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Mental Contamination Among Trauma Survivors: A Scoping Review
Heidi J. Ojalehto and Jonathan S. Abramowitz
Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
Mental contamination (MC), an internal feeling of dirtiness that is typically experienced in the absence of
contact with a physical contaminant, is increasingly recognized as a sequela of trauma. This scoping review
identified 19 studies on MC among trauma survivors and aimed to (a) summarize qualitative research on the
phenomenology of MC among trauma survivors, (b) examine how MC is operationalized and measured in
studies of trauma survivors, (c) identify the nature and extent of research linking trauma exposureto MC, and
(d) identify the nature and extent of research linking MC to other psychopathology among trauma survivors.
Qualitative studies indicated relative coherence in the phenomenology of MC across trauma survivors.
Quantitative studiesshowed strong evidence for a link between sexual assault and MC. There was also strong
support for a relationship between MC and posttraumatic stress symptoms. Insufficient evidence exists for
relationships between MC and obsessive-compulsive symptoms, depression, and suicidal thoughts and
behaviors among trauma survivors. The cross-sectional design of most studies limits conclusions about
the directionality of relationships between trauma, MC, and other psychopathology, including whether
MC represents a transdiagnostic risk factor for psychological distress among trauma survivors.
Keywords: trauma, mental contamination, obsessive-compulsive symptoms, posttraumatic stress symptoms,
suicidal thoughts and behaviors
It is well established that trauma exposure increases risk for the
development of a range of psychological conditions (Breslau,
2009). However, following a traumatic event, most individuals
recover within the first few months, with only a minority experienc-
ing persistent difficulties (Rosellini et al., 2018). Accordingly, it is
important to identify predictors of adverse outcomes following
trauma to facilitate early detection of individuals for whom interven-
tion may be warranted. In this vein, theory and emerging evidence
support mental contamination (MC) as a potential indicator of
poor outcomes following trauma (e.g., Badour & Adams, 2015).
MC refers to an internal feeling of dirtiness that is typically experi-
enced in the absence of contact with a physical contaminant
(Rachman, 2004). MC has become increasingly recognized as a sequela
of trauma, particularly following sexual assault (Badour, 2011;Brake
et al., 2021;Fairbrother & Rachman, 2004). Furthermore, evidence sug-
gests that MC contributes to the severity of posttraumatic stress symp-
toms, obsessive-compulsive symptoms, depression, and suicide risk
among trauma-exposed individuals (Brake et al., 2018;Ojserkis
et al., 2018;Tipsword,Brake,etal.,2022). To date, however, no
reviews have synthesized the literature on MC among trauma survivors,
including its relationship with other psychopathology.
MC
The phenomenon of MC was first discussed in 1980 (Rachman &
Hodgson, 1980). Over a decade later, Rachman elaborated on his
observations of “pollution of the mind”among individuals with con-
tamination obsessions as part of obsessive-compulsive disorder
(OCD; Rachman, 1994). Since that time, MC has received increased
attention, with numerous publications on the phenomenon.
Early empirical and clinical studies were conducted primarily
among individuals with contamination-related OCD symptoms.
According to Rachman (1994),MCisdefined as “a sense of internal
un-cleanness which can and usually does arise and persist regardless
of the presence or absence of external, observable dirt”(p. 311).
Unlike contact contamination, MC does not require physical contact
with a contaminant, and primarily emerges in response to internal
stimuli such as unpleasant memories, intrusive thoughts, and upset-
ting mental images (Rachman, 2004). While much of the initial
research on MC was conducted in the context of OCD, later work
established MC as a distinct psychological phenomenon that cuts
across diagnostic boundaries and can be observed in posttraumatic
stress disorder (PTSD), eating disorders, and depression
(A. Coughtrey et al., 2018;A. E. Coughtrey et al., 2012).
The cognitive model of MC proposed by Rachman (2004) and
elaborated upon by Radomsky et al. (2018) posits that “violation
events,”or experiences involving moral (e.g., degradation,
humiliation) or physical violation (e.g., sexual assault, physical
assault) are key predisposing factors. Catastrophic cognitions
concerning such events are thought to give rise to feelings of
“mental pollution.”For example, interpreting a sexual assault
as evidence that one is damaged, tainted, or tarnished may lead
to a sense of internal contamination that persists long after the
event. Individuals may then try to rid themselves of the mental pol-
lution by engaging in washing or cleaning behaviors (Rachman,
2004), which are rarely effective because the source of the contam-
ination is internal. Moreover, subjective resistance in the form of
avoidance, thought suppression, and substance use paradoxically
results in an increase in these unwanted experiences, completing
a self-perpetuating vicious cycle.
This article was published Online First December 14, 2023.
Heidi J. Ojalehto https://orcid.org/0000-0002-8569-8043
None.
Correspondence concerning this article should be addressed to Heidi
J. Ojalehto, Department of Psychology and Neuroscience, University of
North Carolina at Chapel Hill, Davie Hall, Chapel Hill, NC 27599-3270,
United States. Email: ojalehto@unc.edu
Traumatology
© 2023 American Psychological Association 2024, Vol. 30, No. 4, 661–676
ISSN: 1085-9373 https://doi.org/10.1037/trm0000492
661
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