Intrusive imagery is hypothesised to evoke feelings of contamination and urges to wash. This study aimed to (1) develop a questionnaire to assess imagery associated with contamination fears; and (2) compare contamination imagery in a sample of people with contamination based obsessive–compulsive disorder (C-OCD) with a non-clinical student sample.
Methods
Non-clinical students (n=45) and people with C-OCD and contamination fears (n=45) completed a self-report questionnaire designed to assess images associated with contamination.
Results
Compared to non-clinical participants, people with C-OCD reported images associated with contamination that were more vivid, harder to dismiss and distressing. Participants with contamination fears reported images that directly evoked feelings of dirtiness and triggered compulsive washing behaviours. A small number of participants reported beneficial images that reduced feelings of contamination.
Conclusions
These preliminary findings indicate that imagery can evoke feelings of contamination. However, future research is needed to establish the nature and causative role of imagery in mental contamination. Questionnaire methods may be useful for clinical assessment of imagery associated with contamination fears.
The importance of imagery in obsessive–compulsive disorder (OCD) is acknowledged in the diagnostic criteria that state that obsessions comprise intrusive thoughts, images or urges (American Psychological Association, 1994). Images in OCD are thought to be primarily visual, vivid, unwelcome, uncontrollable and distressing and often lead to feelings of doubt, guilt and shame (Rachman, 1997 and Rachman, 2007). Clinical descriptions indicate that images in OCD have a similar content to intrusive thoughts and impulses with common themes of illness and death, blasphemy, sex, disaster, insanity and violence (de Silva, 1986, Rachman, 1997 and Rachman, 2007). Preliminary research has demonstrated that people with OCD experience unwanted images that are vivid, frequent and distressing (Speckens et al., 2007 and Lipton et al., 2010). People with OCD typically experience images from a field perspective and are more likely to report images associated with harm compared to images experienced by anxious controls (Lipton et al., 2010).
Imagery in OCD may be particularly relevant for people who report contamination fears as a recent cognitive behavioural theory of contamination has suggested that feelings of dirtiness and urges to wash can be evoked by internal events such as imagery (Rachman, 2006). According to the theory of contamination, in addition to ‘contact contamination’, it is possible to feel polluted, dirtied, infected or endangered in the absence of actual physical contact with a contaminant, known as ‘mental contamination’ (Rachman, 2004 and Rachman, 2006). Whereas intrusive images in contact contamination evoke anxiety, it has been suggested that in mental contamination, imagery can directly evoke feelings of dirtiness and compulsive washing. The feelings of internal dirtiness and pollution associated with mental contamination may arise because a person experiences unwanted intrusive images of the human source of contamination (Rachman, 2006). For example, Rachman (2006) described the case of a young actor who had been mistreated by his family and betrayed by his partner. The ex-partner had become a source of contamination and imaging the face of his ex-partner evoked strong feelings of mental contamination: “He was asked to form a vivid image, in turn, of his father, mother and three other relatives. The images provoked strong feelings of contamination… and left him with an urge to wash. Forming an image of his former partner evoked such strong feelings of contamination that he insisted on washing his hands immediately.” ( Rachman, 2006, p
In conclusion, these preliminary findings from the first study to explore imagery and mental contamination suggest that contamination imagery is an area of concern for some patients. The findings imply that assessing and focussing on imagery in therapy for contamination fears may be beneficial. With further development, the MCIQ may be a useful tool for clinicians to quickly asses the presence of imagery related to contamination. This is important as these images may maintain contamination fears and compulsive washing behaviour. Additionally, exploration of the content of the images is likely to reveal critical information about the human source of mental contamination that may have previously been overlooked.