Show Notes
In this long-awaited episode of Breaking the Rules, we finally do a deep dive into contamination-themed OCD — one of the most common, misunderstood, and physically debilitating OCD presentations. This conversation goes far beyond clichés about handwashing and cleanliness. We unpack what contamination OCD actually looks like day-to-day: the pain, the exhaustion, the food avoidance, the disrupted routines, the impact on relationships, parenting, work, and health — and the quiet suffering that often goes unseen. We explore both physical contamination fears (germs, illness, food safety, asbestos, chemicals) and moral contamination, where people fear being “tainted” by proximity to someone or something that conflicts with their values. The episode also tackles one of the trickiest clinical questions: how to work with ego-syntonic rules without turning therapy into another rigid rule system. This is an essential listen for clinicians, clients, and loved ones wanting a clearer, more compassionate understanding of contamination OCD — and how ERP can be done flexibly, ethically, and effectively. 💬 Key themes: What contamination OCD really looks like behind closed doors Why it’s not about being “clean” or “house-proud” The physical toll: pain, skin damage, exhaustion, hunger Food avoidance, illness fears, and misdiagnosis with eating disorders Moral contamination and value-based fear Ego-syntonic vs ego-dystonic rules How to assess contamination OCD properly Flexibility vs rigidity in treatment ERP without reinforcing “right vs wrong” rules Helping clients choose values over compulsions 💡 “Contamination OCD holds people hostage.” 🧠 “This isn’t quirky — it’s devastating.” 💬 “There is no ‘right’ amount. Flexibility is the goal.” 🔖 Chapters 00:00 Why we avoided this topic (and why we’re doing it now) 01:00 What contamination OCD actually means 02:30 Moral contamination explained 05:00 The physical and emotional toll 08:00 Illness fears, COVID, and community safety 10:00 When contamination affects parenting and relationships 12:00 Ego-syntonic rules and client-led goals 14:00 Flexibility vs rigid hygiene rules 16:00 ERP and realistic exposure work 19:00 Messing up rituals and tolerating uncertainty 22:00 Assessment questions clinicians should be asking 25:00 Creative exposure ideas 27:30 Final reflections and encouragement
#OCD #ContaminationOCD #ERP #TherapyPodcast #MentalHealthProfessionals #OCDRecovery #ExposureTherapy #BreakingTheRulesPodcast #ClinicianSupport #MentalHealthAwareness Hosted on Acast. See acast.com/privacy for more information.
More from Breaking the Rules: A Clinician's Guide to Treating OCD
This one's for the parents. In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller tackle one of the most common questions they hear from families - I think my child might have OCD. Where do I even start?
OCD or Anxiety? It's Not a Black and White Question
ERP is the gold standard for OCD. But what happens when it's not enough on its own? In this episode of Breaking the Rules, Dr Celin Gelgec and Dr Tori Miller explore one of the most important — and least talked about — questions in OCD treatment: when and how to bring in other therapeutic modalities, and how to do it without abandoning the principles that make ERP work. Tori shares what traditional manualized ERP actually looked like in the early days of her career — rate your SUDS, watch the clock, wait for the anxiety to come down — and how the field has shifted since the inhibitory learning model changed the way we think about exposure. Celin reflects on her experience of always working in an integrated way, and why the principles of ACT have always felt like ERP to her — because they are. They also get honest about the moments when ERP becomes a battle. When the exposure menu turns into a war. When a client has every reason in the world not to engage — and what to do instead. Whether you're a clinician looking to expand your toolkit or someone living with OCD who's wondered why their therapist keeps talking about values and mindfulness - this episode will change how you think about what treatment can look like.
Four years in, and we're going back to basics. In this episode of Breaking the Rules, Celin and Tori walk through the full OCD assessment process from the ground up - because with new listeners joining and so much focus on treatment in recent episodes, it felt like the right time to start at the beginning.
When Therapists Spiral Too: What OCD Taught Us About Ourselves