Germs and Contamination

By Dr. Melissa Fasteau 

People commonly associate fears of germs and contamination with Obsessive-Compulsive Disorder (OCD), often with images of someone feverishly using hand sanitizer and Lysol to quell their fears. However, this stereotype does not illustrate the correct image of many sufferers. Contamination fears are deeper than not touching certain items or being around certain triggers. The fear behind avoidance and rituals is often the fear of harm coming to themselves or loved ones as a result of becoming contaminated, contaminating others, or obtaining an illness. Others experience contamination fears in the form of emotional disgust, often fearing they will be unable to tolerate the experience of disgust or distress.


Common fears:

  • Becoming or making others sick from germs or illness
  • Touching items perceived as contaminated
  • Fears of public areas and shared items (i.e., restrooms, opening public doors, shopping carts)
  • Bodily waste and fluids
  • Being around certain people and being touched by others
  • Inability to tolerate disgust or distress


Common compulsions:

  • Repeated handwashing, bathing, and cleaning
  • Avoidance of people, touching one’s own body, and public places
  • Frequently changing clothes or throwing out items perceived to be contaminated
  • Asking for reassurance about whether oneself or others will become contaminated or sick
  • Using barriers to prevent oneself from becoming contaminated (i.e., wearing gloves, using a paper towel to open the restroom door)
  • Carrying hand sanitizer



Exposure and response prevention (ERP) is the gold standard treatment for OCD. Exposures are opportunities to confront feared thoughts, situations, and beliefs without engaging in compulsions or avoidance behaviors. Based on the inhibitory learning model, exposures provide the opportunity to engage in new learning, such as creating a discrepancy between what one predicts before the exposure and the actual outcome. Exposures also offer the opportunity to learn about triggering situations in multiple environments. Thus, this allows people to gain confidence in completing exposures in their real life, and not just in the therapy office. Response prevention is the reduction and, ultimately, elimination of rituals and avoidance behaviors. This breaks the link between the believed fear and consequence, ultimately freeing one from their compulsions. One of the key factors to success in treatment is willingness to participate in treatment both in therapy sessions and using treatment as a new lifestyle.





DISCLAIMER: The content found here is intended to serve as educational content and is not intended to replace therapy. For treatment-related questions, please be sure to work with your local provider or contact a local clinician.

Videos: Germs and Contamination

Choose a title below to view related OCD videos

Ben Eckstein, LCSW, discusses contamination--one of the multiple forms of obsessive-compulsive disorder (OCD).

Ben Eckstein, LCSW, discusses the differences between germaphobia and obsessive-compulsive disorder (OCD). Germaphobia is the fear of germs. Germaphobia can lead to contamination OCD if it causes the inability to function during the day.

Ben Eckstein, LCSW, discusses contamination obsessions and how they cause large amounts of distress.

Ben Eckstein, LCSW, discusses the use of exposure and response prevention (ERP) when treating contamination obsessive-compulsive disorder (OCD). He explains hierarchies, which are the ratings of triggers that cause the least amount of anxiety to the most amount anxiety.