Contamination OCD: fear of germs, washing compulsions and treatment

The NHS explains that OCD affects people differently but usually involves an unwanted, intrusive and often distressing thought, image or urge, intense anxiety, and compulsions that temporarily relieve the anxiety before the obsession returns. Contamination OCD is the form in which the feared outcome is dirt, germs, illness or harm from touching something.

OCD-UK describes contamination as one of the traditional main categories of OCD alongside checking, symmetry and ordering, ruminations and hoarding, and says the fear is often that contamination might cause harm to oneself or a loved one. The common compulsions are to wash, clean or avoid.

Most people with OCD recognise that the behaviour is irrational but cannot stop acting on it and feel they need to do it "just in case", according to the NHS. That insight is part of what makes the condition distressing rather than reassuring.

OCD-UK gives many examples of contamination worries. They illustrate how widely the fear can spread.

• Avoiding public toilets, door handles, banisters, money, shaking hands or eating out because of fear of germs from other people.

• Washing or cleaning repeatedly, with rituals continuing until it feels clean.

• Showering or changing clothes after being outside, or keeping indoor and outdoor clothes separate.

• Avoiding particular places or people.

• Physical effects from constant scrubbing and cleaning on the skin, especially the hands, which OCD-UK says can be scrubbed until they bleed.

• Needing reassurance, such as asking others to confirm that something is clean; the NHS lists asking for reassurance among common compulsions.

OCD-UK describes a less obvious form called mental contamination. It says feelings of mental contamination can be evoked by times when a person felt badly treated, physically or mentally, through critical or verbally abusive remarks, so that they feel like dirt. The feeling of being unclean does not need physical contact with a dirty object, and the source is almost always human.

The person may engage in repetitive and compulsive attempts to wash the dirt away by showering and washing, which is where the similarities with contact contamination return. Treatment is similar, but it can help for the therapist to understand which kind of contamination is present.

The NHS says it is important to get help if you think you have OCD and it is having a significant impact on your life, and that OCD is unlikely to get better on its own. There are 2 main ways to get help: refer yourself directly to an NHS talking therapies service, or see a GP.

If you ever feel you cannot go on, the NHS says to contact a GP or care team immediately, or call the Samaritans or NHS 111. It also notes that some people with OCD develop other serious mental health problems, including depression and eating disorders.

If you are worried about a friend or family member, the NHS suggests talking to them about your concerns and suggesting they get help.

The NHS says OCD can be treated, and the 2 main treatments are talking therapy and medicine. A short course of therapy is usually recommended for relatively mild OCD, and more severe OCD may need a longer course of combined therapy and medicine. It can take several months to notice the benefit.

A self-help guide from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust explains exposure with an example of a person afraid of being contaminated by germs. She makes an anxiety ladder of feared situations, from least to most feared, starting with touching her own waste bin with gloves on and ending with using a public toilet, and moves up the ladder step by step.

Response prevention means breaking the cycle of carrying out the compulsive act after exposure. The guide suggests asking family not to reassure you, for example by telling you that you are not contaminated, praising yourself for resisting, noting how anxiety falls, not substituting a new compulsion for the old one, and if stopping all at once seems impossible, reducing the time spent or the number of times gradually.

The NHS notes that the treatment may be hard work, but many people find that when they confront their obsessions the anxiety eventually improves or goes away.

The cleaning and avoidance can limit work, relationships and skin health, as OCD-UK notes, so early treatment protects daily life. Families often need guidance too: the guide cited above suggests that reassurance can stop a person confronting what they really fear, while emotional support is helpful.

Many people find support groups helpful. The NHS says they can provide reassurance and coping advice, reduce isolation and offer information for family members and friends.

On the NHS you can self-refer to a talking therapies service or go through a GP, who can also prescribe medicines. More severe or complex cases can be referred to specialist OCD services. Waiting times vary by area.

Private therapy with a CBT therapist experienced in ERP is an option for some people. It is sensible to check the therapist is accredited and has specific experience in OCD, and to keep the GP informed.