Jana Mettwali

ENG210

Professor Zayas

Literature Review

April 2, 2025

Obsessive-Compulsive Disorder and the Fear of Contamination

Obsessive-Compulsive Disorder (OCD) is a long-term mental illness characterized by repeated, intrusive thoughts and compulsive acts, often carried out to alleviate the anxieties they provoke. Among the several forms of OCD, cleanliness OCD—with an emphasis on contamination phobia—is among the most prevalent and socially identifiable. Individuals suffering from this subtype are gripped by extreme fears of germs and filth and are driven to compulsively clean, wash their hands frequently, and avoid places.

This subject is particularly meriting study because OCD is often misunderstood and viewed as simply a quirk of personality, rather than as a legitimate mental disease. For people who live with cleanliness-based OCD, the disorder can impede everyday activities, isolate them socially, and degrade their quality of life. Discoveries about both the neurological and psychological components of this illness—and investigations into both established and advancing treatments—have the potential to demystify it and enhance the lives of those who live with it.

This review is divided into three sections: (1) the neurobiological underpinnings of cleanliness OCD, (2) psychological processes and coping strategies, and (3) treatments, both standard and novel therapies. The review integrates major studies that explore the way this type of OCD presents itself in the brain, how the fears of contamination are processed psychologically by the patient, and treatments that hold the most potential.

This literature review examines the neurological, psychological, and therapeutic aspects of cleanliness-based Obsessive-Compulsive Disorder to gain improved understanding of its causes, effects, and successful treatments.

Neurological Causes of OCD Regarding Cleanliness

Repeated research has demonstrated that there are hyperactive areas of the brain among those who experience OCD. Fineberg et al. (2013) indicate hyperactivity in the orbitofrontal cortex, anterior cingulate cortex, and striatum—all of these are involved in decision-making, emotion regulation, and repetitive behavior. This hyperactivity generates a cycle of feedback and does not allow the brain to effectively filter unwanted thoughts, and thus it causes compulsions, such as repeated washing or cleansing.

Again, Pauls et al. (2014) clarify that one of the neurotransmitters responsible for OCD is serotonin. When serotonin is depleted, the brain is unable to properly control anxiety and behavior. They attribute serotonin malfunction to abnormally activated fears, and this may account for the fact that those who have cleanliness OCD continue to perform their rituals despite knowing rationally that they are not needed.

A recent study by de Joode et al. (2023) utilized high-tech neuroimagiIing  to identify alterations in lateral occipital cortex metabolism when OCD symptoms were elicited. The results reflected abnormal neurochemistry, indicating that OCD involves not only structural but also metabolic aspects. These findings affirm the robust biological underpinnings of the disorder and pave the way for the investigation of brain-targeted treatments.

Psychological processes and emotion processing

Whereas the neurological infrastructure supplies the physiological explanation, the psychological aspect of OCD concerning cleanliness is just as significant. Based on Reuven, Liberman, and Dar (2014), compulsive cleansing rituals are frequently emotionally motivated reactions to feelings of guilt or moral distress. Their research was able to demonstrate that OCD individuals who performed cleansing rituals experienced temporary relief from feeling emotionally perturbed, reinforcing the compulsion.

This psychological connection between cleanliness and purity is important because it illustrates that OCD is not all about cleanliness—it’s also about regulation of inner states. This understanding accounts for the high efficacy of exposure therapy and cognitive-behavioral therapies because they target the irrational assumptions that drive compulsions.

Furthermore, Stephenson et al. (2021) examined electronically conducted CBT and made use of fMRI scans to monitor the activity of their patients’brains before and after treatment. Their results not only validated the psychological efficacy of CBT but also provided evidence of tangible alterations in brain function, closing the gap between mind and brain. The research adds strength to the case of CBT as both psychological and neurological treatment.

Treatment Approaches: Conventional and Novel The most frequently prescribed treatments are Cognitive Behavioural Therapy (CBT) and medications such as Selective Serotonin Reuptake Inhibitors (SSRIs). For Stein et al. (2019), CBT, and especially Exposure and Response Prevention (ERP), is the best psychological treatment, assisting the patient in resisting the urge to perform compulsions by gradually being confronted by feared situations. SSRIs, however, restore the balance of serotonin, diminishing the intensity and amount of intrusive thoughts.

