The concept of mental contamination , initially studied in the context of the psychological consequences of sexual abuse (Fairbrother & Rachman, 2004), rapidly spread to obsessive-compulsive disorder , in particular the fear of contamination and related washing / cleaning rituals. , giving rise to an important line of research.
What is meant by fear of contamination?
Rachman (2004) defined the fear of contamination as an intense and persistent feeling of having been contaminated, infected or endangered by direct or indirect contact with a person, place or object perceived as dirty, impure, infected. or harmful.
Within the fear of contamination, two different types were subsequently distinguished: the so-called physical contamination (or contact contamination), which we commonly refer to when we talk about OCD, and mental contamination , which we will discuss in this article.
What are the differences?
The physical contamination implies an external sensation evoked dirt from the direct or indirect physical contact (or even just imagined) with a substance, a person or a tangible contaminant object, easily identifiable, such as germs, bacteria, toxic substances, body fluids (in particular , blood, feces, semen and urine).
The mental contamination , however, is a sense of psychological contamination, which implies an inner emotional feeling of “dirt” without any kind of physical contact (triggered, for example, by thoughts, words, memories or specific images).
This sense of dirt is not directly observable by others; it is referred to as something widespread, difficult to identify in a part of the body.
Individuals with mental defilement may report a need to wash, as well as engage in complex mental and control rituals in order to reduce unpleasant emotions, even though they typically never manage to feel totally “clean” and right.
Situations capable of triggering a state of mental contamination can involve both violations suffered, both psychological (for example, a betrayal that made the person feel humiliated, shamed, manipulated, degraded) and physical (for example, sexual violence), but also, on the other hand, having perpetrated despicable actions such as the above (with consequent moral disgust towards oneself); then there are the episodes of so-called self-contamination, or mental events, such as blasphemous, sexualized or violent thoughts (eg aggressive obsessions ), which “contaminate” the person from a moral point of view, so much are they unworthy and unacceptable.
Lady Macbeth effect
The best known example, also because it is literary, of mental contamination is represented by Lady Macbeth.
In Shakespeare’s famous tragedy, Lady Macbeth, complicit in the murder of King Duncan of Scotland and other misdeeds, desperately tries to wash off the imaginary bloodstain by continuing to wash her hands incessantly.
The woman realizes with deep dismay that, although her hand no longer contains any trace of blood, nothing can ever erase the smell, which she still feels on her hands as an indelible mark of her action.
What Shakespeare describes in the tragedy of Macbeth found experimental confirmation in a study conducted in 2006 by Zhong and Liljenquist, in which the authors demonstrated an association between physical cleansing and moral cleansing : exposure to immoral events stimulates a threat to one’s own moral integrity by inducing the need to wash (clean oneself), even if there is no real external dirt and washing has only a symbolic function of “purification”.
In fact, from the results of some studies, it seems that physical cleansing can restore moral purity, without the need to engage in compensatory behaviors (such as, for example, an altruistic gesture of providing help to another).
Mental Contamination: An Important Ingredient of OCD
Our study, recently published in the Journal of Obsessive-Compulsive and Related Disorders (Melli, Carraresi, Stopani, & Bulli, 2014), aimed to investigate the prevalence of mental contamination in a sample of patients with obsessive-compulsive disorder (OCD). ) from contamination and to analyze the role of mediator of mental contamination in the relationship between the trait tendency to feel disgust and obsessive symptomatology.
Of the 63 OCD patients in our sample, over 60% reported the presence of mental contamination .
Our results also confirmed the hypothesis that mental contamination partially mediates the relationship between propensity to disgust and obsessive symptoms.
In other words, OCD subjects with a higher tendency to feel disgust when they experience events that make them feel mentally contaminated (for example, physical or psychological violation, immoral thoughts, morally unacceptable images or impulses), may feel very dirty and disgusted and resorting to maladaptive behaviors (for example, washing compulsions) that keep the obsessive symptoms active.
From our study, it seems therefore that mental contamination plays a significant role in OCD subjects with fear of contamination, in particular as a mediator of the relationship between propensity to disgust and thoughts / behaviors of contamination.
This result can confirm what has been underlined in the literature regarding the importance of an accurate assessment of the critical events precipitating the onset of OCD with fear of contamination .
Mental contamination, as previously mentioned, seems to emerge as a consequence of “polluting” life events in which the person has felt morally wrong (for actions committed) or violated, humiliated (as a result of actions suffered).
What are the implications for the treatment of obsessive compulsive disorder?
Given the “traumatic” nature of the state of mental contamination , we need to reflect on how much the emotions of guilt and disgust with respect to certain stimuli by OCD subjects represent a sort of affect without 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 moment triggers the fear of contamination.
It might be interesting to consider whether everything that the obsessive patient feels compelled to do to avert a situation in which he may feel guilty (or disgusted) represents a way of coping with a negative self-evaluation, as it has been codified in that. critical event, precipitating the onset of the disorder.
In this regard, the purpose of the obsessive activity could be to repair a deeply “polluted” idea of oneself, as it was activated at the moment of the event precipitating the disorder, or to avoid actions that could reactivate that same negative idea of person, making them feel disgusted, humiliated and potentially a source of contempt on the part of the community to which they belong.
The fact that mental contamination is linked to a negative self-evaluation 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 past critical event or events and to how much OCD subjects with mental contamination, through washing and other neutralizing behaviors, try to get away from the thoughts and sensations connected to memory (“wash away the past”).
Understanding the role of mental contamination in contamination DOC allows for the development of potentially more effective treatments.
Thus the possibility of integrating the Exposure and Prevention of Response – which we know to be the treatment of proven efficacy in obsessive-compulsive disorder – a work of re-elaboration of traumatic events, using techniques such as imagery rescripting or EMDR, could increase the success rate of standard cognitive-behavioral intervention .
