OCD: Coping with Contamination Fears and Anxiety

Q: OCD: Coping with Contamination Fears and Anxiety

Hello： Thank you for your hard work! Being troubled by such symptoms can be very distressing. <br>Your symptoms seem to indicate a high possibility of obsessive-compulsive disorder (OCD), but a definitive diagnosis can only be made through an in-person evaluation by a physician.

Obsessive-Compulsive Disorder (OCD) with a focus on cleanliness?

Hello, doctor: Four years ago, I had gastroenteritis and experienced diarrhea, which caused some fecal matter to accidentally get on my pants.
I washed them in the washing machine along with my clothes, and since then, I have been constantly ruminating about this incident, believing that it could contaminate my other clothes.
I worry that those clothes will come into contact with various surfaces, and that my home will be contaminated as well.
I also fear that I will spread this contamination to others when I interact with them.
I find myself repeatedly asking friends and family if they think things are dirty, and they all feel that I am overreacting.
After four years of this, they are quite annoyed by my questions.
I really don’t want to think about it, but these thoughts inexplicably arise, and honestly, it’s exhausting.

Perhaps because of this incident, my obsessive-compulsive tendencies have intensified over the past four years.
For example, when using the restroom, I worry that the urinal might splash, so I hesitate to use it.
After using it, I am afraid to touch my pants, fearing they might be contaminated with urine.
I feel the need to wash my watch because I think it might have been splashed on, and I don’t allow others to touch my pants for fear of contaminating them.
When I see family members at home only wearing underwear, I feel anxious if I accidentally touch their underwear, believing that everything will be contaminated with their urine.
I don’t want to seem like I disdain them, but I can’t help feeling anxious.

I have come across exposure response prevention therapy and have tried it myself by intentionally not thinking about it or cleaning, and by redirecting my attention.
I recognize that these thoughts are compulsive, but my condition still fluctuates; I often wonder why I am like this and wish I could be more relaxed like many others.
Are these symptoms indicative of obsessive-compulsive disorder?

Niming, 20~29 year old female. Ask Date: 2020/11/12

Dr. Lin Mianzhang reply Psychiatry

Hello: Thank you for your hard work! Being troubled by such symptoms can be very distressing.
Your symptoms seem to indicate a high possibility of obsessive-compulsive disorder (OCD), but a definitive diagnosis can only be made through an in-person evaluation by a physician.
It appears that you have also attempted exposure and response prevention, which is indeed very challenging, as many OCD patients are resistant to this type of therapy.
Therefore, your ability to engage in this is highly commendable.
The exact causes of OCD are still not fully understood, but research suggests that it may be related to abnormalities in neurotransmitter levels (such as serotonin and norepinephrine) and dysfunction in certain brain regions (such as the orbitofrontal cortex, caudate nucleus, and thalamus).
Additionally, various psychological stressors may also influence the occurrence of symptoms.
Therefore, to effectively overcome the interference caused by OCD, a multi-faceted approach is recommended for optimal treatment outcomes.
I suggest seeking professional assistance from a psychiatrist, as medication combined with psychotherapy can significantly improve your symptoms.
Wishing you a speedy recovery!

Reply Date: 2020/11/12

More Info

Your situation indeed reflects symptoms commonly associated with Obsessive-Compulsive Disorder (OCD), particularly the contamination fears you've described. OCD is characterized by intrusive thoughts (obsessions) that lead to compulsive behaviors aimed at reducing the anxiety caused by those thoughts. In your case, the fear of contamination stemming from a past experience with gastrointestinal distress has led to a cycle of obsessive thinking and compulsive cleaning behaviors.

The specific incident you mentioned—accidentally washing soiled clothes—seems to have triggered a heightened sensitivity to contamination. This is not uncommon; many individuals with OCD can trace their symptoms back to a specific event that instilled a deep-seated fear. Your compulsive behaviors, such as excessive handwashing, avoiding certain situations, and asking others about cleanliness, are attempts to manage the anxiety that arises from these intrusive thoughts.

It's important to recognize that OCD is not simply a matter of being overly tidy or cautious; it is a mental health condition that can significantly impact daily functioning and quality of life. The distress you feel from these thoughts and the compulsions you engage in to alleviate that distress can be exhausting, as you have noted.

Cognitive Behavioral Therapy (CBT), particularly a subtype known as Exposure and Response Prevention (ERP), is considered one of the most effective treatments for OCD. ERP involves gradually exposing yourself to the sources of your anxiety (in this case, situations you perceive as contaminated) while refraining from engaging in your usual compulsive behaviors. This process can help you learn that the anxiety will decrease over time without the need for compulsive actions, thereby breaking the cycle of OCD.

You mentioned attempting to practice exposure by not cleaning or trying to redirect your thoughts. This is a good start, but it can be challenging to do alone, especially if you're experiencing significant anxiety. Working with a therapist who specializes in OCD can provide you with structured support and guidance as you navigate this process. They can help you develop a personalized exposure plan that gradually increases your tolerance to the anxiety-provoking situations.

In addition to therapy, medication can also be beneficial for managing OCD symptoms. Selective Serotonin Reuptake Inhibitors (SSRIs) such as fluoxetine (Prozac) or sertraline (Zoloft) are commonly prescribed for OCD and can help reduce the intensity of obsessive thoughts and compulsive behaviors. If you are not currently on medication, discussing this option with a psychiatrist may be worthwhile.

It's also essential to practice self-compassion. Understand that OCD is a condition that many people struggle with, and it does not define who you are. Engaging in mindfulness practices, such as meditation or deep breathing exercises, can also help you manage anxiety and develop a more accepting relationship with your thoughts.

In summary, your experiences align with OCD symptoms, particularly concerning contamination fears. Seeking professional help through therapy and possibly medication can significantly improve your quality of life. Remember, recovery is a journey, and it's okay to seek support along the way. You are not alone in this, and with the right tools and support, it is possible to manage your symptoms effectively.

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