want my mother to die,” that their mother will then actually, in reality, die. Of course, most of us wouldn’t want to experience such a nasty and untrue thought about our mothers. People without OCD, though, are unable to brush the thought off as just an unpleasant, but ultimately meaningless, thought.

If the person with OCD experiences thought-action fusion, they may start to worry that perhaps they’ve caused their mother’s death in reality just by having this intrusive thought. In other words, the concept of a thought and the concept of an action are magically fused together and indistinguishable.

Many people who suffer from mental/emotional contamination OCD experience magical thinking; some experts say that this subtype of OCD faces magical thinking particularly frequently. This is usually demonstrated in the form of superstitions that are unlikely to be true but that the sufferer can’t stop believing anyway – for example, that putting on a specific shirt associated with a bad memory will make them disgusting or bad.

Obviously, we know that the bad qualities of people, places, and things won’t magically transfer over onto us just by having contact – and the person with mental contamination OCD might know that somewhere deep down, too. But OCD is a debilitating disorder for a reason; no matter how much they “know” it, they probably can’t stop themselves from engaging in compulsions.

Treatment for Mental Contamination OCD

Luckily, there is excellent and effective treatment out there for mental contamination OCD. At the end of the day, all OCD subtypes are the same disease, which means mental contamination is treated using the same methods as ordinary contamination OCD (or any other subtype of OCD, for that matter): and that’s through specific CBT-based interventions.

ERP for Mental Contamination OCD

Exposure and Response Prevention, or ERP, is considered the gold standard for OCD treatment. This CBT-based treatment helps people to expose themselves to triggers that cause OCD spikes, and mindfully respond to the triggered obsessions without engaging in compulsions – the response prevention.

This teaches people that the obsessive thought is just that: a thought. It may be a scary and uncomfortable thought, but it’s still just a thought. By learning to let the thought be present without engaging with it, we teach our brains that we don’t need to treat every intrusive thought as if it were reality. We can continue on with our lives.

Reversely, when we engage with intrusive thoughts by performing compulsions, we teach our brains over and over again that the danger was real and that compulsions are the only way to make ourselves feel less anxious (or to avoid the danger). OCD becomes a vicious cycle that we get trapped in.

Let’s take Jane’s example. In ERP treatment, her therapist would help her to create a hierarchy of her obsessions ordered by the degree to which they cause her anxiety. Jane has the obsession that by coming into contact with anyone who shares a name with her former friend, she will become dirty and contaminated – a cheater.

The ERP therapist would guide Jane, either by meeting someone with that name in reality or by using imagery, to expose herself to this fear. As Jane becomes more and more anxious, she learns to sit with that fear rather than engage in compulsions. She resists her intense urge to avoid that person, to shower, or to say her “lucky” word in her head to protect or “clean” herself.

As you can probably see, ERP is a difficult and scary process – but incredibly effective.

On top of ERP, some other treatments that have been shown to be effective for mental contamination OCD (as well as all other subtypes of OCD) are mindfulness-based interventions and a category of antidepressant medication called SSRIs.

Self-Help for Mental Contamination OCD

Although going through ERP with a qualified OCD therapist is the best treatment available for this disorder, not everyone has this option available to them. Some people also like to have a self-guided program to work through alongside a therapist.

Self-help programs can be very effective for reducing OCD symptoms. The Impulse Therapy program is an audio self-help program that guides you through each step of ERP for your specific type of OCD. If you suffer from mental contamination OCD, the Impulse Therapy program could help you to finally get rid of these terrifying thoughts once and for all.

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