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Welcome to the Learn OCD podcast,

where we learn about all things OCD.

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My name is Natasha Moharter, and I'm a

licensed counselor and OCD specialist.

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The information presented here

is for educational purposes only.

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It doesn't count as therapy.

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It doesn't create a clinician-client

relationship, and it's not a

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substitute for personalized

treatment from your own provider.

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If you're in crisis, please reach

out to your local emergency services.

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Let's get started.

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/In our previous episode, we talked

briefly about the various ways OCD

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shows up, what clinicians and the

community often refer to as subtypes.

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Over the next few episodes, we're going to

dig into these specific subtypes in depth.

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Before we jump in, let's clarify something

important about how OCD is diagnosed.

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Subtypes like contamination OCD,

harm OCD, or relationship OCD are

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not official diagnostic categories

in medical manuals like the DSM.

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You won't get a separate

diagnosis for contamination OCD.

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Diagnostic manuals simply classify

it as obsessive-compulsive disorder.

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Subtypes are descriptive tools.

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They help clinicians map out your

specific symptoms, help researchers

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study themes, and help people realize,

"Oh, I'm not the only person who

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struggles with this thought pattern."

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Let's do a quick refresher on how

OCD operates across all subtypes.

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OCD consists of obsessions which

are intrusive, distressing thoughts,

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urges, images, or doubts that

are experienced as ego-dystonic.

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Now, lots of people, whether they

have OCD or not, experience weird,

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scary, or uncomfortable thoughts,

but a distinguishing feature of

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OCD is the presence of compulsions.

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These are the actions, both physical

and mental, performed in direct

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response to those obsessive, scary, or

uncomfortable thoughts, in an attempt

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to reduce anxiety, discomfort, or

prevent a feared outcome from happening.

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If you don't fully remember the

difference between ego-dystonic and

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ego-syntonic, our previous episode on

that topic is a great place to start.

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Briefly, OCD obsessions are

ego-dystonic, meaning they are out

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of alignment with your character,

your identity, or your actual values.

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They feel alarming because they

feel so foreign to who you are.

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The brain interprets the thought or

the obsession and says, "This is scary.

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We really need to do something

about this right now," which

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triggers the compulsion, the action.

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On the flip side, ego-syntonic

thoughts align with who you are,

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your values, and who you want to be.

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While people with and without OCD

experience distressing thoughts, OCD

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lacks the internal braking system,

if you will, that tells your brain

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what is or isn't an actual threat.

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The alarm system kind of gets

stuck in the on position.

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This is why reasoning with the

thoughts and traditional talk therapy

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isn't actually effective for OCD.

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Now before we look at contamination

OCD specifically, here is a clue

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clinicians look for when evaluating

whether someone has OCD or something

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else, like a specific phobia.

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First, OCD is a shape-shifter.

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Clinicians and clients often describe

OCD as playing a game of Whack-A-Mole.

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You might spend months working on one

contamination fear, hit a point where

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that theme drops off, and suddenly

a brand new fear, or maybe one that

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hasn't been present for a while pops up.

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Maybe about checking locks,

doubting your relationship, or

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fearing you'll hurt someone.

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That Whack-A-Mole phenomenon

happens because OCD isn't defined

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by what you're obsessing about,

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it's defined by the

underlying anxiety loop.

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As soon as you stop giving into

the compulsions with one subtype,

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the underlying OCD mechanism just

finds a new theme to latch onto.

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Second, we're gonna contrast

OCD with a specific phobia.

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So a specific phobia, like a fear of

dogs, heights, or flying, the distress is

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directly tied to the presence or immediate

anticipation of that specific trigger.

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If you have a phobia of dogs, you

experience intense fear when a dog

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is near you or when you know you're

about to walk into a house with a dog.

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But when you're sitting safely

at your desk with no dogs around,

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the anxiety generally recedes.

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OCD doesn't work like that.

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In OCD, the fear follows you

home, to work, your bathroom.

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Even if the physical trigger is completely

absent, the brain spins "what if" loops.

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What if I touched something

contaminated three hours ago?

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What if I didn't wash

my hands long enough?

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What if my character changed?

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What if I become somebody

that I don't wanna be?

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So if you notice distress that lingers

longer after a trigger is gone,

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accompanied by repetitive mental or

physical actions and fears that jump

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across multiple themes over time, you

might very well be looking at OCD.

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How does this play out when it comes

to the subtype of contamination OCD?

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Let's break it down.

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Contamination OCD is easily

one of the most recognized

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subtypes in popular culture.

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The media often portrays OCD as hand

washing, sanitizing, or obsessively

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organizing because those physical actions

are visual and easy to capture on camera.

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It's much harder for film or TV

to portray someone experiencing

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intense invisible mental distress.

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As a result, society mostly sees the overt

physical cleaning or checking compulsions.

