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Napalm

Split Topic: Public Transport is Dirty

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I thought I'd add a bit to this discussion as someone who, not very long ago, had serious anxiety due to contamination fears.

Firstly, to address the idea that contamination OCD is 'different' to other OCDs: I used to think this too, but I would disagree now. Does food poisoning exist? Yes. Do stomach bugs and viruses exist? Yes. So it's true that the risk of being ill if you eat something with hands that aren't perfectly clean is greater than 0 - but for someone with contamination-based fears, the risk in their mind is greatly exaggerated. There are plenty of other themes that involve a non-zero, but low, risk, e.g. fear of flying, being in a car accident, solipsism, ...

To address this specific case: is public transport dirty? Yes, it often is. But that doesn't mean that the risk of getting sick because of not washing your hands and then eating something on a train is significant. (Sidenote: hopefully this isn't too much reassurance, but it's worth noting that, while there is plenty of evidence of contamination on public transport, there is little evidence of people actually getting sick as a result - for example, faecal matter is quite literally everywhere, but often completely harmless. Sure, handwashing removes contaminants, but how much of the contamination is actually disease-causing?) 

I will happily accept that I still wash my hands more often than many other people - when I go out with friends, for example, they might get through the whole day without washing their hands unless they go to the bathroom, whereas I might routinely wash my hands once every couple of hours. But I'm at a point now where if I don't have access to a sink and running water for a few hours, I won't have horrible anxiety as a result. An important reason I've been able to recover is that I practised resisting compulsions and doing what's considered 'normal behaviour', including eating without washing hands beforehand.

There are certainly some situations where I would definitely be more careful with contamination - if I had a contagious disease, for example, or in a hospital, where hand-washing is far more important and should be done regularly. When cooking and handling food, I'm also quite conscientious of preventing contamination.

Of course most people don't like contamination or dirt, but it's important to strike a balance between hygiene and mental health, if you like: sensible hygiene is good and fine, but obsessive, excessive hygiene is unnecessary and has a negative impact on the wellbeing of an OCD sufferer. With that in mind, doing things such as using public transport and then eating without washing hands is, in my opinion, absolutely fine and helpful with recovery from OCD.

Edited by bobfish

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On 22/07/2019 at 10:19, Napalm said:

That public transport is dirty and a source for catching something unpleasant is a fact though. The OCD isn't entirely lying to the sufferer in this context.  That's what makes contamination-based OCD different to other forms of OCD. It has a valid point: dirty "contaminated" hands increase your risk of catching something that will make you unwell. Again as I said earlier there is a logic to it all that makes sense.

I also do not think resorting to extreme actions such as putting your hand in toilet water and then eating a bag of crisps without washing your hands is helpful or necessary.

Many people without OCD would find doing such a thing utterly repulsive. It could even be viewed as a form of psychological abuse.

Actually, OCD lies ALL the time. It never tells the truth. That public transportation is not the most sterile place is immaterial. And there is no more logic with contamination obsessions.

With this topic in mind, what are the actual obsessions? Is it a little thought stating, "public transportation is dirty." No. That's not what enters the sufferer's mind. If it was, it could be more easily dismissed. The actual obsession comes across like...

THIS PLACE IS A GERM FACTORY! IT'S DISGUSTING! YOU ARE GOING TO GET SICK FOR SURE AND PROBABLY DIE! THIS IS A THREE-ALARM EMERGENCY! DO SOMETHING!

Do you see the difference? OCD lies always, not that there isn't a small grain of truth to the thought, but the panic instilled and the thought and belief that this is a catastrophic situation.

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On 19/07/2019 at 07:15, Napalm said:

The thing is public transport is filthy, so I suppose that makes it difficult for someone with OCD to be entirely comfortable.

When I see people touching the handle bars on public transport and then using their fingers to eat food (which is a common sight in inner-city London), I can't help but feel a sense of disgust. 

Yup, so are lots of things, most things in fact.  We live in a world filled with dirt and germs, etc.  Its an unavoidable fact of life.

Its perfectly reasonable to not like these sorts of things, or to want to be reasonably clean.  The problem is, as a few others have mentioned in this thread, when that urge to be clean grows out of proportion with the risk and impacts your life in a significant negative fashion.