Even though these treatments are available, many of these patients are treatment-resistant. New treatments, including Deep Brain Stimulation (DBS) and Transcranial Magnetic Stimulation (TMS), hold promise to help those who are severely affected. Although experimental, these treatments target brain areas directly responsible for OCD. According to Stein et al. (2019), these treatments were shown to effectively lower symptoms, particularly those who were not responsive to standard treatments.

Social perception is also involved in the way people experience and react to treatment. The media’s portrayal of OCD tends to oversimplify it as compulsive cleanliness and ignores the depth and diversity of the disorder. A recent article, Behind the Scenes: Unveiling the Misportrayal of Obsessive-Compulsive Disorder Depicted in Film and Television (2024), critiques those portrayals and their function as perpetrators of stigma. Proper awareness may enhance early diagnosis and encourage more individuals to seek treatments.

Cleanliness OCD is a complex disorder that is characterized by dysfunctional neurology, emotional processing, and learned behavioral habits. As there is ever-greater understanding of the brain areas and neurotransmitters implicated, psychological research keeps highlighting the underlying emotional drivers of the compulsions. CBT and SSRIs remain the established treatments, but newer therapies including DBS and TMS are breaking the mold for those who are looking beyond.

At the same time, combating societal misconceptions and stigma is equally as important as developing clinical treatments. In continuing to study both the biological and psychological aspects of cleanliness-OCD, we can work toward more empathetic care, more successful treatments, and improved lives for those afflicted by this frequently misunderstood disorder.

References

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. 

The Lancet, 374(9688), 491–499.

https://doi.org/10.1016/S0140-6736(09)60240-3

Behind the Scenes: Unveiling the Misportrayal of Obsessive-Compulsive Disorder in Film and Television. (2024). 

International Journal for Multidisciplinary Research, 6(5). https://doi.org/10.36948/ijfmr.2024.v06i05.29274

de Joode, N., van den Heuvel, O., Koster, M., Clarke, W., van Balkom, A., Schrantee, A., & Vriend, C. (2023). The Effect of OCD-Symptom Provocation on Neurometabolites in the Lateral Occipital Cortex and Their Relation to the BOLD Response, a Combined fMRS and fMRI Paradigm. 

Biological Psychiatry, 93(9), S242–S243.

https://doi.org/10.1016/j.biopsych.2023.02.608

Fineberg, N. A., Reghunandanan, S., Brown, A., & Pampaloni, I. (2013). Obsessive-compulsive disorder: 

The role of neuroimaging in diagnosis and treatment. Neuroscience & Biobehavioral Reviews, 37(10), 2256–2272. 

https://doi.org/10.1016/j.neubiorev.2013.02.014

Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive disorder: An integrative genetic and neurobiological perspective.

 Nature Reviews Neuroscience, 15(6), 410–424.

https://doi.org/10.1038/nrn3746

Reuven, O., Liberman, N., & Dar, R. (2014). The Effect of Physical Cleaning on Threatened Morality in Individuals With Obsessive-Compulsive Disorder. 

Clinical Psychological Science, 2(2), 224–229.

https://doi.org/10.1177/2167702613485565

Stephenson, C., Malakouti, N., Nashed, J. Y., Salomons, T., Cook, D. J., Milev, R., & Alavi, N. (2021). Using Electronically Delivered Therapy and Brain Imaging to Understand Obsessive-Compulsive Disorder Pathophysiology: Protocol for a Pilot Study. JMIR Research Protocols, 10(9), e30726. https://doi.org/10.2196/30726

Stein, D. J., Costa, D. L. C., Lochner, C., et al. (2019). Obsessive–compulsive disorder. Nature Reviews Disease Primers, 5(1), Article 52. https://doi.org/10.1038/s41572-019-0102-3

1. Reuven, O., Liberman, N., & Dar, R. (2014).

The Effect of Physical Cleaning on Threatened Morality in Individuals With Obsessive-Compulsive Disorder. Clinical Psychological Science, 2(2), 224-229.https://doi.org/10.1177/2167702613485565

Summary: In the current study, the correlation between compulsive cleaning and moral distress in patients with Obsessive-Compulsive Disorder (OCD) has been examined. Physical cleaning has been shown to decrease feelings of guilt and distress in the short term, reinforcing the compulsive cleaning behavior. OCD patients are more likely to engage in cleaning rituals when experiencing moral conflicts, supporting the psychological link between cleanliness and morality.

