The term OCD (obsessive compulsive disorder) has become overused and dilutes the actual experience. Myths and flippant remarks undermine the gravity of this illness and its serious impact on the person, their relationships and working life.
A clinical diagnosis of OCD refers to unwanted obsessions and compulsions that significantly impede daily functioning and cause significant distress. In about 80 per cent of cases, onset of symptomatology occurs before 18 years of age. Onset is a result of a complex interaction of biological, psychological and environmental factors. The contamination subset involves an intense feeling of having been infected, dirtied or endangered after contact with someone or something. This type of OCD is the most common subset in the world.
OCD-UK list a range of triggers associated with the contamination subset such as using public toilets, shaking hands, touching handles and other used areas, GP waiting rooms, hospitals, being in a crowd and wearing clothes. Viruses, bacteria, mucus and bodily fluids all cause extreme suffering and can induce panic. Ritualised, repetitive behaviours are engaged in to relieve the discomfort and the extreme anxiety experienced. Avoidant and neutralising behaviours provide temporary relief but negatively reinforce the compulsions.
Washing clothes, showering for hours, scrubbing hands raw or cleaning excessively all feature. The person needs to 'feel' clean and may be terrified of contracting serious diseases or fear that loved ones will be infected. The famous business magnate and film director Howard Hughes disappeared from public life at the age of 46 and isolated himself to avoid contamination. Having his hair cut involved hours of rituals. In a psychological autopsy, it was revealed that he burned his clothing if someone near him was ill. He forced his compulsions on others, requesting staff to wash their hands multiple times and to cover them with paper towels when serving food.
Magical type contamination includes thoughts, words, mental images and places. Decontamination rituals are used such as saying certain words, prayers or washing in a certain way to cancel out the fear or to to ‘feel’ right. Family members are often drawn in to provide reassurance, told not to touch certain things or asked to clean in a certain way. Such interrogations can create tension and stress. There are often fears that contamination has transferred or spread, and that others are carriers of contaminants. The person’s system incorrectly identifies the triggers as dangers.
Contamination OCD
Contamination OCD is a maladaptive reaction to commonplace experiences of disgust and discomfort. Their alarm response gets activated, but it is a false alarm, everytime. A large body of evidence links feelings of disgust to the fear of contamination. Recent research has identified that exaggerated disgust reactions can drive contamination based symptoms. Disgust activates the parasympathetic nervous system resulting in physiological reactions such as nausea.
While some who experience OCD contamination are in fear of harm, others try to eliminate feelings of disgust. Research also shows that OCD and trauma have a significant overlap. Psychologist Stanley Rachman proposed that people are more susceptible to experience obsessions when exposed to stressful events.
So what does the research reveal about the treatment of OCD contamination?
Even the most severe cases have had symptoms alleviated. Like with all mental health issues, hope needs to be instilled. According to the International OCD Foundation, exposure and response prevention remains the most accepted form of treatment. At a strategic pace, the individual is exposed to triggers, resists engaging in compulsions and learns coping skills to handle anxiety levels.
Cognitive therapy is effective in challenging faulty beliefs and promoting healthier thought processes, such as: “Nothing will happen if I touch this.” As many who are diagnosed are prone to over thinking, methods to stay out of the head are introduced.
However, there are those who are left with treatment resistant OCD. As a counselling psychologist, I feel a positive therapeutic alliance and going beyond the label is essential. Empathy, non- judgment and active listening play a vital role. For some, even getting to outpatients or the therapy room is like walking through a mine field. Professionals need to be educated about the person’s triggers and psychoeducation explored with the individual. An understanding of what OCD contamination is and is not and what is reality versus OCD, lays the foundation for further interventions.
DIY steps
Some DIY steps that will be useful include a visit to your GP, accepting that it is OCD and that the fears or feelings that elevate levels of discomfort can be tolerated. Think about what small steps you can take to slow the mental washing machine on fast spin such as exercise, activities, new interests, creativity, daily mindfulness practices. Listen to music, dance or play an instrument. Structure your day and activate healthy routines. Build up your non-OCD world. Studies have shown that adequate sleep, avoiding screens and stimulants at least one hour before bedtime and keeping a regular sleep pattern benefits mental health.
There is a plethora of workbooks with which to educate yourself and others in your life. Set up some daily achievable OCD related goals for yourself. If someone close to you struggles with OCD contamination, you may need support for yourself and healthy outlets to cope with stress. Try not to criticise or tell them to stop but instead empathise, praise any progress and try not to collude with their OCD. Develop a mutually agreed plan. Remind them that it is OCD, to use breathing exercise, distractions and other strategies that they are trying to implement.
There is no one size fits all solution and each person needs to be understood in their own right, beyond the label. Addressing a traumatic event without re-traumatising may be important to recovery. Insight based therapy is not enough. While the established first line treatments are cognital behaviour therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), not all respond adequately.
The latest cutting edge research is investigating brain structures using imaging data which will help develop treatment that works better and faster. However professor of psychology Adam Radomsky and others are concerned that neuroscience may become further and further away from those who experience and treat OCD. Researchers and practitioners need to work closely with each other and learn from those who live with this every day.
Pharmacological augmentation, specific support from family and friends, a positive rapport with professionals, a combination of treatment modalities, home assignments and lifestyle changes are all part of the alleviation of suffering.
