Transcript

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Dr. Celine Gelgich (1:33)

Hi, I'm Dr. Celine Gelgich.

Dr. Tori Miller (1:35)

And I'm Dr. Tori Miller. Welcome to Breaking the Rules. On breaking the rules, we talk about all things OCD.

Dr. Celine Gelgich (1:42)

Obsessive compulsive disorder. OCD impacts up to 1 to 2% of the population. We are here to provide not just education, but to inspire clinicians, families and people who are impacted by OCD to be able to access the treatment they need in order to get better.

Dr. Tori Miller (1:58)

Catch us every fortnight wherever you get your podcasts.

Summary

Podcast Summary: Contamination OCD Isn’t Quirky

Breaking the Rules: A Clinician's Guide to Treating OCD
Hosts: Dr Celin Gelgec & Dr Victoria (Tori) Miller
Date: February 23, 2026
Duration: ~28 minutes of core content

Episode Overview

In this episode, Dr Celin Gelgec and Dr Tori Miller take a deep dive into contamination-themed OCD. Recognizing its reputation as the “cliché” of OCD presentations, they set out to counter common myths—especially the idea that contamination OCD is merely quirky, cute, or centered on simple handwashing. The discussion unpacks clinical realities, common struggles, and effective therapeutic approaches, including assessment nuances and exposure tasks. Designed for mental health professionals, it’s a guide for compassionate, nuanced, and evidence-based care.

Key Discussion Points & Insights

1. What Is Contamination OCD?

[02:36-03:43]

Definition: A deep fear of environmental contaminants: dirt, germs, chemicals, asbestos, and illness—but also “moral contamination”.
Moral Scrupulosity: The fear that proximity to ‘bad’ people or behaviors can ‘rub off’ morally.
- Dr. Tori Miller: “Fearing that the bad essence of that person or that thing will rub off on you...That will then turn you into a bad person.” [03:17]
Stereotypes: Contamination OCD is not just hand-washing and cleaning.

2. Clinical Realities and Daily Impact

[03:44-09:40]

Obsessive Cleaning: Spotting external compulsions is easier than mental ones, but the distress goes unappreciated.
- Compulsive cleaning isn’t about pride or aesthetics—people would gladly stop if they could.
- Sufferers often have physical consequences: eczema, dermatitis, bleeding from excessive washing.
Daily Functioning: Daily routines are severely disrupted.
- Example: Using multiple rolls of toilet paper, showering for hours, preparing food they feel unable to eat.
Dr. Celine Gelgec: “Clients literally shower with bleach...Bleeding bums, cracked bums, everything, like, all of it.” [05:52]
Eating and Food Safety OCD: Can mimic an eating disorder.
- Tension between environmental values (avoiding food waste) and OCD-driven behaviors.
- “Having clients who might present to therapy looking like they've got an eating disorder, when really we're dealing with contamination OCD.” [07:31]

3. The Hidden Debilitation & Social Effects

[09:41-12:00]

Beyond Hygiene: Delays getting out the door, impacts work, family, relationships, and finances.
COVID-19 as Trigger: Pandemic provided temporary validation but increased distress post-lockdown.
- Dr. Tori Miller: “A lot of my clients with contamination felt so validated...as we started coming out...that's when a lot of it spiked.” [10:06-10:24]
Family Dynamics: OCD’s reach can prompt behaviors in loved ones that are misaligned with their values.
- Striking example of a parent “hosing down” their children out of contamination fear—realization leads to meaningful therapeutic action.

4. Treatment – Navigating ‘Ego-syntonic’ and ‘Ego-dystonic’ Aspects

[12:00-18:52]

Assessment Challenges: Some contamination behaviors are considered ‘normal’ or ‘desired’ by clients.
Flexibility of Rules: The aim is not rigid normalization but restoring agency and flexibility.
- Dr. Celine Gelgec: “Our role is to help lead towards the gray.” [20:09]
- Dr. Tori Miller: “Because it's about flexibility in life.” [14:48]
Practical Questions for Guided Treatment:
- What rules feel genuinely important versus OCD-driven?
- Can clients be flexible when routines are disrupted (e.g., no soap in a public bathroom)?
- Is health compromised by rigidity (avoiding eating or drinking to not use public toilets)?
“Is This OCD or Normal?”:
- There’s no “right” amount of handwashing; use WHO guidelines as rough parameters, but choices ultimately belong to the client.
- Uncertainty and relinquishing certainty is itself valuable exposure work.
- Dr. Tori Miller: “There is no right...they’re guidelines, our clients actually get to decide for themselves.” [19:15-19:34]