Evaluation: This study is highly relevant because it informs us about the psychological mechanisms behind cleanliness-related OCD. Having been published in a peer-reviewed psychology journal, the study has strong empirical data on the role played by compulsions as coping mechanisms.

Relevance: This research elucidates why individuals with OCD engage in repetitive cleaning rituals, as it supports the argument that obsessions and compulsions are based on emotional regulation and cognitive processing.

2. Stephenson, C., Malakouti, N., Nashed, J. Y., Salomons, T., Cook, D. J., Milev, R., & Alavi, N. (2021).

Using Electronically Delivered Therapy and Brain Imaging to Understand Obsessive-Compulsive Disorder Pathophysiology: Protocol for a Pilot Study. JMIR Research Protocols, 10(9), e30726.https://doi.org/10.2196/30726

Summary: This study investigates the effectiveness of electronically delivered Cognitive Behavioral Therapy (e-CBT) in patients with Obsessive-Compulsive Disorder, with functional MRI (fMRI) scans assessing brain activity before and after the therapy. Findings indicate that e-CBT decreases symptoms of OCD, such as cleanliness-related compulsions, and alters brain activity in the principal brain sites involved with obsessional thinking.

Evaluation: This research is highly reliable, having been published in a peer-reviewed medical journal and using advanced neuroimaging techniques to analyze the outcomes of the therapy. The sample size is small, but the findings are consistent with other research on CBT as the sole treatment for OCD.

Relevance: This source supports CBT as an effective intervention for the treatment of OCD compulsions through the documentation of neurobiological change following therapy.

3. Behind the Scenes: Unveiling the Misportrayal of Obsessive-Compulsive Disorder in Film and Television (2024).

International Journal for Multidisciplinary Research, 6(5).https://doi.org/10.36948/ijfmr.2024.v06i05.29274

Summary: This article criticises the misrepresentation of OCD in the media, the stereotyping of compulsive cleanliness as the primary symptom in particular. The research identifies the ways in which the representations perpetuate stigma, reinforcing the myth that the complexity of OCD extends only as far as bodily compulsions.

Significance: This study is important because it addresses the social consequence of OCD misrepresentation. Peer-reviewed in a multidisciplinary journal, it gives a cultural perspective on the disorder, complementing clinical and neurological results.

Relevance: This source demonstrates the effect that media stereotypes have on public opinion, supporting the need for more awareness about OCD beyond the cleanliness compulsions that the media portrays.

4. de Joode, N., van den Heuvel, O., Koster, M., Clarke, W., van Balkom, A., Schrantee, A., & Vriend, C. (2023).

The Effect of OCD-Symptom Provocation on Neurometabolites in the Lateral Occipital Cortex and Their Relation to the BOLD Response, a Combined fMRS and fMRI Paradigm. Biological Psychiatry, 93(9), S242-S243.https://doi.org/10.1016/j.biopsych.2023.02.608

Summary: This study investigates the brain neurometabolic alterations when OCD symptoms are triggered. Using functional Magnetic Resonance Spectroscopy (fMRS) and functional Magnetic Resonance Imaging (fMRI), researchers detected significant neurochemical differences in the lateral occipital cortex in patients with OCD compared to control populations. The findings show that OCD compulsions are linked with abnormal neurochemical activity.

Evaluation: This research is highly valuable as it gives direct neuroscientific evidence for brain chemistry changes when symptoms of OCD are triggered. In a top psychiatric journal, it gives the newest information on the biological mechanisms involved with OCD. Relevance: This source supports the stance that OCD compulsions, as in the case of excessive cleaning, are neurobiologically rooted, lending justification for brain-based treatments.

Jana Mettwali

English 2100

proof Zayas

march 17, 2025

Obsessive-Compulsive Disorder of cleanliness, commonly referred to as Obsess

Obsessive-Compulsive Disorder, or OCD, is a mental disorder characterized by intrusive, recurring thoughts (obsessions), which cause the individual to excessively perform compulsive behaviors. One of the most common types of OCD is cleanliness-related OCD, where the individual has an excessive fear about germs and contamination, causing excessively washing their hands, constant cleaning objects, or avoiding places that are considered dirty. This research aims to analyze the neurological and psychological causes of cleanliness-related OCD, its quality-of-life impacts, and the most current treatments available.