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Contamination OCD goes far beyond a simple

fear of germs, bacteria, or getting sick.

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At its core, traditional contamination

OCD revolves around tangible physical

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dangers, some examples of triggers

are germs, viruses, toxic chemicals,

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household cleaners, bodily fluids, dirt,

asbestos or environmental pollutants.

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The fears associated can be

physical illness, disease, bodily

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harm, or inadvertently causing

harm or death to someone else.

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Some experiences are fear, anxiety,

and often hyperresponsibility.

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What you'll notice as we break down

these subtypes is that there is

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significant overlap across OCD themes.

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Contamination OCD rarely

exists in a vacuum.

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It often overlaps with harm OCD, like

the terrifying thought of bringing

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home an illness that sickens an

elderly relative, an infant, or a pet.

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It can also overlap with fears

of being irresponsible, careless,

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or a bad person, or not cleaning,

quote-unquote, "properly."

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Let's look at a concrete scenario.

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Imagine someone with contamination

OCD touching a gas pump.

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Their brain immediately

signals an emergency.

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What if there was a toxic chemical

or pathogen on that handle?

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If I don't wash my hands for five

minutes in scalding water, I'll transfer

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it to my steering wheel, bring it to

my house, and then poison my family,

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especially if I'm making dinner tonight.

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The obsession is the thought of physical

danger through that chemical or pathogen.

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The compulsion is the repetitive

action that follows that up.

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Immediate ritualized cleaning

to neutralize that physical

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threat is an example.

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Now let's pivot to a variation of

contamination OCD that is less talked

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about, but equally distressing.

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This is called emotional

contamination OCD.

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In this subtype, the perceived threat

shifts away from physical triggers

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of germs, chemicals, pathogens,

et cetera, and moves into the

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realm of identity, psychological

well-being, and abstract concepts.

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In emotional contamination OCD, an

individual fears that an undesirable

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feeling, personality trait, intrusive

thought, moral flaw, or bad luck can

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literally transfer from a person,

place, or object onto themselves.

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The triggers can be many different

things, including everyday social

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encounters, someone being rude, people

perceived as having undesirable traits

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or negative energy, objects that were

used while having a negative or intrusive

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thought, locations tied to unpleasant

memories, or specific words, dates, or

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items associated with unwanted emotions.

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Now, this is where it's also important

to rule out trauma, because many of these

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can sound like trauma responses as well.

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Let's walk through a couple scenarios

related to emotional contamination.

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Imagine someone is wearing a specific

piece of clothing during a distressing

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or tragic event, and later feels

that that garment is permanently

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tainted by that negative experience.

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The thought isn't the jacket has germs.

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The thought is, "If I wear this

jacket again, it could bring back

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that horrible emotional state.

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It could trigger something else really bad

to happen, so I'll just avoid it instead.

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Here's another example.

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Someone is listening to a

specific song while having an

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intrusive or upsetting thought.

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They come to feel that that song itself

is contaminated by that thought, believing

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that hearing it again will force the

intrusive thought back into their

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mind or corrupt their emotional state.

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This happens because of something

that we call magical thinking.

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Magical thinking includes the belief that

thinking or saying something can directly

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cause it to happen in the real world, even

if there is no logical connection between

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the thoughts, objects, or the event.

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Magical thinking is basically

if I say it, if I look at it,

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if I write it, it will happen.

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It's when the brain tricks you

into believing that bad luck, sad

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feelings, or unwanted thoughts can

physically rub off on objects like

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a jacket or a song and pass to you

when you touch or listen to them.

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Now let's pause and take a closer look at

a big feeling that often gets overlooked.

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The feeling of being super

grossed out or disgusted.

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When people talk about OCD, they

usually talk about fear and anxiety.

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But researchers now know that

disgust sensitivity, or how easily

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someone gets grossed out, plays

a huge role in contamination OCD.

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And it works differently depending

on whether the contamination

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is physical or emotional.

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With physical contamination, feeling

grossed out can happen even without fear.

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Someone might know in their mind

this sticky door handle won't make

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me super sick, but they still feel

a strong uncomfortable reaction

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to dirt, slime, body fluids,

things that feel really gross.

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The goal of the compulsion isn't

always to protect their health, but

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to get rid of that intense distressing

yuck, this is gross feeling.

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With emotional contamination, that

grossed out feeling can often shift

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to what we call moral scrupulosity

and also psychological disgust.

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Moral scrupulosity isn't just the

feeling of being physically grossed

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out, it's also about the feeling

of being a bad person inside.

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It could happen when you have an unwanted

thought, saw someone do something that

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you really don't wanna do, or read

something that you strongly disagree

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with, and the fear is that it has somehow

contaminated or rubbed off on you.

