OCD & Contamination: Reasons Why People Do Rituals/Compulsions

Posted by Steven J. Seay, Ph.D. on Dec 15, 2011 in Contamination/Health-Related Symptoms, OCD, OCD - General | 1 comment

Why do people with health-related OCD wash, clean, and sterilize? The obvious answer is that these rituals remove or destroy potential pathogens. However, the more accurate answer is that these behaviors allow one to escape from unwanted feelings of danger, vulnerability, and potential harm.

In my last post, I identified several idiosyncratic feared outcomes in OCD that are associated with contamination/health-related obsessive-compulsive disorder (OCD). Obsessions are intrusive, recurrent, and distressing thoughts, impulses, or images related to these feared outcomes. Today, I’ll discuss the function of compulsions.

Why do people with OCD do rituals?

Compulsions, or rituals, are the other main feature of OCD. These physical and/or mental behaviors reduce the anxiety brought on by obsessions and reflect one’s attempt to avoid, reduce, or prevent certain feared outcomes from occurring. Ask someone with a fear of contamination, disease, illness, or germs why they ritualize; and they will likely tell you that rituals serve as a means to destroy, neutralize, or escape from potential pathogens. As a consequence, rituals common to health-related OCD often incorporate washing, cleaning, disinfecting, and sanitizing behaviors. Excessively long OCD-driven shower routines can become the norm.

Continuous OCD doubt and uncertainty about whether or not one’s hands are sufficiently “clean” perpetuates these rituals. Although the obvious function of washing-related compulsions is to neutralize health-related threats, this is not the “true” reason why people wash.

Washing actually serves the more subtle function of changing a feeling.

Rituals are attempts to shift one’s mental state: to exchange feelings of threat for feelings of safety. Compulsive behaviors neutralize a perceived threat and reduce feelings of vulnerability to danger. They allow you to “escape” from unwanted feelings. In this context, the true function of washing becomes apparent: washing is the means by which individuals with OCD reduce unwanted fear and anxiety.

OCD-contamination-exposure-ERP-long-shower

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In a sense, compulsions can be conceptualized as maladaptive coping skills. Unfortunately, adherence to rituals as a primary coping mechanism prevents the development of other, healthier coping skills. Compulsions also prevent the occurrence of corrective learning experiences that would otherwise disconfirm faulty OCD-related beliefs.

Rituals Eventually Stop Working

Another problem with rituals is that they provide only temporary relief and often their perceived effectiveness decreases with time. This causes the individual to perform longer or more elaborate rituals to achieve the same amount of anxiety reduction. It’s a bit like chasing a feeling that continually gets further and further out of reach. The more you reach for it, the more elusive it becomes. This is why, if left untreated, rituals tend to increase and become more time-consuming.

Fortunately, exposure and response prevention can short-circuit the OCD cycle and reduce your symptoms.

Join me next time when I describe common health-related OCD compulsions and avoidance behaviors.

Questions? Comments? Why do you perform your health-related rituals? Share below…

One Comment

Cheryl / October 9, 2014

My son and daughter-in-law aren’t getting on well. My daughter-in-law now cleans the toilet as soon as her husband (my son) has used it, and washes his towel as soon as he has used it. She doesn’t do this with the children who are much less hygienic! She is already “over the top” with some other aspects of cleanliness but this is causing stress for my son. What can he do? By the way she is quite untidy with clothes, leaving things on the floor. It doesn’t make sense.