What is meant by non-contact contamination fears?
First, let me briefly touch on contact-contamination fears. 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 lengthy handwashing ritual. Here you can see that a contact contamination obsession produces a feeling of discomfort that is felt in response to physical contact. Non-contact contamination, on the other hand, is when a triggering stimulus takes place by human connection. Also, the fear can be interaction with an animal, 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. This can, but not always, be the environmental onset for developing OCD, if predisposed. 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 contamination and contact contamination fears?
Yes, “Sam” fears coming into contact with germs by touching door handles (contact contamination); and also being close to the private area of another person, 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).
For example, when Sam squeezes past someone in a busy area like the school corridor and makes brief contact with that person below the belt, he immediately becomes distressed. Subsequently, he feels the need to use “safety” behaviours without delay. These would be to “de-contaminate” his clothes and take a prolonged shower to “prevent” becoming infected with an STD. Moreover, he starts to ruminate about being contagious and that he’ll spread the disease by mixing with others despite there being no contact.
Sarah, on the other hand, has a fear of feeling filthy by being close to females, which triggers the dirty sensation. She also cannot tolerate underwear from female family members being put in a laundry basket, going in the washing machine or being hung out to dry. Also, seeing, reading or hearing words associated with menstruation makes her feel unclean.
Do thinking errors confuse the problem?
Yes, a negative interpretation of a person’s obsession is a crucial factor to note since these interpretations stem from particular beliefs, such as labelling oneself shameful or sullied. As an example, Sarah’s argument is: ‘Women who menstruate are dirty (thinking error); when I am near them, they contaminate me and that makes me dirty (labelling).’
How else might a person perceive their problem? As with all obsessional themes, an individual usually thinks about their problem as one of “threat”. Their understanding of the problem is irrational and links to over-importance of thoughts. In other words, emotional reasoning clouds rational thinking about what is humanly okay; the person tends to overthink things, and will question their real values. This might be that they care deeply about relationships, or feel sentimental about particular objects, but cannot get past the barriers that confuse them.
How do objects play a part in emotional contamination?
Sam, for example, will not touch anything belonging to a person he thinks is contaminated. To him, handling the object has him thinking he’ll be infected with the other person’s “disease”. There are other instances where people pick up “bad vibes” from specific devices and will stay clear of them. In other cases, people believe someone’s habits, traits or sexual orientation can pass to them through two-way interaction or spread from an interchange with someone else onto them. Receiving mail from someone, or talking with them on the phone are other exchanges that make them think they can become contaminated.
What is the treatment for this type of OCD?
Contact contamination is primarily a cognitive disorder (S. Rachman). Because an environmental factor is often at the root of the problem, a cognitive approach would be the treatment of choice. Correcting someone’s thinking errors, which are linked to firmly held beliefs, is involved in cognitive therapy. Additionally, carrying out behavioural experiments helps to strengthen cognitive change, including exposure response prevention (ERP).
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.
One example is known as 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). To put this another way, Worry (theory B) is to feel anxious about something unpleasant that may have happened or may happen in the future, and Threat (theory A) comes with “warning signals”.
A person agrees in therapy 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 people being infected with an STD is close to zero.
Since counselling (active listening) is at the core of cognitive behavioural therapy, this method can gently address past issues by briefly eliciting and locating possible triggers. However, this is not the focus of treatment. The attention centres on how the person influences what happens next. In which case, a therapist keeps the person in the present and helps them resolve past events that may have latched on to the obsession (refer to Sam and Sarah’s past events). The outcome for bringing in different methods (eclectic approach) helps people like Sarah and Sam overcome their contamination fears.