Founder
Dr. Roland Segal is a leading psychiatrist with extensive experience and is the Managing Partner and MD Psychiatrist at Legacy Recovery Center. After earning his medical degree from the University of Arizona, College of Medicine, he completed general psychiatry training at Banner Good Samaritan Medical Center in Phoenix, Arizona, and advanced his expertise through a forensic psychiatry fellowship at USC’s Keck School of Medicine.
With over a decade of diverse experience in clinical, administrative, and forensic psychiatry, Dr. Segal is double board-certified in General and Forensic Psychiatry. His previous roles include Chief Medical Officer at Valley Hospital in Phoenix, Arizona, and president of the Arizona Psychiatric Society. He has also served as the legislative committee chair and contributed to numerous state and national boards, committees, and organizations. Additionally, Dr. Segal teaches as a clinical assistant professor of psychiatry at the University of Arizona, College of Medicine, mentoring medical students and residents.
Dr. Segal acts as an expert psychiatry consultant for multiple superior and regional courts, including those in Maricopa and Yuma counties, Salt River, as well as city governments like Phoenix, Lake Havasu, and Mesa. He also consults for prominent organizations such as the United States Postal Service, Social Security Administration, Immigration Health Services, and the U.S. Departments of Justice and Homeland Security.
Guided by principles of objectivity, ethics, mindfulness, and cultural awareness, Dr. Segal remains dedicated to providing compassionate, inclusive psychiatric care, impacting lives across Arizona and beyond.
Imagine you went to open the door for a friend who came to visit. However, once you had barely touched the handle, and with a glove, you told your friend to “just watch a movie”.
Then you spent the next two hours washing your hands, wrists, and forearms til they bleed, to “get rid of all the germs so we don’t get seriously ill”. And your friend left, leaving you alone, saying “perhaps another time”. Such is a life with contamination OCD.
Obsessive Compulsive Disorder (OCD) affects 2-3% of the general population, and of those, 46% suffer from contamination OCD [1]. Millions of people in the US are affected, and with great personal distress and public health costs. In this article, I explain what it is, the symptoms, triggers, and available treatments.
The Vicious Cycle of Fear and Rituals: Recognizing the Symptoms
One of the main types of OCD, contamination OCD, involves a cycle of intense, intrusive thoughts (obsessions) and subsequent ritualistic behaviors (compulsions) in an attempt to be free of the thoughts. It causes intense fears of illness, germs, dirt, or impurity by various substances, environments, or people.
These overwhelming and persistent fears frequently cause significant distress and interfere with daily life. These behaviors temporarily reduce anxiety but reinforce the OCD cycle.
Contamination fear refers to “an intense and persisting feeling of having been polluted, dirtied, or infected, or endangered as a result of contact, direct or indirect, with an item/place/person perceived to be soiled, impure, dirty, infectious, or harmful” [2].
There is a close relationship between contamination fear and disgust. Some people with contamination OCD have a pattern of overestimating the threat of contamination. Current thinking is that individuals who have heightened levels of both obsessive beliefs and disgust feelings may be particularly at risk for developing contamination-related OCD.
Obsessions (The Intrusive Thoughts)
The symptoms include obsessions such as [4] [5]:
- Fear of catching or spreading illness
- Anxiety about surfaces, money, or people being contaminated
- Fears related to chemicals or toxins
- Fear of coming into contact with perceived contaminated substances, such as germs or dirt
- Constantly feeling like their hands are not clean, even after just washing them
- Wanting to go to the store or restaurant, but being worried about the food or beverages being contaminated
- Unwanted thoughts or mental images related to sex
- Fear of making a mistake
- Excessive concern with morality (“right or wrong”)
- Feelings of doubt or disgust
- Need for order, neatness, symmetry, or perfection
- Need for constant reassurance
- Worrying that trying on clothes in a store will contaminate them
- Feeling the need to shower after being in a public place
- Wondering about air ventilation, or immediately feeling sick when they’re in a space
- Being too afraid to take public transportation, like a bus or cab, because they might catch something from the germs
- Fear of causing harm to yourself or someone else because you’re not careful enough or you’re going to act on a violent impulse
Compulsions (The Ritualistic Behaviors)
These repetitive behaviors are not about hygiene but are desperate attempts to alleviate intense fear and to ease or get rid of the obsessions. Common compulsions include:
- Excessive handwashing, showering, cleaning
- Repeatedly checking things, such as locks, switches, and doors
- Avoidance of public places or certain people
- Frequent changing or washing of clothes, use of gloves, wipes, or sanitizers
- Designating areas that are off-limits to others
- Collecting or hoarding items that have no personal or financial value
- Not leaving home
- Arranging things in a very specific way, such as items on your dresser
- Constantly checking that you haven’t caused someone harm
- Hoarding
- Superstitious behaviors
- Rituals related to numbers, such as counting, doing a task a specific amount of times, or excessively preferring or avoiding certain numbers
- Other behaviors aimed at preventing or removing perceived contamination
- Seeking reassurance or engaging in mental rituals like praying or reviewing thoughts to “purify” themselves
Beyond Germs: The Surprising Triggers of Contamination Fear
Contamination OCD is not just about fear of germs. Triggers can be both tangible and intangible. Some of the triggers include:
Physical Triggers
- Germs and Bodily Fluids: Public spaces, restrooms, hospitals, other people who appear sick.
- Chemicals and Toxins: Household cleaners, pesticides, industrial areas, new furniture/carpet smells.
- Sticky or Unclean Surfaces: Grease, dirt, dust, sticky residues.