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Just having a scary or bad thought pop

into your head can trick your brain

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into feeling like you've done something

wrong, or that your character or who

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you are on the inside has been ruined.

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Understanding whether a compulsion is

driven by fear, anxiety, or disgust is

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really important because dealing with

disgust in therapy works a bit differently

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than dealing with fear or anxiety.

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Fear often goes up and down pretty

quickly, while feeling grossed out

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can stick around longer and can

often feel much harder to shake off.

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To help solidify all this, let's

put emotional contamination and

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physical contamination side by side.

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In contamination OCD with physical

triggers, the triggers can be things like

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pathogens, chemicals, dirt, something

that is gross, food, you name it.

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With emotional contamination OCD,

you're gonna see that threats

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can often be negative personality

traits, bad luck, unwanted emotions.

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The thought that somebody else might

have had a bad thought while they

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were preparing something for you, like

dinner, and if you eat the dinner,

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it could corrupt you in some way.

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In various presentations of contamination

OCD, the feelings can be of fear,

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anxiety, physical disgust, moral

scrupulosity, feelings of dread.

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We also want to pay close attention

to how compulsions present in

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emotional contamination OCD because

they are often misdiagnosed.

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With physical triggers for

contamination, washing hands or

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bleaching a counter logically connects.

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In the person's mind, this

is going to kill the germs.

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In emotional contamination, a person

might still wash their hands or

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shower for hours, but if you ask

them why, they might say they aren't

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necessarily trying to remove bacteria.

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They might try to symbolically be washing

away a bad feeling, a painful memory,

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disgust, or an unwanted personality trait.

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Furthermore, emotional

contamination OCD relies heavily

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on covert or mental compulsions.

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These can be things like neutralization

or repeating a "good" or "safe" word

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in their head to cancel out the bad

person's name that they just thought of.

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They could also discard possessions.

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They could throw away perfectly good

clothes, furniture, or gifts because they

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feel permanently tainted by association

with a negative person, thought, or event.

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There's also often avoidance, such as

refusing to walk down a certain street

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because maybe an unhoused person lives

there and I have a fear that I could

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lose my house and become unhoused and

end up on drugs and then want to do

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something to harm myself or others.

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As we're talking about this, I want

you to see that OCD can present in

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a lot of different ways, and we are

barely scratching the surface with

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the examples that I'm giving today.

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The main evidence-based treatment

for OCD is called Exposure and

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Response Prevention therapy, and it's

often combined with Acceptance and

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Commitment Therapy, also known as ACT.

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For contamination OCD, ERP might involve

touching a door handle or delaying hand

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washing, leaning into the uncertainty.

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I often think about is it OCD or CDC?

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The CDC does say that I should wash

my hands after I touch my dogs.

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OCD says if I don't wash my hands very

specifically after touching my dogs,

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I could get myself and my family sick

because there might be fecal matter

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on my dog and that fecal matter can

now be transferred across my house

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to loved ones who are unknowingly

touching this and could get sick or,

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cause something bad to happen to them.

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In emotional contamination OCD, ERP might

involve intentionally wearing the sweater

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associated with the arrogant person or

the negative thought, or sitting in a

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room tied to a bad memory, or driving

down a road that feels contaminated

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because somebody that you knew and didn't

like lived there or worked near there.

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Again, you might be hearing overlaps and

similarities to how trauma presents and

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this is where, it is really important

any time that you're assessing for

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OCD that you also rule out trauma.

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Now going back to working with

moral scrupulosity, the goal of ERP

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isn't to convince yourself that an

arrogant person was actually good.

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The goal is teaching your brain that

feelings of disgust, uncomfortable

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thoughts, and memories don't

have the power to alter who you

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fundamentally are as a person.

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Your values and character remain

intact even when uncomfortable

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feelings are present.

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So to summarize, today's main

takeaways are that contamination

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with physical triggers will often

ask, "Will this make me sick or

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physically harm someone I care about?"

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Emotional contamination will often ask,

"Will this change who I am, taint my

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character, or ruin me in some way?"

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Remember, subtypes are just

descriptions of the symptoms.

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They aren't separate diagnoses,

and it is completely normal if

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your OCD shifts themes over time.

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This is actually expected when you are

doing really good response prevention.

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You stop giving power to the obsessive

thought by not doing the compulsion, which

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tells your brain, "Oh, that's actually

not as important as we thought it was.

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Let's move on to something else."

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And this is often where it will bring

up something else and say, oh, that

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fear that I was worried about last week.

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That is so last week.

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I am not even worried about that anymore."

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It's that game of Whack-A-Mole.

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Thank you for tuning in today.

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Make sure to hit subscribe,

leave a review, and share this

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episode with anyone interested in

understanding the complexities of OCD.

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Join us next time as we continue

exploring other subtypes in depth.

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Until then, I hope you take care.