Millions of individuals all over the world are affected by cleanliness-related OCD, which negatively affects daily life and interpersonal relationships. Understanding the neurological and psychological mechanisms underlying the disorder could lead to the development of more effective treatments, such as Cognitive Behavioral Therapy (CBT) and medications such as Selective Serotonin Reuptake Inhibitors (SSRIs). New therapies, such as Deep Brain Stimulation (DBS) and Transcranial Magnetic Stimulation (TMS), could be alternatives for those who do not respond to the standard treatments. This work could also help reduce the stigmatization of OCD, which would encourage affected individuals to seek proper treatments and care.

Research has shown that OCD has been associated with hyperactivity in the striatum, anterior cingulate cortex, and orbitofrontal cortex, the brain areas that deal with decision-making and repetitive behaviors. Furthermore, an imbalance in the neurotransmitters serotonin also plays a role in the severity of the symptoms. According to research, those with cleanliness-related OCD suffer from excessive anxiety and an illogical fear of contamination, which causes compulsive acts despite their knowledge that the acts are illogical.

In addition to the progress that has been made in understanding OCD, many issues remain unresolved. For instance, are the brain differences found in those with OCD the cause or the result of the disorder? Do different treatments alter brain function in those with cleanliness type OCD, and are new treatments possible that target the brain areas affected more specifically? Answering these questions could lead to better diagnosis and treatment, providing those affected with more control over their symptoms and a higher quality of life.

Feedback: There is a lot of informative interesting information about your topic, maybe just shorten it a bit since it feels a bit too much for a proposal, also try to include yourself answering why you find this topic interesting, something like that, overall though it’s good.

Sources

1. Fineberg, N. A., Reghunandanan, S., Brown, A., & Pampaloni, I. (2013). Obsessive-compulsive disorder: The role of neuroimaging in diagnosis and treatment. Neuroscience & Biobehavioral Reviews, 37(10), 2256-2272. https://doi.org/10.1016/j.neubiorev.2013.02.014

2. Stein, D. J., Costa, D. L. C., Lochner, C., et al. (2019). Obsessive–compulsive disorder. Nature Reviews Disease Primers, 5(1), Article 52. https://doi.org/10.1038/s41572-019-0102-3

3. Pauls, D. L., Abramovitch, A., Rauch, S. L., & Geller, D. A. (2014). Obsessive-compulsive disorder: An integrative genetic and neurobiological perspective. Nature Reviews Neuroscience, 15(6), 410-424. https://doi.org/10.1038/nrn3746

Abramowitz, J. S., Taylor, S., & McKay, D. (2009). Obsessive-compulsive disorder. The Lancet, 374(9688), 491-499. https://doi.org/10.1016/S0140-6736(09)60240-3

Jana Mettwali

English 21003

Professor Zayas

Introductory Letter

February 5, 2025

My Journey in Language and Identity

If you had met me a few years ago, you might not have recognized me as the same person writing this letter. My story is one of transition—across countries, languages, and even within myself. Moving to the U.S. twice, first as a child and later as a teenager, shaped the way I see the world, the way I write, and even the way I express myself. Writing has always been my tool for navigating these shifts, though it wasn’t always easy.

I have always found words fascinating. Language is more than just a way to communicate—it is a way to connect, to express, and to shape one’s identity. Being bilingual has made me deeply aware of how language influences thoughts and emotions. Sometimes, I feel like I live between two linguistic worlds: my native Arabic and the English I have worked hard to master. There are ideas and emotions that I can express better in one language than the other, which sometimes makes me feel like two versions of myself exist.

I’m passionate about understanding people—their thoughts, emotions, and behaviors—which is why I chose to study psychology. I love exploring how the human mind works, especially in relation to mental health and sleep deprivation, a topic that deeply interests me. I’ve personally experienced how stress and anxiety can impact sleep and overall well-being, and I want to learn more about the science behind it. I hope that one day, my studies will allow me to help others who struggle with mental health challenges.

Beyond academics, I have a passion for storytelling. Whether it’s through writing, conversations, or analyzing books and movies, I find great value in narratives. Stories are how we make sense of the world and how we connect with others. I enjoy observing people’s expressions, tone of voice, and mannerisms—small details that reveal their emotions and experiences.

 However, I haven’t always been confident in my voice. Moving back to the U.S. after years away meant struggling with language barriers, adapting to a new academic system, and sometimes feeling like an outsider. At first, my accent made me hesitant to speak in class, and I feared judgment. Over time, I realized that my experiences—learning English, adjusting to new environments, and pushing past discomfort—made me stronger.

