Dark Side of OCD

Dark Side of OCD

Hello, people! Thanks for checking out the blog. Last week, I introduced a new series on unusual OCD subtypes, the darker side of OCD, with compulsions that go beyond the stereotypical examples most people think of. While doubt is still the core issue, people with these obsessions aren’t arranging their colored pencils, checking the light switches, or washing their hands until they’re red and raw. These obsessive thoughts often center more on function- am I swallowing correctly? Can I still blink? Those are examples of the first subtype we covered last week, hyperawareness OCD, also called sensorimotor or somatic OCD. This is an obsession with a part of the body, or with an involuntary bodily function. Breathing, blinking, and swallowing are the top three obsessions, but it can involve the location of a mole or freckle, placement of hands, or even how the skin feels, if it’s itchy, for example. This week, I’m going to cover another subtype, called emotional contamination OCD.

Contamination OCD generally revolves around the classic “feeling germy” or disease obsession. I have patients with this that may take 8 to 10 showers a day, sometimes more if they’re really “in it.” Others have to wear cotton gloves because they’ve washed their hands so much the skin has deep, angry cracks that bleed, yet they still worry they aren’t clean. But with emotional contamination OCD, the obsessive thoughts center on “catching” more abstract things from others, like ideas, values, and traits, as if they are infectious. They constantly ask themselves, what if being near this person causes me to lose my values and assimilate theirs… what if I start believing in what they believe in, instead of what I believe in? It’s a scary thought, right? Imagine having to worry that if you sit next to someone on a train to work, when you arrive, you might not think like you any longer, you might be infected with their thoughts. Will you even still know how to do your job? Yikes! What if you meet someone who’s immoral or a criminal? If you stand near them, touch them inadvertently, or sit in a chair they once sat in, those immoral thoughts may transfer to you, like a virus. You might start stealing things, or cheating on your wife. People with emotional contamination doubt the authenticity and stability of their thoughts. If a thought pops into their heads, it’s ‘did I think that? Or did I catch it from that person?’ And once the thought of contamination begins, it’s so hard to stop. 

The obsessive trigger may be a person, a geographical location, or an object, and by touching it, sitting near it, or even going to a place associated with it, people with emotional contamination OCD think they’ll somehow become contaminated with its essence. I had a patient we’ll call John. Great guy- a kid, really- who developed terrible emotional contamination. He was in college on a scholarship, and lived with a roommate, a guy named Mike, who was pretty successful academically as well. They were both business majors, so it sounded like a great setup. Well, as it turns out, Mike was successful because he was entitled and ruthless, and always took advantage of people that offered to help him. This didn’t sit well with John at all, he was a sensitive kind of guy, and he began to worry that he would start to think and act like Mike. He didn’t know why, but he found himself thinking about it constantly, obsessing about it. He was terrified that if he kept living with Mike, or even came into contact with him, that he’d become a ruthless user too. So he started avoiding him, and any friends who interacted with him. He stopped going to the coffee shop where he studied, the bars he frequented, and the restaurants where he ate. He even switched his major so that he and Mike wouldn’t have any crossover. If someone in one of his classes had taken a course in the business building- where Mike took classes- John would have to drop out of that class. Not only that, but he felt so contaminated that he had to throw away the books and study materials, and even the clothes he was wearing when he saw that person. Like many people with emotional contamination OCD, John felt that the traits could also spread through the air, through an association with other people, and even through the internet, so that anything and everything could really become contaminated at any time. 

Before long, John had to give up his scholarship and drop out of school. He continued to get rid of his belongings repeatedly- books, computer, clothes- it had to go if it had any prior affiliation with Mike. He had to move into a room above his parent’s garage, he couldn’t go into the main house because Mike’s name had been mentioned there. But Mike had never been discussed in that room, so that was a “Mike free” zone. When he tried to take classes online, he found that even the internet was contaminated by Mike, because his social media profiles were also on the web. When he reached the point where he was getting ready to move into another apartment in a town fifteen miles from his parents, and he was about to buy his fifth computer, he finally decided to get help, and came to see me. 

