What is meant by non-contact contamination fears?
To describe contact-contamination fears first, let’s suppose you have an aversion to shaking hands with people. Now let’s assume the fear is that you’ll catch a disease and spread germs. After shaking hands, you might first use anti-bacterial wipes followed by a prolonged handwashing ritual. You can see how it produces a feeling of discomfort in response to physical contact. Non-contact contamination OCD, on the other hand, is when a triggering stimulus takes place by human or animal interaction without touching. Also, handling an inanimate object or through word association.
Why does this happen?
Non-contact contamination fears, also known as mental or emotional contamination OCD, can be linked to an unpleasant memory or event. If predisposed, this can, but not always, be the environmental onset for developing OCD. For example, as a small child, “Sarah” shared a toilet cubicle with her “aunt”. On seeing she was menstruating and not understanding what it was, she remembers being horrified. After her first menstrual cycle, she developed an aversion towards women, triggering emotional contamination fears.
Can someone have both emotional and contact contamination fears?
Yes, “Sam” fears coming into contact with germs by touching door handles (contact contamination); and also being close to the groinal area of others, even when clothed.
Why would someone’s emotional contamination fears be focused on the private areas of others?
Well, Sam, for example, was on the verge of reaching puberty when he acquired OCD. Having to reluctantly sit in sex-education classes reinforced to him that his body was changing. Yet, emotionally, he hadn’t reached the stage for grasping the concept of what was involved in the topics discussed (e.g., relationships, birth control and sexually transmitted diseases – STDs).
How else is someone affected?
Imagine Sam squeezes past someone in a busy area like the school corridor and makes brief contact with that person below the belt. What happens is that he immediately becomes distressed and feels the need to use “safety” behaviours without delay. These would be to “de-contaminate” his clothes and to take a prolonged shower to “prevent” becoming infected with an STD. Even after washing and changing, he starts to ruminate (thinking compulsion) about being contaminated. He fears that he’ll spread the disease by merely interacting with others despite there being no contact. As a further example, Sarah has a fear of feeling filthy by being close to females with or without touching. She also cannot tolerate anyone putting female underwear in a laundry basket or the washing machine. Just the sight of underwear makes her feel dirty.
Do thinking errors confuse the problem?
A negative interpretation of a person’s obsession can worsen the problem. These interpretations stem from particular beliefs, and with those beliefs, the person tends to label themselves. Sarah labels herself dirty and shameful. As an example, her argument is: “Women who menstruate are contaminated (thinking error); when I am near them, they contaminate me; that makes me dirty (labelling).”
What’s another way a person might see their problem?
As with all obsessional themes, an individual usually sees their problem as one of “threat”. Their understanding of the problem is irrational and links to over-importance of thoughts. In other words, their emotional reasoning clouds rational thinking about what is humanly okay; they tend to overthink things, and will question their real values. It might be that they care deeply about relationships, or feel sentimental about particular objects, for example, but cannot get past the barriers that confuse them.
How do objects play a part in emotional contamination OCD?
Sam, for instance, will not touch anything belonging to a person who he thinks could be infected with an STD. To him, this would mean the spread of disease. In other instances, people believe someone’s traits or sexual orientation can pass to them by interacting with them, receiving mail from them, or talking with them on the phone etc. There are other instances where people pick up “bad vibes” from particular objects and will stay clear of them.
What makes someone think another’s traits or sexual orientation can pass to them?
It relates to thought-action fusion (TAF). Some people think something terrible is more likely to happen because they had a thought about it, which is likelihood TAF. Others think they are more capable of doing something wrong because they thought about it – this is moral TAF. And others think objects bring an eerie disturbance, or that another’s presence can transmit through correspondence as in the example of an email, video call, phone call or letter. They feel an uncanny uncomfortableness in which they think an unwanted trait or sexual orientation will pass to them – this is object-TAF.
What is the treatment for non-contact contamination fears?
Exposure-response prevention (ERP) is the tried and tested formula that can reduce symptoms or lead to remission. But because emotional contamination OCD is primarily a cognitive disorder (S. Rachman), a cognitive approach would be most helpful. Cognitive therapy would address the environmental factor that is often at the root of the problem, previously noted. Correcting thinking errors linked to firmly held beliefs for Sam and Sarah and carrying out behavioural experiments helps disprove their fears.
What is the difference between behavioural experiments and ERP?
First, ERP has someone agree to face their obsessions in graded steps (exposures) and then resist all corresponding compulsions (response prevention). This method builds a tolerance to distress, reduces the urge to ritualise, and eventually starves the obsession. A behavioural experiment differs in that the person gathers information about their feared belief, which is then discussed and resolved in the therapy session.
Do you have an example of a behavioural experiment
One approach is the “Theory A and Theory B” experiment (Salkovskis & Bass, 1997). In this instance, a person with non-contact contamination OCD would look at their problem as worrying (theory B) about what bothers them instead of having a fear of being under threat (theory A).
Worry (theory B) is to feel anxious about something unpleasant that may have already happened or may happen in the future, and threat (theory A) carries “warning signals”.
What a person does is agree to test out theory B by finding workable solutions to overcome their worry, thus removing the threat element. Sam, for example, might be instructed to observe others brushing past each other and noting down the different types of responses that occur in this type of situation. Later, discussion with his therapist would be to clarify the following:
Theory A: The problem is that anyone could be contaminated with an STD, and I’m terrified that they might infect me if I brush past them. I would then be infectious and a threat to others.
Theory B: The problem is that I care very much about closeness with others and the thought that they could contaminate me causes me a lot of distress. My behavioural experiment has shown me that the likelihood of becoming infected with an STD by brushing past someone is close to zero.
How else can treatment help?
Part 2 of this document looks further into treatment options and includes two therapist-patient dialogues on motivational interviewing. Plus, a homework check to reinforce the learning objective is included. A password will be sent to your email address after a £1 donation to help support children and their families living with OCD has been processed. Please allow 1-3 days for the password to arrive in your inbox. Please see below for payment instructions. Groups welcome, simply click the arrow button to add the number of people you want in your interactive group. Thank you.
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A Solution to Reducing Non-Contact Contamination Fears
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