OCD subtypes
Contamination OCD

What Is Contamination OCD and How Common Is It? Your Guide to the Misunderstood OCD Subtype

5 min read
Keara Valentine
By Keara Valentine

Contamination OCD is a subtype of obsessive-compulsive disorder (OCD) where a person experiences obsessive thoughts around fears of becoming contaminated, contaminating others,  or contracting and spreading disease. These thoughts are a significant source of anxiety, and are accompanied by compulsive actions like excessive hand-washing or repeatedly sterilizing surfaces. 

Though everyone might worry about an unclean surface at one point or another, for people experiencing contamination OCD, the anxiety these thoughts cause is incredibly high. The thought patterns can last for hours and often don’t subside unless the individual takes a compulsive action designed to neutralize the anxiety. 

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Fear of germs accompanied by hand-washing might be the most commonly discussed form of contamination OCD. However, there are many different ways this subtype can manifest. Some examples include avoiding crowded spaces, avoiding certain objects (like doorknobs) or surfaces for fear that they are contaminated, and frequently changing clothes. A person experiencing this subtype of OCD might have obsessive thoughts like, “I just gave my sister’s baby a serious illness when I held him,” or, “This whole place is full of bad bacteria, I can just tell.” 

How common is contamination OCD?

Contamination OCD is likely what most people think of when they hear the term OCD. It’s also one of the more common subtypes of OCD. In fact, it is one of the commonly listed “symptom dimensions” in the DSM-5, along with symmetry, forbidden/ taboo, and harm thoughts., It is estimated that at least four percent of the population experiences some form of OCD. While it’s difficult to say exactly how many people experience contamination OCD, we can deduce that it is likely a significant percentage of individuals with OCD. 

Because contamination OCD takes many forms, and varies widely from person to person, it can be difficult to diagnose.

Oftentimes what people believe to be OCD doesn’t adequately depict the experiences of those with contamination OCD despite it being one of the more widely recognized subtypes.  For example, mainstream media often portrays individuals with contamination OCD as being highly neat and organized. They may be shown as being diligent in cleaning or living in a spotless home with no sign of dust, mess, or clutter.. However, a person with contamination OCD might engage in different compulsions or experience their OCD in ways not accurately represented by the media’s depictions. For example, a person might spend hours researching the expiration dates of food in their fridge, might leave garbage in their home due to fear of becoming contaminated while disposing of it,  or might engage in excessive research around contamination, bacteria, and how to prevent contamination. Since this isn’t what most people think of when they think about OCD, it might be hard to identify the condition. Likewise, aperson could spend hours performing mental rituals, such as keeping mental lists of what is clean and what is dirty which is not perceivable  from an outsider’s perspective.

As described, a person with contamination OCD could be characterized as simply being overly anxious, neat and organized. However, these stereotypes are not accurate depictions of all of those who experience this distressing and impairing diagnosis and misunderstanding can prevent someone from seeking out proper treatment. 

Common compulsions for contamination OCD

Some common compulsions people use to deal with contamination OCD include: 

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  • Repeatedly and excessively washing your hands or showering 
  • Throwing away items because they might be contaminated
  • Using harsh chemicals on your skin to stay clean
  • Excessively researching germs and illnesses
  • Scraping off skin you think might be contaminated 
  • Excessively changing clothes 
  • Avoiding specific places or touching objects for fear that they are contaminated
  • Excessively and repeatedly sterilizing objects around you
  • Creating a safe space or “off limits” section in your home that is clean and that others cannot enter
  • Performing certain rituals like praying, knocking, repeating or thinking certain thoughts
  • Maintaining mental lists of items that are clean versus items that are dirty 

Another common fear within this OCD subtype is an intense and excessive fear of contracting an STI, becoming sick or contracting a terminal disease, which could lead those that experience such thoughts to avoid saying words associated with STIs, or seek outexcessive and repeated health tests to be absolutely certain a person is healthy. 

Contamination OCD can significantly impact people’s relationships with others. For instance, individuals with this subtype of OCD may seek reassurance from others, such as repeatedly asking a loved one if a particular surface is contaminated or if a particular object has been thoroughly cleaned. In some cases, people might go out of their way to avoid a particular relative or friend for the fear that they might be contaminated or refrain from engaging in intimate physical contact.

Treatment options for contamination OCD

The good news is that treatment is available for people experiencing contamination OCD. Exposure and response prevention (ERP) therapy, a specific type of cognitive behavioral therapy (CBT), has proven to be an effective method of treatment for contamination OCD and OCD more broadly. Research shows that 80% of patients respond positively to ERP, and it is considered to be the gold standard for OCD treatment. 

When someone is living with contamination OCD, there is a cycle of obsessive thoughts followed by a compulsive action to alleviate those thoughts. For example, exposure to a public restroom could cause an acute anxiety of germs, followed by compulsive ritualistic hand-washing. But the compulsive action doesn’t make the fear go away; it only alleviates it temporarily. The idea behind ERP is that in order to break the cycle, a patient has to expose themselves to the cause of the compulsive action (in this case, the public restroom) and then resist the urge to alleviate the fear with the compulsive action. This allows them to learn that they can tolerate the discomfort or anxiety.

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Though the process can initially create anxiety, in the long run, it has been found to be effective in reducing the fear associated with the specific perceived threat, by helping patients realize that the danger they are perceiving — whether of a doorknob, a surface or something else — won’t materialize if they fail to act or that they will be able to manage if it does.
If you’re interested in learning more about ERP, you can check out the NOCD app or schedule a free call with the NOCD clinical team to learn about treatment options and be matched with a therapist who specializes in treating OCD and has received ERP-focused training. You can also join our Contamination OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

Keara Valentine

Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.

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Ted Faneuff

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Naveen Mohideen

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Licensed Therapist, LCSW

I’m a licensed therapist with specialized training in treating OCD using Exposure and Response Prevention (ERP) therapy, the gold standard of treatments. ERP treats all types of intrusive thoughts, including violent and taboo, so that you can overcome OCD.

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