The Four Basic Types of OCD - Part 1 Contamination

Here is my blog post for this week. I apologize that it is a few days late, but my week got a little hectic. As always I hope you find this helpful and let me know if there are any topics you’d especially like me to cover in future posts. I hope you all have a good week.

The Four Basic Types of OCD

Part 1 - Contamination

Though there are many variations in how OCD presents itself, there are four basic types: Contamination, Checking, Just Right and “Pure O”/Intrusive Thought . This is the first of four blog posts about the four types and I will cover the other three in subsequent posts.

Contamination OCD is perhaps the type that most people associate with OCD. People with this type are afraid to touch something because they fear being exposed to germs, bacteria, anything they think will lead to them or their loved ones getting sick or being harmed in some way. I have had clients who fear such things as blood, bodily fluids of any kind, mold, psychedelic drugs, asbestos, lead, bleach, household cleaners, “germs” of any kind (these clients often call themselves”germophobes”), etc., and they avoid touching anything they fear would expose them or their loved ones to the feared substance. 

Perception of Exaggerated Risk

As with all types of OCD there is some real risk of being exposed to any of the above, but OCD exaggerates the risk way beyond what is reasonable and leads people to take unnecessary precautions. For example, blood is something that most people are uncomfortable being exposed to, but they are not constantly vigilant for any red/brown spots wherever they go, whereas someone with OCD who is concerned about blood will see red/brown spots everywhere and will carefully avoid touching, or even coming close to, anything they think might be blood. 

The same pattern occurs with any of the above feared substances. If the feared substance is lead then any possible exposure is carefully avoided: older homes with possible lead paint is a common one. Anyone who lives in or has spent time in an older home may have touched lead paint so that person is avoided or, if they can’t be avoided, then they cannot be touched. If they are touched then a shower must be taken asap and the clothes that were worn must also be washed or, in more extreme cases, discarded entirely. I recall a client who feared any type of exposure to bleach and after purchasing some new shaving supplies in the store immediately discarded the new items because he had seen a “wet spot” on the conveyor belt and feared that this spot “might” have been bleach that had spilled from a previous customers items. Even the aisle in the store where bleach was stored had to be avoided. As he drove home from the store he saw a white plastic bottle on the side of the road which he feared “might” have been a discarded bleach bottle and so when he got home he had to clean the tires on his car because they might have driven through bleach from the discarded container. And as with the blood fear, the clients who feared lead and bleach also “saw” lead and bleach “everywhere” they went.

Are Yellow Cars Dangerous?

To illustrate why my clients see their fear substance everywhere they go I use the following story. The last time you went driving did you happen to notice if there were any yellow cars on the road? My guess is that the answer to that question is “No”. Now let’s suppose I tell you that I just heard on the radio that there are terrorists driving around town with guns and bombs, and they are all driving yellow cars. How do you think that new information would affect what cars you notice the next time you drive? Of course, you would be very vigilant for yellow cars because you now believe they are dangerous and we naturally orient toward what we believe to be dangerous. 

What if it’s Really Dangerous?

A frequent obstacle to overcoming this type of OCD is that there is always a kernel of truth to what they fear. Blood exposure can lead to contracting some nasty diseases, you want to avoid exposure to lead and ingesting bleach wouldn’t be a good idea. But most people don’t go to the extremes that OCD requires. Reasonable precautions are appropriate but OCD asks much more of us and what it asks (demands?) is usually way beyond what is reasonable or necessary.

What to Watch Out For

Some of the signs to watch out for with this type of OCD are things such as excessive washing, frequently using hand sanitizer, using gloves more often than most people would, spending unusually long amounts of time in the bathroom (usually washing/showering), being unnecessarily cautious about avoiding a substance or place and seeking frequent reassurance (even from people who may not be qualified to answer the question). People with any form of OCD are usually a bit embarrassed by their behavior because they almost always know that they are overreacting (yet they find it very difficult to stop) and they often try to hide doing their compulsions and it may prove difficult to really understand what’s going on. 

Treatment

As with all forms of OCD the treatment involves Exposure with Response Prevention (see my earlier post on ERP). Recognizing that they are being unnecessarily cautious and gradually reducing/stopping the compulsions is the best way to combat virtually any type of OCD.