 

On 23/07/2019 at 02:19, Napalm said:

That public transport is dirty and a source for catching something unpleasant is a fact though. The OCD isn't entirely lying to the sufferer in this context. 

Again, as others have said, of course there can be an underlying possibility, thats true for basically every OCD worry.  

But you are treating this as if its black and white, either situations are completely fair to be worried about, or its an exaggeration to worry about them.  But situations in life, all situations don't fit in to one or two or three buckets, they exist on a spectrum, the risk varies and as it varies so should our response to that risk.

So yes, there ARE public health campaigns to promote hygienic behaviors like hand washing.
And yes, germs ARE a real problem, you can get sick, you can even die.
Both of these things are true, no question.  
But that doesn't mean the level of worry and anxiety you have about a topic is therefore rational or reasonable.  OCD isn't "is my fear real or not" its "is my response to a potential risk reasonable or not".
 

On 23/07/2019 at 03:38, Napalm said:

That's why I think contamination-based OCD is different to other OCDs.

OCD is all the same, and all very simple to understand (though difficult to overcome). It all stems from irrational levels of anxiety over a misperceived level of risk.  Not the mere existence of risk, everything carries some degree of risk, but the LEVEL of risk is too high.  
So yes its true that public transit is dirty (lots of public facilities are).
And yes its true that you really get sick from that "contamination".
But that doesn't mean you are evaluating the level of risk accurately and responding reasonably. 
So whether its dirty subways or dying from a heart attack or being arrested for a crime you didn't commit, its all the same at its core, exaggerated worry, irrational response.

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I am very torn on this one because:

1. Normal people really should wash their hands more. If everyone washed their hands with soap after using the toilet and before eating, it would all but eliminate infections like Norovirus, which are caught from tiny quantities of faecal matter on people's hands! These infections are just unpleasant for normal people but are dangerous for the elderly, for infants and for immune compromised people and terrifying for Emetophobes! 

2. Contamination OCDers (like me!) do need to take risks and to look for facts contrary to our OCD fears; so for example my OCD tells me that if I touched a chair on the tube and then ate without cleaning my hands I would definitely get ill, when in fact most people do it and only get sick about 2 times per year. There would probably be about a 1 in 182 chance of getting sick on any given day if I did everything that normal people do (so e.g. use public loos, touch tube chairs, handle cash etc.) and probably a 1 in several thousand chance of getting sick, just from touching the chair and then eating. 

3. I know that if I do things in the way that normal people do then I am slightly more likely to get sick but it's still not very likely AND I have a good chance of feeling less stressed and anxious and of getting my life back!  

 

 

 

 

 

Edited by BelAnna

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8 hours ago, BelAnna said:

1. Normal people really should wash their hands more. If everyone washed their hands with soap after using the toilet and before eating, it would all but eliminate infections like Norovirus, which are caught from tiny quantities of faecal matter on people's hands!

Even if everyone washed their hands, its highly unlikely norovirus would be eliminated.  The amount of effort required to achieve the sterility levels necessary to eliminate such infections is far beyond what is reasonably practical.  Further over sanitation has been found to negatively impact the immune system (if not exposed to enough negative agents it does not gain sufficient strength) and in particular over use of anti-biotic agents in hand washing situations (among others) is having a negative impact by increasing bacterial resistance.  I'm afraid you are letting your norovirus anxiety take over in these kind of situations.   Yes, washing hands is a good idea, I do it every time I use the toilet and usually before I eat, but it is not something that one needs to be  so scrupulous about as suggested by the OP.
 

8 hours ago, BelAnna said:

These infections are just unpleasant for normal people but are dangerous for the elderly, for infants and for immune compromised people and terrifying for Emetophobes! 

While extra care does need to be taken when interacting with people who have lower resistance, the answer is not what has been suggested by the OP.  And while terrifying for emetophobes, the wrong thing to do is to cater to that anxiety, thats just feeding a compulsion.  The correct path forward is to challenge the fear and move past it.

