The concept of mental contaminationinitially studied in the psychological consequences of sexual abuse (Fairbrother & Rachman, 2004), has quickly extended to obsessive-compulsive disorder, in particular to fear of contamination and related washing/cleaning rituals, giving rise to an important research vein.
What is meant by fear of contamination?
Rachman (2004) defined the fear of contamination Like an intense and persistent feeling of having been contaminated, infected or endangered by a contact, direct or indirect, with a person, a place or an perceived object, impure, infected or harmful.
Within the fear of contamination, two different types were subsequently distinct: the so -called physical contamination (or contact contamination), to which we commonly refer to when it comes to DOC, and the mental contaminationwhich we will talk about in this article.
What are the differences?
There physical contamination It implies an external feeling of dirt evoked by direct or indirect (or even imagined) physical contact with a substance, a person or a tangible contaminating object, easily identifiable, such as germs, bacteria, toxic substances, body fluids (in particular, blood, feces, sperm and urine).
There mental contaminationInstead, it is a sense of psychological contamination, which implies an internal emotional feeling of “dirt” without any physical contact of any kind (unleashed, for example, by thoughts, words, memories or particular images).
This sense of dirt is not directly observable by others; It refers to something widespread, difficult to identify in a part of the body.
Individuals suffering from mental contamination can report a need to wash, as they can engage in complex mental rituals and control in order to reduce unpleasant emotions, even if they generally never manage to feel totally “clean” and place.
Situations capable of triggering the state of mental contamination They can imply both violations suffered, and psychological (for example, a betrayal that made the person feel humiliated, defenseless, manipulated, degraded) and physical (for example, sexual violence), but also, on the other hand, having perpetrated despicable actions such as the aforementioned (with consequent moral disgust towards oneself); Then there are the episodes of so-called self-condomination, or mental events, such as blasphemous, sexualized or violent thoughts (e.g. aggressive obsessions), who “contaminate” the person from a moral point of view, so much are unworthy and unacceptable.
Macbeth Lady effect
The best known example, also because literary, of mental contamination It is represented by Lady Macbeth.
In the famous tragedy of Shakespeare, Lady Macbeth, accomplice of the murder of King Duncan of Scotland and other misdeeds, desperately tries to wash the imaginary blood stain by continuing to wash his hands incessantly.
The woman realizes with deep dismay that, although her hand no longer contains any trace of blood, nothing can ever delete the smell, which she still feels on the hands as an indelible brand of her action.
What is described by Shakespeare in the Macbeth tragedy found experimental confirmation in a study conducted in 2006 by Zhong and Liljenquist, in which the authors demonstrated an association between Physical cleaning and moral cleaning: exposure to immoral events stimulates a threat to one’s moral integrity by inducing the need to wash (cleaning yourself), even if there is no real external dirt and washing has only a symbolic function of “purification”.
From the results of some studies, in fact it seems that physical cleaning can restore moral purity, without the need to implement compensatory behavior (such as, for example, an altruistic gesture of providing help to another).
Mental contamination: an important ingredient of obsessive compulsive disorder
One of our study, recently published on Journal of Obsessive-Compulsive and Related Disorders (Melli, Carraresi, Stopani, & Bulli, 2014), proposed to investigate the prevalence of the mental contamination In a sample of patients with obsessive-compulsive disorder (DOC) by contamination and to analyze the role of mediator of mental contamination in the relationship between the sudden tendency to feel disgust and obsessive symptoms.
Of the 63 DOC patients of our sample, over 60% reported the presence of mental contamination.
Our results also confirmed the hypothesis that the average mental contamination partially partially the relationship between propensity to disgust and obsessive symptoms.
In other words, the DOC subjects with the highest tendency to feel disgust when they experience events that make them feel contaminated from a mental point of view (for example, physical or psychological violation, immoral thoughts, morally unacceptable images or impulses), can feel very dirty and disgusted and resort to maladative behaviors (for example, washing compulsions) that maintain active obsessive symptoms.
From our study therefore it seems that the mental contamination Game a significant role in DOC subjects with fear of contamination, in particular as a mediator of the relationship between propensity to disgust and thoughts/contamination behaviors.
This result can confirm what is underlined in the literature regarding the importance of an accurate assessment in relation to the critical events precipitating the debut of the DOC with fear of contamination.
Mental contamination, as mentioned above, seems to emerge as a consequence of “polluting” life events in which the person felt morally wrong (for actions committed) or violated, humiliated (as a consequence of actions suffered).
What implications for the treatment of obsessive-compulsive disorder?
Given the “traumatic” nature of the state of mental contaminationthere is to be reflected on how much the emotions of guilt and disgust compared to certain stimuli by the doctors represent a sort of Affect Withut Recollection (Clark, 1999).
In other words, certain situations could activate the emotional experience connected to the traumatic memory, even if the patient limits himself to the contingent problem that at that time triggers the fear of contamination.
It may be interesting to consider whether everything that the obsessive patient He feels pushed to do to avoid a situation in which he can feel guilty (or disgusted) represents a mode in the face of a negative evaluation of himself, as has been codified in that critical event, precipitating the debut of the disorder.
In this regard, the purpose of the obsessive activity could be to repair to an idea of profoundly “polluted” self, as the disorder precipitating has been activated at the time of the event, or avoid actions that could reactivate that same negative idea of the person, making it feel disgusted, humiliated and potentially a source of contempt by the community of belonging.
The fact that the mental contamination It is linked to a negative evaluation of self as a consequence of critical events activates reflection on how much this internal feeling of dirt is linked to a problem of non -processing/integration in the autobiographical memory of the event or past critical events and as much as the DOC subjects with mental contamination, through washing and other neutralization behaviors, try to move away from thoughts and sensations connected to the memory (“Wash Away the Past”).
Understanding the role of mental contamination in the DOC by contamination allows the development of potentially more effective treatments.
Here is the possibility of integrating the exposure and prevention of the response-which we know is the treatment of proven effectiveness in obsessive-compulsive disorder-a work of reworking traumatic events, through techniques such as Imagory Rescripting or EMDR, could increase the success rate of the standard cognitive-behavioral intervention.
Bibliography
- Clark, D. (1999). Anxiety Disorders: Why They Persist and How To Treat Them. Behaviour Research and Therapy, 37S5-S27.
- Fairbrother, N., & Rachman, SJ (2004). Feelings of Mental Pollution Subsequent to Sexual Assault. Behaviour Research and Therapy, 42173-190.
- Melli, G., Carraresi, C., Stopani, E., & Bulli, F. (2014). Disgust Propensity and Contamination-Related OCD Sympoms: The Mediating Role of Mental Contamination. Journal of Obsessive-Compulsive and Related Disorders, 377-82.
- Rachman, SJ (2004). Fear of Contamination. Behaviour Research and Therapy, 421227–1255.
- Zhong, C, & Liljenquist, K. (2006). Washing Away Your Sins: Threatenened Morality and Physical Cleansing. Science, 3131451-1452.
