Review of Fear of contamination: Assessment and treatment.

Abstract

STANLEY RACHMAN Fear of Contamination: Assessment and Treatment New York: Oxford University Press, 2006, 208 pages (ISBN: 0-19-929247-7, C$144 Hardcover) Reviewed by DAVID A. CLARK As a renowned expert on obsessive compulsive disorder (OCD), Professor Rachman's contributions have shaped current psychological theory, research, and treatment of OCD more than any other contemporary psychologist. In recent years, Dr. Rachman has argued for a new to OCD that is based on specialized theories and treatments that target specific phenomenological characteristics and processes underlying OCD subtypes. The current book, Fear of Contamination, adopts the author's current emphasis on fine-grained analyses of OCD, digging deep into the unique phenomenology of specific obsessional concerns. In the last 10 years, this microanalytic approach has provided remarkably fresh insights into core cognitive processes of OCD that promise to increase our understanding and treatment of the many varying shades of this disorder. Based on his prior cognitive formulations for obsessions, Dr. Rachman's present book proposes a new cognitive-behavioural model for another OCD subgroup that has been neglected in recent years, those with fears of contamination. It begins with a convincing argument for taking a fresh look at our understanding and treatment of contamination OCD. Throughout the remainder of the book, the author provides a fascinating and highly innovative analysis of contamination fears. He breaks through the rigid boundaries of DSM-IV and offers new insights into a fear that spreads well beyond the standard diagnostic confines of OCD. After providing a thorough and highly original analysis of the phenomenology of contamination fears, Professor Rachman pinpoints the critical cognitive variables responsible for the persistence of these irrational fears and then constructs a new theoretical model rich in originality, clarity, and clinical relevance. Woven throughout the book, but especially in the later chapters, are detailed descriptions and case illustrations of a cognitive-behavioural treatment for contamination fears derived from his cognitive-behavioural model. The book also contains assessment tools, psychometric information, and clinical resource materials that are invaluable for any clinician treating contamination fears. The introduction begins with a short, informed account of the development of the behavioral treatment of OCD, with the author confronting one of the most common misconceptions about exposure and response prevention (ERP) : that the treatment is highly effective for contamination fears and washing compulsions. With a strong commitment to critical inquiry and empirical verification, Professor Rachman argues that we must not be satisfied with the level of therapeutic effectiveness achieved with ERP for contamination fears. Instead he proposes that a fundamental reanalysis of contamination fears based on a more cognitive perspective is clearly warranted. Chapters 1 through 4 provide a thorough phenomenological description and conceptualization of contamination fears complete with definitions, distinctions, and a classification scheme. The author identifies two main types of contamination fears: Fears that focus on contact with physical contaminants such as germs or dirt, and those that have a more internal or cognitive origin, which Rachman labels mental contamination. Mental contamination, is considered a highly heterogeneous subgroup of contamination fears that includes physical violation, psychological violation, mental pollution, self-contamination, and morphing. Although recognizing considerable overlap between these different subtypes of contamination fear, it is their distinctive features that are the most innovative aspect of this analysis. Chapter 2, with a focus on physical contamination, delineates the various sources of external contamination and its continuity with the fears of disease and contamination found within the general population. …