Emotional and Abstract Triggers
- Mental Contamination: Feeling “dirty” or “polluted” after being treated unfairly, criticized, or experiencing a moral violation. The trigger is not physical but a feeling or thought.
- Perceived “Immoral” Sources: Fear of contamination from people or objects associated with “bad” behavior or concepts (e.g., criminals, certain numbers, or words).
Reclaiming Your Life: Effective Treatment for Contamination OCD
Recovery is about managing the condition, not just “thinking positive”. Contamination OCD is treatable. However, up to 40% of OCD patients do not experience adequate symptom relief from treatment with first-line interventions. Data suggest that around 60% of OCD patients in the general community remain untreated. And patients on average initiate effective treatments 17 years after the onset of the disorder [1].
Gold-Standard Psychotherapy: Exposure and Response Prevention (ERP)
Exposure and Response Therapy is currently the first-line treatment for contamination OCD.
It is a form of Cognitive Behavioral Therapy which aims to change negative and harmful thought patterns, in a controlled, safe environment.
Your therapist gradually and systematically exposes you to feared situations, objects, images or thoughts where the compulsive behavior is triggered. Your therapist has you resist the urge to perform a compulsion. For example, first touching a “clean” floor at home, then a doorknob, then a public trash can lid, then not washing hands after the exposure, or delaying it for a set time.
By staying in a feared situation without anything happening, you learn that you can manage them without compulsive behaviors, and that the behavior is actually unnecessary and even harmful. Exposure is gradually increased and tolerance builds [3] [5].
More behavioral-focused therapies for OCD tend to be more effective than those emphasizing cognitive aspects.
ERP has notable limitations with some patients finding that they cannot tolerate it. As many as half of all patients who initiate treatment do not improve and only a quarter of patients are asymptomatic post treatment.
Likewise, 20% cannot continue treatment (ie, drop out) and a quarter are unwilling to start ERP, largely because of fear of the procedures [1].
Acceptance and Commitment Therapy (ACT):
With ACT, you can learn to accept obsessive thoughts as just thoughts, removing their power. With an ACT therapist you can learn to live a meaningful life despite your OCD symptoms [4].
Virtual Therapy With Smartphones
New approaches have been developed using video-conference administered CBT (vCBT) and telephone-administered CBT. Research shows that remote interventions for OCD are more effective than control (ie, attentional control group or wait list) and as effective as in-person CBT [1].
Moving a step further, innovative smartphone solutions can be personalized for each patient. and promote the learning of adaptive strategies to eradicate compulsive urges. This allows for targeted therapies and for patients to participate actively in their recovery process, One example is LiveOCDFree, a self-help app-guided ERP treatment for OCD.
Medication
SSRI antidepressants are considered the first-line medication treatment for OCD, ideally together with ERP when taken for at least 12 weeks. They help reduce the overall intensity of the obsessions and anxiety, making it easier to engage in ERP.
Although some clinics provide combined medication (SSRI or clomipramine) and psychological treatment (CBT), there is no clear evidence to conclude that combined treatment is superior to either drugs or CBT alone [1].
Other Treatment Strategies
For many who are treatment-resistant to ERP/CBT and SSRIs, with significant debilitating impact, several therapeutic strategies have been developed and studied, including:
- Alternative medications, taken alone (monotherapies)
- Augmentation strategies: Other medications taken together with SSRIs or clomipramine
- Invasive procedures: Neurosurgical techniques
- Less invasive procedures: deep brain stimulation, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and vagal nerve stimulation (VNS) have all proved ineffective but worthy of further study
There is currently no clear consensus on how to best treat patients once SRIs and CBT have proven inadequate [6].
Building a Support System and Self-Care
If you see yourself in these symptoms, know that you are not alone and that with the right therapy you may be able to break the cycle and live a life not ruled by fear.
When searching for a therapist, find one specializing in OCD. Family education is also helpful to reduce their unintentional accommodation of rituals (e.g., a partner doing all the “dirty” tasks).
Mindfulness and stress-management techniques can be helpful supplements to ERP but are not a replacement.
Residential treatment may be recommended for those for whom ERP and medication alone are not effective.
Get Expert Help at Legacy Recovery Center
Legacy Recovery Center is a highly rated, premier addiction and mental health treatment center in Arizona. Legacy is owned and operated by two psychiatrists with over 40 years of combined experience, as well as a robust therapeutic team.
We’re unique among residential treatment centers thanks to our ability to help people suffering from mental health and/or substance abuse issues. Our expert psychiatric team is equipped to treat multiple issues concurrently, focusing on your specific needs. Contact us today!
Sources
[1] Jalal, B.et al. (2022). Obsessive-compulsive disorder-contamination fears, features, and treatment: novel smartphone therapies in light of global mental health and pandemics (COVID-19). CNS spectrums, 27(2), 136–144.
[2] Cisler, J. et al. (2010). Disgust and Obsessive Beliefs in Contamination-related OCD. Cognitive therapy and research, 34(5), 439–448.
[3] Surles, T. 2025. Contamination OCD: Symptoms, Causes, and Proven Treatments. Treatmyocd.com
[4] Cleveland Clinic. Obsessive-Compulsive Disorder (OCD).
[5] Rice, M. 2022. Contamination OCD: Symptoms & Treatment.Talkspace.com
[6] Pittenger, C.et al (2005). Clinical treatment of obsessive compulsive disorder. Psychiatry (Edgmont (Pa. : Township)), 2(11), 34–43.