 

8 hours ago, BelAnna said:

I know that if I do things in the way that normal people do then I am slightly more likely to get sick

You may feel this way, but its also entirely possible your odds of getting sick won't change at all, its entirely possible the behaviors you engage in, like many anti-OCD behaviors, don't actually impact the feared scenario at all, they just appear to.

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12 hours ago, BelAnna said:

I know that if I do things in the way that normal people do then I am slightly more likely to get sick but it's still not very likely AND I have a good chance of feeling less stressed and anxious and of getting my life back!  

This!

You can do this BelAnna.   I hope this next piece will help you, it was published in the charity magazine 14-years ago, and re-published as a FAQ feature with Professor Salkovskis last month.

Question from one of our forum users/charity members...

Quote

I watched with great interest the Five documentary about OCD in January (AF - screened in 2004), which included showing sufferers undergoing treatment with you. One of the types of OCD which I suffer from is “contamination OCD” and I wondered if you could reassure me that the type of exposure I saw both you and the sufferers undergoing is safe or not. By that, I mean that the programme helped me a lot in that I saw that you were not taking all the ‘precautions’ that I would necessarily take and you are seemingly fine from that, so I wondered if you could reassure me that it’s safe to do what you were doing?
Jo, Manchester 

Response by Professor Paul Salkovskis

Quote

 

The Five programme, although excellent, was of very brief contact and of necessity didn’t show the way treatment unfolded. In terms of my safety, I’m fit and well, perhaps a little overweight but I can’t blame that on my work with OCD!

By definition, if you contaminate yourself with anything the risk goes up. My risk of developing a stomach problem went from, say, one in 10,000 to four in 10,000 by doing what I did.
Notice that the reason I “toilet dipped” was not so that Katie could do it too, but so that she could take a crisp from a packet with her hands… which she managed as a first step in normalising. She also increased her risk by taking that crisp.

Now set that risk against the risk… no, I mean the certainty, that her life would be severely damaged by her OCD, and you get a different perspective. Think of it like driving. I drove on the M25 today, and increased my risk. I took that risk because travelling on public transport would have been much more of a problem, so there was a cost benefit analysis. Sometimes, with OCD, the cost benefit analysis gets out of balance, and needs rebalancing.

You need to think about my motivation; why do I do the things I do (even though they increase my risk)? The answer is that I know that it will help, and its worth that for me. How much more is it therefore worth for Katie (in the Five film). However, it is always the choice of the sufferer. One of the first things we always say is that we might ask the person to do things, but “no” is always an acceptable answer. All we ask is for permission to try to persuade the person, help them see why they need to try and so on.

In summary; contaminating yourself might slightly increase danger, can’t deny that, but the REAL danger is not a risk… that’s the danger that OCD will destroy your life

 


During the webchat (remember them?!?) I responded to this question.  I knew the answer of course, but was asking a question that people frequently asked us.

Quote

Do you think asking OCD patients to do something a non sufferer would not do, like putting their hand down a toilet is an acceptable treatment strategy?


Paul’s reply:

Quote

Absolutely, yes. Sometimes, if you want to get back to normal you have to do abnormal things for a while.

Think of it this way. If you broke your leg, you would probably have to wear a plaster cast. “But…” you splutter to the doctor, “why should I wear a plaster cast? It’s certainly not normal to wear a plaster. Why, if I go into the street just now, probably no-one else will be wearing one”. Similarly, if you are height phobic, you may simply wish to visit your gran on the third floor. However, spending an hour up the post office tower (Blackpool tower if you are from the north and the Scott Monument if you are even more northern) will mean that you won’t even be vaguely nervous when you go visit your granny. However, if you had confined yourself to getting used to the third floor…

 

The fascinating part of the entire webchat was that we did it in Paul's Institute of Psychiatry office in 2005... over 14 years ago, yet the majority of those questions and Paul's answers are valid today as they were in 2004.

