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 viawashing/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.
Key Points
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:
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
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
Measurement of MC
The Relationship Between Trauma and MC
Potential Mechanisms Linking Trauma and MC
MC and Posttraumatic Stress Symptoms
MC and Obsessive-Compulsive Symptoms in Trauma Survivors
MC and Depressive Symptoms in Trauma Survivors
MC and Suicidal Thoughts and Behaviors Among Trauma Survivors
Insight
This review indicates that trauma-related mental contamination (MC) is a relatively common and distressing experience for survivors of sexual trauma in particular.
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.
Whilecognitive-behavioral treatmentstargeting OCD-related MC show promise (Jung & Steil, 2013), further intervention research focused specifically on trauma populations is needed.
Strengths
Limitations
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.
Sinceexposure therapymay 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
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
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
