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Introduction
I feel contaminated by everything, 24 hours a day. . . all over my body and inside myself. To me everything is contaminated, it is just a case of to what degree. . . All the washing and cleaning brings no relief. Just thinking about the government. . . seeing a brown envelope. . .thinking about my wife and all that happened. . .I feel dirty and contaminated and I have to wash. (A patient, referred to as David, talking about his OCD symptoms)
Obsessive Compulsive Disorder (OCD) affects between 1% and 2.5% of the population (Torres et al., 2006; Karno, Golding, Sorenson and Burnam, 1988) and has been found to be associated with high comorbidity, significant social and occupational impairment and high rates of attempted suicide compared to other anxiety disorders (Torres et al., 2006). Contamination concerns and the related compulsion to wash excessively is one of the most common presentations of OCD, reported by 38-50% of people with the disorder (Rachman and Hodgson, 1980; Foa et al., 1995). Common contamination concerns tend to be culture-specific, with clinically presenting themes being relevant to the difficult-to-see threats in a given society at a given time. For example, contamination-based obsessions increased following the discovery of germs and their link to illness in the late 1800s, with concerns about radiation increasing following World War II and more concerns about illnesses such as HIV and CJD over the last 20 years given media coverage. To date, our understanding of contamination concerns has been predominantly based around the presumption that people experience worries and feelings of contamination when in direct physical contact with a contaminant where there is a threat to life or health, most often dirt, germs or toxic substances (Rachman, 2006). However, is this explanation of contamination adequate to formulate the quote presented above?
If direct physical contact with a life threatening contaminant is required in contamination obsessions, how can we explain obsessions of contamination where no physical contact with a life threatening substance takes place? The quote above is taken from a patient, later referred to here as David, who was not concerned by dirt, germs or toxic substances; David's feelings of contamination were triggered by anything he viewed...