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7 hours ago, Ashley said:

Similarly, if you are height phobic, you may simply wish to visit your gran on the third floor. However, spending an hour up the post office tower (Blackpool tower if you are from the north and the Scott Monument if you are even more northern) will mean that you won’t even be vaguely nervous when you go visit your granny. However, if you had confined yourself to getting used to the third floor…

I've been following this thread with interest as contamination is also my current theme and am trying to work through it. It's actually helpful to me to hear the argument so clearly on both sides as it's like the 2 parts of my own mind. I used to be probably less hygienic than most before I had the contamination theme. I didn't get sick more often, no diseases etc...so I actually try to think back to how I used to be as part of my encouragement to face some of my current fears.

I find the above quote as something I really need to contemplate further, as so far I really feel like I'm trying to just get to the third floor (metaphorically speaking) and just face my angst around that. I can really see how taking the exposure exercises to a more extreme level would be helpful if done properly. I just can't even imagine getting there at this point! Something to work toward I guess!

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I had this when I began to travel two years back. This July I caught the Whooping Cough on a trip to NY. So there is some risk, not gonna sugarcoat it. 

However people can protect by getting the Dtap vaccine & masks. Traveling a lot you really wanna ask your doc for vaccines it’s common sense. 

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9 hours ago, leif said:

I just can't even imagine getting there at this point! Something to work toward I guess!

The good news is you don't have to go to the extreme to improve, though the more you can push the limits, the faster you will likely make progress.  People in general, and OCD sufferers in particular often get stuck in black and white/ either or thinking.  But life operates on a spectrum!  Maybe you aren't ready to do an activity that is a 10 on the anxiety inducing scale, but how about a 7 or even a 4?  At some point those level 4 activities will become level 1 anxiety activities, which means the old level 10 activities will probably be closer to level 7 now.  Remember, OCD recovery is a marathon, not a sprint!

Edited by dksea

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2 hours ago, Handy said:

However people can protect by getting the Dtap vaccine & masks. Traveling a lot you really wanna ask your doc for vaccines it’s common sense. 

Unless there is a specific medical advisory or legal requirement for a vaccine its not necessary to get them for all possible conditions, that would not be common sense.
Meanwhile masks used in specific situations (such as surgery or hospitals) have some benefit, but in general the masks sold and used by the public or of limited functionality at best.  Millions of people get by without using masks, for an OCD sufferer using a mask, except specific circumstances as mentioned before, would be a compulsive behavior and not generally beneficial to their recovery.

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9 hours ago, Handy said:

I had this when I began to travel two years back. This July I caught the Whooping Cough on a trip to NY. So there is some risk, not gonna sugarcoat it. 

However people can protect by getting the Dtap vaccine & masks. Traveling a lot you really wanna ask your doc for vaccines it’s common sense. 

As you can see Handy I have removed your post from Sophhs thread to this, because it covers old ground and I do not believe your advice is helpful for Sopphh. 

Do you think telling someone with an OCD fear of public transport to get vaccine for public transport is helpful?  I am trying to understand why you felt that was helpful in any way, shape or form? 

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On 25/07/2019 at 08:34, Ashley said:

This!

You can do this BelAnna.   I hope this next piece will help you, it was published in the charity magazine 14-years ago, and re-published as a FAQ feature with Professor Salkovskis last month.

Question from one of our forum users/charity members...

Response by Professor Paul Salkovskis


During the webchat (remember them?!?) I responded to this question.  I knew the answer of course, but was asking a question that people frequently asked us.


Paul’s reply:

 

The fascinating part of the entire webchat was that we did it in Paul's Institute of Psychiatry office in 2005... over 14 years ago, yet the majority of those questions and Paul's answers are valid today as they were in 2004.

Thank you Ashley! that's really helpful. A few times on my recent holiday I thought about your hand-in-toilet ERP to help me to face some of the challenges (which were much more minor than the toilet-task) that the trip involved. I think it's good that Paul acknowledged that there is a slightly increased risk of illness in these situations but just that it might be worth it if it leads to recovery from OCD.

