Overcoming Obsessive Cleanliness: Coping with Fear of Contamination

I'm worried about getting dirty..?

Hello Doctor: I am extremely afraid of dirt and even more terrified of homeless people on the street.
Just brushing against them or walking on the path they have taken makes me feel dirty.
I constantly wash my hands, take showers, and wipe down everything, including my bag and its contents, with wet wipes.
Every time I encounter a homeless person, I feel immense distress.
I can't understand what happens when I come into contact with them.
Why do I always feel dirty? My family cannot understand me; they think that encountering a homeless person is not a big deal.
Should I try to come into contact with homeless people without cleaning myself afterward to see what happens? I have seen a doctor, but the medication has not improved my condition.
The doctor said that compulsive disorders are ineffective with behavioral therapy and can only be treated with medication, but even with medication, I still find myself repeatedly washing after encountering a homeless person.
Am I hopeless? Will medication really help with my obsessive-compulsive disorder? Please, doctor, I would appreciate your response.
Thank you!

Xingxing, 20~29 year old female. Ask Date: 2016/02/19

Dr. Ding Shuyan reply Psychiatry

Hello, compared to behavioral therapy for obsessive-compulsive disorder (OCD), medication often leads to faster improvement.
However, the effects of medication may not be immediately apparent within one or two months, and the dosage may need to be gradually increased to a moderate or high level.
Therefore, it is important to take medication as prescribed by a physician and patiently wait for its effects.
Everyone has things they fear or dislike; some people are afraid of snakes, heights, mice, cockroaches, etc.
When confronted with these fears, it can feel as if the brain is shocked, leading to a tingling sensation, increased heart rate, and panic.
However, once they escape the situation, most people do not dwell on it and naturally shift their focus to the next task.
In contrast, obsessive thinking involves fixating on distressing images or thoughts, worrying about the potential negative outcomes and the harm it may cause oneself, and how to resolve it.
In reality, the situation that triggered these thoughts no longer exists in the present moment.
Constantly ruminating does not help alleviate anxiety; instead, it often intensifies it.
As the saying goes, if worrying could solve problems, then everyone should worry together! In fact, one should learn to respond like an average person, gently redirecting attention to the current tasks at hand, allowing those thoughts to fade away naturally.
Wishing you all the best.
Sincerely, Dr.
Ding Shuo-Yan.

Reply Date: 2016/02/19

More Info

Overcoming obsessive cleanliness and the fear of contamination can be a challenging journey, especially when it manifests as obsessive-compulsive disorder (OCD). Your description of feeling extreme anxiety when encountering homeless individuals and the subsequent compulsive behaviors—such as excessive washing and cleaning—indicates that you may be experiencing symptoms commonly associated with OCD.
OCD is characterized by intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions) aimed at reducing the anxiety caused by those thoughts. In your case, the fear of contamination from street individuals triggers a cycle of anxiety and compulsive cleaning behaviors. This cycle can be exhausting and distressing, as you have described.

It's important to understand that your feelings are valid, even if they may seem irrational to others. The fear of contamination is a common theme in OCD, and it can be exacerbated by societal perceptions and personal experiences. The fact that you feel compelled to clean after encountering someone you perceive as "dirty" is a reflection of the anxiety that OCD can create.
While medication can be beneficial for managing OCD symptoms, it is often most effective when combined with cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP). ERP involves gradually exposing yourself to the source of your anxiety—in this case, the fear of contamination from street individuals—while refraining from engaging in the compulsive behaviors that typically follow. This approach can help desensitize you to the anxiety-provoking situation and reduce the compulsive need to clean.

You mentioned that you have seen a doctor and are currently on medication, but you still feel the urge to clean excessively. It’s crucial to communicate openly with your healthcare provider about your ongoing symptoms and concerns. If you feel that medication alone is not sufficient, you might want to explore the possibility of therapy, specifically CBT with a focus on ERP. Many individuals find that combining medication with therapy leads to more significant improvements in their symptoms.

Additionally, it may be helpful to practice mindfulness techniques and grounding exercises. These can assist in managing anxiety in the moment and help you to focus on the present rather than getting caught up in obsessive thoughts about cleanliness. Techniques such as deep breathing, progressive muscle relaxation, or even engaging in activities that bring you joy can serve as effective coping mechanisms.

You also raised a valid question about whether you should try to confront your fears by not cleaning after encountering a street individual. This is a fundamental aspect of ERP. However, it’s essential to approach this gradually and with the guidance of a mental health professional. Jumping into exposure without proper support can lead to overwhelming anxiety and may reinforce the compulsive behaviors rather than diminish them.

Lastly, remember that recovery from OCD is often a gradual process. It requires patience, persistence, and a willingness to confront uncomfortable feelings. Many people with OCD find relief and improved quality of life through a combination of medication, therapy, and self-help strategies. You are not alone in this struggle, and with the right support and treatment plan, it is possible to manage your symptoms effectively.

In conclusion, I encourage you to seek a comprehensive treatment approach that includes both medication and therapy. Open communication with your healthcare provider about your experiences and feelings is crucial. Recovery is possible, and many individuals with OCD lead fulfilling lives with the right support and strategies in place.

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