5. Examples of Exposure Tasks (ERP) and Assessment Strategies

[21:00-27:56]

Disrupt Rituals and Compulsions:
- Mess up routines—reduce soap/wipes, skip steps, do things out of order.
- Reduce safety behaviors (e.g., putting toilet paper on seats, “chair-drobes” for clean/dirty clothes separation).
- Family involvement: loved ones refuse to abide by OCD-driven rules.
Imaginative Exposure:
- Clients read stories/scripts about worst fears (e.g., food poisoning, being publicly humiliated due to perceived contamination).
Data Gathering:
- Ask clients about rituals—what, when, patterns—during assessment to target exposures effectively.
- Dr. Celine Gelgec: “Collecting that data is really important. Because then it informs your exposure task planning.” [27:40-27:55]
Notable Quotes:
- Dr. Tori Miller: “It is a lovely feeling as a therapist to be able to say very clearly...you know this is the rule...But ultimately, that would just be reinforcing OCD.” [20:19-20:45]

Notable Quotes & Memorable Moments

On Misconceptions:
- Dr. Celine Gelgec: “Contamination isn't cutesy or quirky. It's pretty full on and very debilitating.” [10:24]
On the Cost of OCD:
- Dr. Tori Miller: “They talk about, you know, how sore their hands and their bodies are. You know, about the eczema and dermatitis they get...the sore knuckles, the redness from the hot, hot water and intense detergents.” [05:09]
On Flexibility vs. Rigidity:
- Dr. Tori Miller: “Are there compromises that you're making to your health and your well being by being too rigid around these rules? So I'm okay if you actually are someone who moves through your life where you have choice... But what about when you don't?” [15:38]
On Family Impact:
- Dr. Celine Gelgec: “OCD can be so insidious that it can really use that fear where people end up doing stuff that is so not in line with what they would otherwise want to be doing. And they don't really even realize it until someone calls it out.” [11:44]
On Assessment:
- Dr. Celine Gelgec: “When someone says they've got, you know, contamination, OCD...collecting that data is really important because then it informs your exposure task planning.” [27:40]

Important Timestamps

02:36 – Defining contamination OCD (including moral contamination)
05:03 – The “cliche” myth: handwashing is not always about aesthetics
06:23 – Food fears and overlap with eating disorders
10:06 – COVID-19’s impact on contamination OCD
11:50 – Example of impact on parenting and values
13:03 – Navigating client expectations and rules
14:37 – “OCD time” vs. everyday life (the difference between ‘OCD wash’ and ‘quick wash’)
16:14 – The “hand in the toilet” exposure and making exposures realistic
19:15 – No “right” answer to handwashing: guidelines not rules
20:09 – Therapeutic process: embracing the ‘grey’, not rigid rules
21:07 – Example ERP (Exposure & Response Prevention) tasks
22:32 – Differentiating between compulsions and rituals
27:40 – Importance of thorough assessment for exposure planning
28:16 – Summary and message to clinicians and sufferers

Takeaways for Clinicians

Contamination OCD is complex, deeply distressing, and often vastly misunderstood.
Treatment must balance respect for clients’ values with confronting OCD’s grip; flexibility, not rigid normalization, is the goal.
Thorough assessment is key: understand both surface compulsions and underlying patterns.
Exposure tasks should be individually tailored, realistic, and target both behavior and the intolerance of uncertainty.
Family and social contexts matter; OCD’s consequences ripple outward.
Supporting agency and self-efficacy is just as important as reducing symptoms.

“So just summarizing: contamination, not being cute or quirky, it's being quite dire, impacting lots of different aspects of life. There are so many other parts of contamination that we probably haven't even touched on.”
— Dr. Celin Gelgec [28:01]

For more insight, clinicians and those impacted are encouraged to listen to the full episode or seek professional consultation regarding OCD treatment.

Contamination OCD Isn’t Quirky