OCD has two essential characteristics – obsessions and compulsions. Obsessions are the intrusive thoughts that come into the person’s mind without their will. Compulsions are the “safety” behaviours that act counter to the obsessions and which relieve anxiety momentarily. Compulsions unfortunately reinforce and maintain the problem.

What is meant by emotional contamination fears?

First, let me just 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 your contact contamination OCD produces a feeling of discomfort that is felt in response to physical contact. Emotional contamination on the other hand, also known as mental contamination or non-contact OCD, is when a triggering stimulus takes place by human interaction. In this case the emotional response occurs without there being an external contaminant.

Why does this happen?

This can, but not always, be linked to an unpleasant memory or event and 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 Sarah developed an aversion towards women.

Can someone have both emotional contamination and contact contamination fears?

Yes, “Sam”, for instance, fears external contaminants such as touching door handles and also coming into contact with the private areas of others, when clothed. Additionally, he suffers intense emotional responses when interacting with certain people without contact. Sam was on the verge of reaching puberty when he acquired OCD. Having to 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, sexually transmitted diseases – STDs).

How do the two together cause distress?

Well, let’s say Sam squeezes past someone in a tight area like the school corridor and makes brief contact with that person below the belt. What happens afterwards is that Sam immediately becomes distressed and will feel the need to use “safety” behaviours without delay. These would be to “de-contaminate” his clothes and to take a lengthy shower to “prevent” becoming infected with a STD. In a non-contact situation Sam has intrusive thoughts that tell him if he is infected he could spread the disease simply by interacting with females. Other intrusive thoughts make him feel that he might infect himself (or someone else) by touching one area of his body and then touching another part of his body (or someone else’s body) that he believes is a vulnerable area for potentially transmitting or acquiring the disease.

Do thinking errors compound the problem?

Certainly a negative interpretation about a person’s obsession is an important factor to note. These interpretations stem from certain beliefs, such as labelling oneself shameful or sullied. As an example, Sarah’s interpretation is: “Women are dirty (thinking error); when I am near them they contaminate me; others then see me as dirty (labelling).”

How else does a person perceive their problem?

As with all obsessional themes, a person usually perceives their problem as one of threat. With emotional contamination OCD a person’s understanding of the problem is based on an irrational concept, which confuses healthy functioning. This would further link to overimportance of thoughts, where emotional reasoning further clouds rational thought about what is humanly okay, and about the person’s true values, which might be that they care deeply about relationships, yet cannot get past the barriers that confuse them; or whatever the difficulty for them might be.

What is the treatment for this type of OCD?

Emotional contamination is essentially 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 thinking errors linked to strongly held beliefs is involved in cognitive therapy, and follows with carrying out behavioural experiments. This is to help disprove the person’s hypothesis.

What is the difference between behavioural experiments and ERP?

ERP has a person agree to face their obsessions in graded steps (exposures) and then resist corresponding compulsions (response prevention). This method builds distress tolerance and 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 example is known as the Theory A and Theory B experiment (Salkovskis & Bass, 1997). In this instance, a person with emotional contamination OCD would look at their problem as worrying (theory B) about what bothers them instead of fearing being under threat (theory A).  

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. One suggestion is for the person to observe others brushing past each other and noting down the different types of responses that occur in this type of situation. For example:

Theory A: The problem is that anyone could be contaminated with a STD and I’m terrified that they might infect me if I brush past them. I would then be 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 great distress.

As noted, by working on rational concepts for theory B the threat element (theory A) starts to weaken.

How can a person who is afraid to use theory B overcome emotional contamination fears?

There are times when a person controlled by OCD will convince themselves they do not want a war with the disorder. They fear living with risk and uncertainty, even when that risk is extremely low. In some sense they make a pact with OCD because they believe OCD keeps them “protected”. Sometimes, it takes time for a person in this type of situation to dare to open up. When they are ready then standard CBT would gently address past issues to briefly elicit and locate possible triggers; however, these are not the focus of therapy. The focus is on how the person influences what happens next, in the present, and with the purpose of reaching desired goals. Motivational Interviewing is useful because this uses open questions and helps the person find their own rational answers, and where they agree with themselves that it’s okay to make solution-focused decisions.

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