Most people don’t know that I love deep conversations, but I struggle to initiate them. Small talk doesn’t interest me much, but I’m always eager to hear about people’s lives, thoughts, and dreams. I prefer late-night conversations about the meaning of life over casual talk about the weather. However, I sometimes hesitate to ask deeper questions because I don’t want to come across as intrusive.

I also have a habit of overanalyzing things—conversations, decisions, even simple interactions. It can be exhausting, but it also makes me observant. I notice small details that others might overlook, and I think deeply about the emotions and intentions behind people’s words. This tendency has helped me in many ways, but it has also made me prone to second-guessing myself. I am learning to balance my introspective nature with a more relaxed approach to life.

I can be patient with a lot of things, but ignorance without the effort to learn frustrates me the most. Whether it’s people refusing to see different perspectives or making assumptions about others, I struggle with how unwilling some are to step outside their own worldview. This ties into another pet peeve—when people don’t take responsibility for their actions. I believe in owning up to mistakes and learning from them rather than avoiding accountability.

I also get frustrated when people judge others without knowing their full story. Everyone carries experiences and struggles that shape who they are. I try my best to understand people before forming an opinion, and I wish more people would do the same.

My friends and family see me as determined but reserved. They know that when I set my mind to something, I won’t stop until I achieve it, whether it’s excelling in my coursework or adjusting to a new environment. They also see me as someone who thinks deeply but doesn’t always express everything I feel. While I love understanding others, I sometimes struggle to open up about my own emotions.

At the same time, my friends often tell me that I have a calming presence. I am someone they can turn to when they need to vent, and I listen without judgment. I value deep connections, and I try to be there for the people I care about.

One of the biggest turning points in my life was moving back to the U.S. two years ago. Adjusting to a new school system, learning academic English, and catching up with my peers in a short time were overwhelming challenges. But they also shaped me. I worked hard, took multiple exams, and earned my spot at City College of New York—something I’m incredibly proud of. That experience taught me that I’m capable of more than I sometimes believe.

Another defining moment was when I realized that mental health affects everything—especially sleep. I’ve experienced firsthand how anxiety can disrupt sleep, making everything harder to manage. This led me to research the impact of sleep deprivation, and it has now become one of my academic interests.

Additionally, my experiences adjusting to different cultures have shaped my perspective on identity. I have struggled with the feeling of belonging—of not being fully American but also not being fully the person I was before moving. Over time, I have learned to embrace this complexity as a strength rather than a limitation.

As a writer and student, I bring my unique perspective as someone who has navigated multiple cultures and languages. My background shapes how I observe the world, and I hope to refine my ability to express my thoughts with clarity and confidence. I want to grow into someone who not only analyzes and understands people but also connects with them through meaningful conversations and writing.

In the future, I hope to use my knowledge of psychology to make a difference, whether through research, counseling, or another path I have yet to discover. I want to help others navigate their own struggles, just as I have worked through mine.

This letter is just a small introduction, but I hope it gives you a glimpse of who I am. I look forward to learning more in this class—not just about writing, but about how writing helps us understand ourselves and the world around us.

Hello! My name is Jana Mettwali and I’m a student at the City College of New York.
I enrolled in the Writing for the Sciences course in order to enhance my scholarly writing skills specifically in science and health topics.

This portfolio consists of all the work I’ve produced this semester—my reflective writings all the way through to the culminating research paper.
Beyond the classroom, I also like learning about psychology, assisting people, and communicating through writing.

This course taught me not only to better organize ideas but also to present them well and confidently. Thank you for taking the time to visit my page!

During the semester of Writing for the Sciences, I have not only learned how to write in an academic way—I have also learned to think, revise, and reflect as both a science student and as a writer.

The greatest thing I have learned from this course is how to arrange ideas and back them up with credible sources. Initially, I had problems with structure and referencing, but through the annotated bibliography, literature review, and peer response, I enhanced skills in summarizing, paraphrasing, and integrating information.

I have also become aware of how to write for a specific audience and with specific purposes in mind, which assisted me in communicating more effectively. I was taught how to make scientific language simpler through the group project, and the peer reviews made me more critical of what I was writing.

I have to continue to improve at managing time more effectively in the drafting process and in using more descriptive terms in describing complicated concepts. Overall, however, I’m satisfied with the progress made.

This portfolio contains drafts, final assignment, reflection, and short assignments to reveal how I have evolved and improved throughout the semester.