I understand the logic of taking things to extremes to deal with the contamination OCD. One issue I have is that my Emetophobia seems to complicate things a bit; so for example when I was at the ADRU I could do some exposure exercises BUT then my friend's son came to the Unit with Norovirus and instantly I couldn't do the exposure exercises any longer and went back to extreme avoidance (disposable gloves, lots of carex, sanitizer, wipes etc.) and left the Unit prematurely. If for example, I put my hands down a toilet and was OK afterwards I think that I might feel ok and feel a bit better about facing other contamination challenges BUT then the second anyone mentioned that there was a stomach virus/norovirus going around, I would not be able to cope and immediately return to OCD behaviours because my fear of vomiting is very severe and the likelihood of catching one is much higher with poorer hand hygiene. The standard CBT for Emetophobia did not work and actually seemed to make things worse!

Edited by BelAnna

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13 hours ago, dksea said:

The good news is you don't have to go to the extreme to improve, though the more you can push the limits, the faster you will likely make progress.

yes for sure! I've definitely seen lots of improvements along the way, but I do wonder if i should be pushing myself to the 'top floor' if I  want true recovery.

2 hours ago, BelAnna said:

If for example, I put my hands down a toilet and was OK afterwards I think that I might feel ok and feel a bit better about facing other contamination challenges BUT then the second anyone mentioned that there was a stomach virus/norovirus going around, I would not be able to cope

I'm similar BelAnna and think many of us are. That's what I find with controlled exposures--if I know what I'm exposing myself to, and feel ready to face it, I can do ok. However if a trigger comes up that I wasn't planning for, and it touches on my deeper fears, I tend to go back to compulsions/avoidance. For me the fears are usually around blood borne diseases. And exactly that feeling that "I won't be able to cope" comes up.

 

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Frankly there are some great points. A lot depends you see on whether a person is speaking from a logical mind rather than fear based. 

Public areas can be dirty yes, but they are also routinely cleaned by janitors that use sterilization chemicals.  Also doorknobs are often constructed of metals that bacteria can’t thrive on. 

Yes, I travelled this month & got whooping cough & also a doctor did a biopsy this month on a lump & it has to come out.  That’s just how it is. 

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1 minute ago, Handy said:

A lot depends you see on whether a person is speaking from a logical mind rather than fear based. 

Do you understand what ocd is, handy? Genuine question. 

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22 minutes ago, Handy said:

Public areas can be dirty yes, but they are also routinely cleaned by janitors that use sterilization chemicals.  Also doorknobs are often constructed of metals that bacteria can’t thrive on. 

All of which is completely irrelevant to discuss on the forum for various reasons. 

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8 hours ago, BelAnna said:

Thank you Ashley! that's really helpful. A few times on my recent holiday I thought about your hand-in-toilet ERP to help me to face some of the challenges (which were much more minor than the toilet-task) that the trip involved. I think it's good that Paul acknowledged that there is a slightly increased risk of illness in these situations but just that it might be worth it if it leads to recovery from OCD.

I understand the logic of taking things to extremes to deal with the contamination OCD. One issue I have is that my Emetophobia seems to complicate things a bit; so for example when I was at the ADRU I could do some exposure exercises BUT then my friend's son came to the Unit with Norovirus and instantly I couldn't do the exposure exercises any longer and went back to extreme avoidance (disposable gloves, lots of carex, sanitizer, wipes etc.) and left the Unit prematurely. If for example, I put my hands down a toilet and was OK afterwards I think that I might feel ok and feel a bit better about facing other contamination challenges BUT then the second anyone mentioned that there was a stomach virus/norovirus going around, I would not be able to cope and immediately return to OCD behaviours because my fear of vomiting is very severe and the likelihood of catching one is much higher with poorer hand hygiene. The standard CBT for Emetophobia did not work and actually seemed to make things worse!

Is it that CBT didn't work or you didn't give it a chance?

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22 hours ago, PolarBear said:

Is it that CBT didn't work or you didn't give it a chance?

CBT for my Emetophobia did not work.

I definitely gave it a chance- I worked all the way through the tasks (tasks like watching youtube videos of people vomiting; writing down words related to puking; listening to a vomit CD; spinning around to mimic or induce nausea; looking at a vomit-concoction (just vegetable soup really!) in a toilet etc.etc. It just didn't help and the clips of people vomiting just made me anxious about those situations, for example there were some of people stopping their cars to vomit- now I am anxious every time a car stops close to ours! 

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