People with emotional contamination OCD feel compelled to avoid the person or idea that’s contaminating them, and that quickly becomes a gargantuan task. Not only does it spread through air, people, objects, and the internet, it can spread through language, so even hearing a word or phrase that sounds like the obsession can trigger the fear and feelings of danger. People end up avoiding television, newspapers, radio, the internet, computers- a constantly expanding circle of people, places, and things- completely isolating themselves to avoid any risk of a potential reminder of their obsession. Eventually, that circle can make it nearly impossible to function. 

Imagine you develop emotional contamination around Hershey, Pennsylvania. Very quickly, it wouldn’t be enough to just avoid that town; you wouldn’t be able to go to any towns surrounding it, either. Then you wouldn’t be able to eat Hershey’s chocolate bars, because they share the same name. Then, you’d have to avoid parts of the grocery store, because you’d see the chocolate bars. Then you realize, much to your horror, that Hershey’s makes other food products too, and you need to avoid them. Then you’re stuck in the grocery store for hours, reading labels to make sure you don’t have any contact with Hershey’s products. You can see how it swiftly becomes a big problem. And who knows when and where else you might randomly be triggered. Maybe you go to grandma’s and she asks you to get her favorite hot cocoa from the cabinet, and you discover it comes in a tin that says… you guessed it. You don’t think about the connections between things in life, until they cause you anxiety. When you have emotional contamination, you’re constantly thinking about exactly that, because you have to avoid certain things. But it’s difficult to completely avoid being triggered, even when you’re trying to.

Emotional contamination is rooted in what’s called magical thinking, a psychological concept that your thoughts, imagination, or beliefs will lead to something actually happening in the real world. The phenomenon is present in many subtypes of OCD, but is especially prevalent in emotional contamination. Sometimes people’s thinking can become so “magical” that emotional contamination OCD can even be misdiagnosed as psychosis if a therapist hasn’t dealt with it before. It can be difficult to get a handle on because it’s so nebulous, but the good news is that, like all types of OCD compulsions, emotional contamination can be treated using ERP therapy- exposure and response prevention therapy- which is considered the gold standard for OCD treatment. 

If you’ve ever tried to not think about something, you know how hard it is to control your thoughts. If I tell you don’t think about that dumb purple dinosaur Barney, and definitely don’t sing his silly song in your head. What are you doing right now? Are you singing “I love you, you love me, we’re a happy family…” Exactly. So ERP therapy takes the opposite approach; instead of trying to make yourself stop your obsessive thoughts, you welcome them, and deal with them. The concept behind it is that repeated exposure to the obsessive thoughts, and thus the discomfort that comes with them, affords you the best chance to avoid the compulsion and alleviate that discomfort. When you continually submit to the urge to do compulsions, it only strengthens the need to engage in them. But on the flip side, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to deal with them, and that generally leads to a reduction in anxiety. 

Because doubt and uncertainty are at the core of the obsessions, ERP gives you a chance to live with it, to experience it and get through it another way. During ERP therapy, you discuss and track your obsessions and compulsions, and develop a list of alternative ways to face your fears. A therapist then designs exposures, which slowly put you into situations that bring on your obsessions, and cause anxiety or discomfort. You respond, eventually, hopefully in a way that is not compulsory, and this reduces or eliminates the anxiety. In other words, you regain some control, so you prevent yourself from performing whatever compulsion you normally do, be it a physical or mental compulsion, and that eliminates the anxiety or discomfort. Get it? Exposure and response prevention. It can take time, but with continued exposures, you build toward reaching whatever goal you’ve set. ERP therapy can make a huge difference in an OCD patient’s life, and it has a decent success rate, about 80 percent. 

That’s a good place to stop for this week. Next week, another OCD subtype, one you won’t want to miss. I hope you enjoyed this blog and found it to be interesting and educational. Please feel free to share it with family and friends. Be sure to check out my YouTube channel with all of my videos, and I’d appreciate it if you would like, subscribe, leave comments, and share those vids! As always, my book Tales from the Couch has more educational topics and patient stories, and is available in officeand on Amazon. 

Thank you and be well people!

MGA