OCD & Contamination Fears: Feared Outcomes (Example: HIV/AIDS)

Posted by Steven J. Seay, Ph.D. in Obsessive-compulsive disorder (OCD) In my last post, I identified several types of obsessions that are associated with contamination/health-related obsessive-compulsive disorder (OCD). These include the fear of: Germs and getting sick. Making others sick. Developing an incurable illness in the future. Experiencing extreme and uncontrollable disgust or distress. Other unwanted negative outcomes related to the spread of germs, contaminants, or other agents. Given the idiosyncratic nature of obsessive-compulsive disorder (OCD), I thought it would be useful to talk a bit more about feared outcomes. Feared outcomes can be very different for different people, even when you’re dealing with the same surface obsession. Moreover, sometimes the immediate feared outcome (getting sick) differs from the ultimate feared outcome (dying from a disease). Consider the OCD fear of being infected with HIV. Individuals who experience this health-related OCD obsession often experience distress related to very different feared outcomes. OCD: Feared Outcomes Related to AIDS/HIV Obsessions Many are afraid of death and fear dying from AIDS. Others are afraid of pain and discomfort during the years preceding death. They may fear symptoms of the illness or even the side effects of treatment (e.g., nausea). Others fear that if they were to contract HIV that they would become severely depressed. It is the thought of a potentially chronic depression that is intolerable. Some worry that if they developed AIDS and experienced depression that they would have no option other than to commit suicide. The possibility of killing oneself then fuels moral, religious, or ethical distress. Thoughts of developing AIDS then begin to elicit automatic thoughts of a hopeless moral bind or even the possible threat of damnation (due to committing an “unpardonable sin”). Others worry that if they developed AIDS, they might die and leave behind loved ones (e.g., spouse, children) who might have a difficult time providing for themselves. Others worry that chronic illness will be a burden on their families. They fear potential guilt or the emotional or financial toll of chronic illness. Others fear the social stigma associated with AIDS and worry that when others learn of their illness, they might assume that they are promiscuous or homosexual. Others fear that if they die from AIDS, their lives would have been pointless or meaningless. It is the fear of a meaningless existence that makes the thought of contracting HIV so distressing. Some fear that if they do contract HIV, they might be responsible for unintentionally...
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Contamination & Health-related OCD: Obsessions, Fears, & Worries

Posted by Steven J. Seay, Ph.D. in Obsessive-compulsive disorder (OCD) What are common obsessions in contamination/disease/illness/health-focused OCD? OCD: Fear of Getting Sick Contamination- or health-related OCD is associated with persistent worries about one’s health or the health of loved ones. Common obsessions in contamination-related OCD include the fear of getting sick with a serious illness like rabies, ebola, H1N1 (swine flu), Creutzfeldt-Jakob disease, mad cow disease, hepatitis, or avian influenza. Other frequent obsessions focus on the fear of contracting sexually-transmitted diseases (STDs) such as AIDS/HIV, herpes, HPV, syphilis, or chlamydia. Chronic progressive diseases, like AIDS, that have no known cure tend to evoke extreme anxiety. Individuals with OCD fear both getting sick and the negative consequences associated with illness, which may range from pain and discomfort to serious repercussions such as death, sterility, or deformity. OCD: Fear of Making Others Sick Other individuals’ obsessions focus almost exclusively on potentially infecting other people. These individuals may be convinced that they are carriers for certain illnesses and may worry that they will spread disease to children, loved ones, or strangers. This type of OCD is common in parents (especially mothers) who are afraid of infecting their children. Because OCD is based on fear rather than logic, these worries tend to persist even if the individual is in perfect health. In other cases, individuals with OCD are actually disease carriers. These individuals often experience extreme guilt and fear over the possibility of infecting others with their illness. They tend to be very conscientious and possess a heightened sense of responsibility for guarding others’ health. This type of OCD is especially distressing in the context of chronic illnesses like STDs (herpes, HPV, AIDS), because the individual may feel guilt over having contracted the original illness. OCD: Fear of Getting Sick in the Future In still other cases, OCD health-related obsessions tend to focus more on negative health events that might occur at some future date. These fears include getting cancer, having a stroke, or developing Alzheimer’s disease. These events might occur relatively unpredictably or might involve exposure to present risk factors (e.g., smoking, exposure to asbestos/lead/mold, carcinogens, chemicals, or radiation). OCD: Fear of Disgusting Things & Situations Sometimes contamination-related OCD is triggered by exposure to “disgusting” things. Common triggers include oily and sticky substances, body fluids and bodily secretions, and animals. The fear of sexual fluids (semen, sperm, vaginal secretions, other sexual fluids), feces, urine, sweat, saliva, blood, and body hair can illicit...
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