Mental contamination is an internal feeling of dirtiness or pollution typically experienced in the absence of contact with an actual physical contaminant. It often involves feelings of shame, anxiety, or disgust and urges to wash or otherwise rid oneself of the contamination.
Radomsky et al. (2018) state that “violation events” involving moral degradation/humiliation or physical violation (e.g. sexual assault) are key predisposing factors.
Individuals may then try to rid the mental pollution via washing/cleaning (Rachman, 2004), but these are rarely effective since the contamination is internal.
Paradoxically, avoidance, thought suppression, and substance use aimed at resisting the contamination actually perpetuate it, resulting in a self-sustaining vicious cycle.
Ojalehto, H. J., & Abramowitz, J. S. (2023). Mental contamination among trauma survivors: A scoping review. Traumatology. Advance online publication. https://doi.org/10.1037/trm0000492
Key Points
- Mental contamination (MC) is an internal feeling of dirtiness typically experienced without contact with a physical contaminant. MC is increasingly recognized as a common experience for trauma survivors.
- Qualitative studies indicate trauma survivors experience MC as a relatively stable phenomenon that trauma reminders can trigger. Feelings of internal dirtiness and urges to wash are common.
- Most quantitative measures adequately capture the central components of MC (i.e., internal feelings of contamination and dirtiness).
- MC appears more prevalent and severe among sexual assault survivors, however other trauma survivors also experience MC.
- Significant associations were found between MC and PTSD across multiple studies of trauma survivors. Bidirectional relationships were demonstrated between MC and PTSD symptoms.
- Insufficient evidence exists for relationships between MC and obsessive-compulsive, depressive, and suicidal symptoms among trauma survivors.
- Prospective research is needed to establish causal relationships between trauma, MC, and psychopathology.
Rationale
Prior research indicates mental contamination (MC) may be a common experience for trauma survivors that contributes to adverse outcomes like PTSD (Badour & Adams, 2015).
Despite growing research on links between trauma, MC, and psychopathology, no reviews have synthesized this literature. This scoping review aimed to:
- Summarize qualitative research on trauma survivors’ experiences of MC
- Examine how MC is measured among trauma survivors
- Identify research linking trauma and MC
- Identify research linking MC to psychopathology among trauma survivors
Method
A literature search adhering to PRISMA guidelines was conducted using 5 databases – Scopus, PubMed, PsycInfo, ProQuest Central and Dissertations/Theses Global.
Searches were completed between June 2022-May 2023 without restrictions.
Search terms captured mental contamination, trauma exposure and variants.
Inclusion criteria
- Used a trauma-exposed sample or measured trauma exposure among participants
- Assessed mental contamination as defined by Rachman (1994) using an empirically established self-report instrument, a visual analog scale, or qualitative descriptions
- Examined mental contamination in a trauma-exposed sample or in relation to a trauma measure
- Were peer-reviewed journal articles or unpublished dissertations or theses
- Were available in English
Additionally, the paper states that trauma exposure was defined as:
Exposure to any event that threatens injury, death, or the physical integrity of oneself or others, consistent with the definition proposed by the International Society for Traumatic Stress Studies (2020).
This includes sexual violence and childhood abuse (i.e., sexual abuse, physical abuse, emotional abuse, neglect).
Results
19 studies met inclusion criteria. 4 included qualitative descriptions of MC, 9 reported on links between trauma and MC, 16 reported on links between MC and psychopathology.
Phenomenology of MC Among Trauma Survivors
- Trauma survivors describe MC as a feeling of internal dirtiness, often involving distressing emotions like shame, anxiety, disgust
- MC was described as a whole-body feeling that was emotional rather than physically localized
- Triggers include trauma reminders
- Attempts made to avoid/escape feelings of contamination (e.g., distraction, washing/cleaning, thought suppression, self-harm, substance use, social withdrawal, and experiential avoidance)
- Consistency noted between survivors’ descriptions and Rachman’s (2004) conceptual model
Measurement of MC
- Most measures appear to capture central components, including internal contamination, associated emotions, urges to wash
- Some limitations exist (e.g., may not capture idiographic aspects)
The Relationship Between Trauma and MC
- Higher rates and severity of MC found in sexual assault survivors
- Less research on MC after other trauma types
- Disgust reactions, negative appraisals, PTSD symptoms implicated as mechanisms
Potential Mechanisms Linking Trauma and MC
- Disgust experiences during trauma
- Disgust and contamination aversion during the trauma may become associated with the self through classical conditioning
- Trauma survivors who experienced greater disgust reactions during the assault reported higher levels of subsequent MC
- Disgust propensity and disgust sensitivity have been linked to MC severity
- Negative appraisals about self/trauma
- Appraisals concerning the degree of violation, responsibility, and perpetrator’s morality/cleanliness have been tied to MC
- Believing the trauma provides evidence that one is tainted or damaged predicts greater MC
- PTSD symptoms
- PTSD symptoms like intrusions predict short-term increases in MC during script-driven imagery and trauma recall
- PTSD symptoms were shown to prospectively predict daily fluctuations in MC
MC and Posttraumatic Stress Symptoms
- 14 studies found links between MC and PTSD symptoms
- Bidirectional relationships demonstrated
- More research needed on underlying mechanisms
MC and Obsessive-Compulsive Symptoms in Trauma Survivors
- Mixed support for relationship between MC and OCD symptoms
- More research needed, particularly using prospective designs
MC and Depressive Symptoms in Trauma Survivors
- Insufficient evidence to conclude MC linked to depression
- Theoretical reasons exist but limited empirical examination
MC and Suicidal Thoughts and Behaviors Among Trauma Survivors
- Insufficient evidence on links between MC and suicide risk
- Preliminary findings suggest MC may increase risk indirectly via PTSD severity
Insight
This review indicates that trauma-related mental contamination (MC) is a relatively common and distressing experience for survivors of sexual trauma in particular.
