When we think of obsessive-compulsive disorder or OCD for short, lots of examples spring to mind. For example, someone who won’t shake your hand, touch a door handle, or borrow your pen without being compelled to wash their hands, all because of a fear of germs. I’m sure many of us are guilty of using the phrase “you’re so OCD” to categorize our friends, family, and colleagues who have obsessive cleaning habits or use their antibacterial hand gel a few too many times a day.
Despite this being a very over-simplified idea of OCD, it’s based on an important and common feature for many sufferers; contact contamination fear. Contact contamination can be described as a feeling of dirtiness or discomfort that is felt in response to physical contact with harmful substances, disease or dirt, which will contaminate the body, most often the hands. Relief can be felt in response to cleansing the contaminated areas, for example through hand washing. Much of the focus by academics in previous literature has been on contact contamination, as well as focus from the media, which surrounds us with examples of contamination fears in OCD through TV series such as Obsessive Compulsive Cleaners and Monk.
However, for some sufferers the feelings of discomfort and dirtiness can also be caused without physical contact with something that is dirty or germy. Instead, feelings of contamination can be triggered by association with a contaminated person who has betrayed or harmed the sufferer in some way, or even by their own thoughts, images or memories. This ‘mental contamination’ leads to an internal sense of dirtiness, rather than being localized to a particular body part, and therefore can’t be cleansed away by hand washing. For example, one patient, “Jenny” started feeling internally dirty after she discovered that her husband had been unfaithful and her marriage broke down. She would feel dirty and wash her hands after touching any of his possessions or speaking to him on the telephone. “Steven” also experienced severe mental contamination that was triggered by intrusive images of harming others. The source of mental contamination is not an external contaminant such as blood or dirt but human interaction. The emotional violations that can cause mental contamination include degradation, humiliation, painful criticism, and betrayal.
There is much less knowledge of mental contamination amongst the public, possibly due to a lack of focus on the topic by professionals, meaning we simply don’t recognize examples or situations in which we might feel mentally contaminated. Similar to the normative experience of contact contamination, there are numerous examples of feeling contaminated without touching something dirty in everyday life, for example the washing away of sins when being Baptized, or when cleansing the body for worship; known as Wudu in Islam. Sins here are referring to an internal type of uncleanliness, which can be provoked without contact, for example through having blasphemous thoughts. Another example is not listening to a song which reminds you of an ex-partner who wronged you, as it makes you feel tarnished inside. Even the phrases we use can be seen as representing a form of mental contamination, for example “dirty money”, “muck up”, and “feel like dirt”. Milder forms of mental contamination are prevalent in society, for example in the course of a bitter divorce, where a wronged person develops feelings of contamination that are evoked by direct contact with the violator or indirect contacts such as memories, images or reminders of the violation.
A lack of knowledge of mental contamination is perhaps also due to it being a harder concept to comprehend than contact contamination. We can all understand the math behind contact contamination; you touch something dirty, your hands become dirty, you wash your hands, the dirt is gone, you feel relief. The process makes logical sense, as the cause is visible. Mental contamination can be seen in the same way, it just doesn’t require a visible cause, and often the cause is associated with a previous psychological or physical violation. Without this visible cause for their problems, the true source of discomfort is often unknown to sufferers. Imagine you’re taking part in an experiment, you’re asked to try on a jumper which was brought from a charity shop, and report your feelings. If you know the jumper is physically clean, you’d probably feel fine, no discomfort, you might even like wearing it. Now, imagine being told that the jumper belonged to a murderer, and suddenly for no explainable reason you aren’t okay with wearing it anymore. You have that disturbing, spine-tingling, and shivery feeling as if the jumper were made of tarantulas. Despite knowing the jumper is physically clean, there’s a cloud of dirtiness hanging over it, and you feel mentally contaminated.
Intrusive thoughts associated with mental contamination are normal, but it is the interpretation of the thoughts that is important in determining whether or not the person will then engage in compulsive washing behaviour. To you or me, these are just weird feelings which are easily forgotten, but to someone with mental contamination they are harmful, and could damage their personality in some way. Take the jumper scenario; a person suffering from mental contamination might worry that somehow they will adopt the negative traits of the murderer through their clothing.
The discovery of mental contamination has large and immediate implications for clinical treatment. Cognitive behavioural therapy can be used to effectively treat mental contamination in OCD patients, by changing the meaning or interpretation of obsessive intrusive thoughts, so that they are no longer seen as harmful. Subsequently, this also reduces the frequency of compulsive washing behaviours. For many OCD sufferers Cognitive Behavioural Therapy provides hope that a life free from the daily interference of mental contamination and compulsions is achievable.
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