Conceptually, trauma-related MC appears similar to MC among OCD samples as described by Rachman (2004).
According to Rachman, mental contamination stems from “violation events” that lead to catastrophic cognitions about the self being damaged, tainted, or polluted. This results in persistent and distressing feelings of internal dirtiness and urges to wash or cleanse oneself.
Significantly, PTSD symptoms appear bidirectionally related to feelings of trauma-related MC over time. That is, not only might MC serve as a maintaining factor in PTSD due to increased use of avoidance coping, but PTSD symptoms like intrusive memories may also trigger and perpetuate MC.
Together, these findings highlight the need for trauma-focused treatments to directly address trauma-related MC and associated maintenance cycles.
While cognitive-behavioral treatments targeting OCD-related MC show promise (Jung & Steil, 2013), further intervention research focused specifically on trauma populations is needed.
Strengths
- Comprehensive search using multiple databases
- Inclusion of qualitative and quantitative studies
- Use of rigorous PRISMA guidelines
- Examination of multiple relationships involving trauma, MC, and psychopathology
Limitations
- Many studies used cross-sectional designs limiting causal conclusions
- Some studies had modest sample sizes and few included clinical samples
- Samples predominately white females and focused on sexual assault
- Variability in measures of MC and trauma exposure
Clinical Implications
Trauma-related mental contamination appears to involve the same central components outlined in Rachman’s general model of mental contamination – internal dirtiness/pollution, negative emotions, misappraisals of self as tainted, and avoidance coping.
This coherence supports the validity of the construct of trauma-related mental contamination. It also suggests that treatment strategies developed for OCD-related mental contamination may hold promise for alleviating trauma-related mental contamination.
More research is still needed, however, to adapt and test such interventions, specifically among trauma survivors.
Since exposure therapy may be less effective for contamination concerns, alternative approaches like Cognitive Restructuring and Imagery Modification should be considered (Jung & Steil, 2013; Steil et al., 2011).
Given that mental contamination is common among sexual assault survivors and linked to adverse outcomes, clinicians should assess for trauma-related feelings of contamination which may impede recovery.
References
Badour, C. L., & Adams, T. G. (2015). Contaminated by trauma: Understanding links between self-disgust, mental contamination, and post-traumatic stress disorder. In P. A. Powell, P. G. Overton, & J. Simpson (Eds.), The revolting self: Perspectives on the psychological, social, and clinical implications of self-directed disgust (2015-21776-008; pp. 127–149). Karnac Books.
Jung, K., & Steil, R. (2012). The feeling of being contaminated in adult survivors of childhood sexual abuse and its treatment via a two-session program of cognitive restructuring and imagery modification: A case study. Behavior Modification, 36(1), 67–86. https://doi.org/10.1177/0145445511421436
Jung, K., & Steil, R. (2013). A randomized controlled trial on cognitive restructuring and imagery modification to reduce the feeling of being contaminated in adult survivors of childhood sexual abuse suffering from post-traumatic stress disorder. Psychotherapy and Psychosomatics, 82(4), 213–220. https://doi.org/10.1159/000348450
Rachman, S. (2004). Fear of contamination. Behaviour Research and Therapy, 42(11), 1227–1255. https://doi.org/10.1016/j.brat.2003.10.009
Radomsky, A. S., Coughtrey, A., Shafran, R., & Rachman, S. (2018). Abnormal and normal mental contamination. Journal of ObsessiveCompulsive and Related Disorders, 17, 46–51. https://doi.org/10.1016/j.jocrd.2017.08.011
Steil, R., Jung, K., & Stangier, U. (2011). Efficacy of a two-session program of cognitive restructuring and imagery modification to reduce the feeling of being contaminated in adult survivors of childhood sexual abuse: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 325–329. https://doi.org/10.1016/j.jbtep.2011.01.008
Keep Learning
- What theories might explain the heightened experience of MC specifically among sexual trauma survivors?
- How might culture or individual differences influence the experience of MC among trauma survivors?
- What type of study design could best establish causal links between trauma, MC, and psychopathology?
- What interventions, besides cognitive restructuring, might help alleviate trauma-related MC?
- What is the conceptual distinction between MC stemming from OCD versus trauma? Is this clinically meaningful?
