Episode 347: Contamination OCD vs COVID Safety & Violated Consent in a Relationship

Hello, friends! This one is a bit of a doozy. Please be aware that the subject matter is somewhat more intense than other episodes recently. In this one, I tackle the following listener questions:

  • Should I get treatment for my excessive concerns about germs and contamination? How can I re-engage socially with the continuing concerns about COVID-19?
  • My partner violated my consent and sexual boundaries repeatedly, but they seem sorry and I still love them. What can I do?

As always, you can send me questions to duffthepsych@gmail.com and find the show notes for this episode at http://duffthepsych.com/episode347


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Question 1:

Dear Dr. Duff,

I have always been a bit more concerned that the average person with avoiding some things that I consider gross or dangerous. For example, I avoid putting clothes that have been outside of the house on my bed because of the risk of bedbugs, or eating raw leafy greens because of the risk of e. coli. These precautions have never caused me any struggles in my professional life, but they’ve interfered with my ability to have romantic relationships, yet never to the point that I’ve felt the need for professional help. However, I have internalized covid safety protocols, and with them being lifted everywhere, I am now finding myself stuck at home and unable to go to work or to social events, or even to maintain friendships with people who accept greater risks than I find acceptable for myself.

I am wondering if there would be therapeutic approaches that could help me. Right now, the only thing I can imagine is that a therapist would try to talk me into giving up wearing a mask so that I can fit in with people, but I already know that I wouldn’t keep seeing someone who thinks that is a proper solution.

I’m sorry there isn’t a clear question in here, but hopefully this is a topic you could discuss.

Good question. Thank you for this. What I’m gathering is that you’ve always had some quirks when it comes to the possibility of contamination, but you’ve been able to work around them. In your private life, you are able to engage in certain avoidant behaviors so that you don’t feel like you are putting yourself at risk of things like bed bugs or e. coli. But in relationships, it’s been a barrier. Now you are seeing an uptick in the intensity and the impact of these behaviors due to COVID-19 protocols.

I talk frequently about how one of the defining characteristics of something being a mental health disorder is a disruption in relationships, work, or health. I think that you could very likely fall into this category. I think that the COVID-19 issue certainly makes this a murkier picture, but even prior to that, it sounds like you were engaging in plenty of behaviors to mitigate the possibility of contamination. With COVID-19, many people have had difficulty reintegrating into the “post-pandemic” world, even though the pandemic is not gone by any means.

But, I would ask for yourself whether there is a reason for the heightened concern? It’s tough because you are totally within your rights to want to protect other people by masking and avoid the potential of COVID-19 in yourself. So, in the event that this is just the current thing for your contamination fears to latch onto, it’s very easy to rationalize. I’m not going to attempt to diagnose you here, but I am concerned that you could have something like contamination OCD or contamination phobia, which has been exacerbated by the pandemic.

You mentioned that you imagine a therapist telling you to give up wearing a mask so that you can fit in with people. I don’t think that would be a common response, at least from good therapists. There is a form of therapy for OCD, which is called exposure and response prevention or ERP. With OCD, you typically have compulsive behaviors or avoidant behaviors that are used to reduce the stress caused by exposure or potential exposure to the trigger. However, this approach is typically not one that uses flooding, where you just thrown into the deep end and asked to endure the most difficult triggers. Rather, a gradual approach is used. This means that an ERP therapist would not tell you to just throw away your mask and go have fun.

There is also the cognitive side of things. Part of treatment for OCD is often recognizing that we live in a world that is inherently risky. We can be happy or unhappy about that. It doesn’t stop the universe from being random and unfair. When you take a good look at your situation, a therapist may help you recognize that your attempts at control and avoidance aren’t actually protecting you. They may actually be harming you in ways that are harder to recognize. Everybody needs to make their own educated choices about what they feel safe doing in this pandemic and in life. However, working with a knowledgeable therapist can help you determine where you are engaging in compulsive or avoidance behavior vs where you are making a choice based in sound logic.

If you have an autoimmune disease or you have a close family member that has struggled with a long COVID syndrome, it’s totally reasonable for you to be more careful than most about masking. But if I were your therapist, I would be less interested in your specific behaviors and beliefs about contamination or the pandemic, and I would be more interested in the reasoning behind them. I would highly suggest that you find a therapist to work with that specializes in OCD. They will be able to dig in and ask the right questions. They will also be knowledgeable about the ways in which the pandemic has interacted with mental health because you will not be the only one of their patients experiencing something like this.

The issue here is not really the pandemic; this is just highlighting the broader issue. I think that there is a lot of work that can be done here to recognize the areas in which avoidance is not truly protecting you from danger and is possibly hurting you emotionally.

Connecting to your values in life can also be impactful. Risk is inherent in life, and you need to decide what is worth embracing that risk to you and what is not.

I hope that you can find some relief because it sounds like you are feeling exhausted and held back.

I believe in you!

Question 2:

Hey Duff,

My partner and I have been together for two years and he’s always been very loving and supportive of me. Ever since we moved in with each other last year he’s started crossing my sexual boundaries. At first it was just small stuff but it kept escalating until one day he raped me. It happened in my sleep and afterwards we spoke about it and he apologised profusely saying it was a misunderstanding and it would never happen again. Two months later I got black out drunk and it happened again.

After that I pushed for us to go to couples counseling as I had already tried my best to educate him on the importance of consent by watching documentaries together and reading books etc. I was hoping to feel more understood there but while the therapist acknowledged that what happened was absolutely not okay, when I explained I would have rather none of it had happened, she responded by saying it’s a learning process for both of us and that none of this is my boyfriends fault either because he just struggles to understand boundaries.

I agree that it’s a learning process but personally I don’t find the concept of consent that confusing. It feels like I’m the one sacrificing my body and emotional well-being for this “process” while he gets to satisfy his sexual desires and it feels like everyone is expecting me to be okay with that until he learns better.

I love him very much and he seems genuinely sorry about what happened but everything has been so traumatising for me that I‘m struggling with depression and don’t know whether I’m able to just “forgive and forget” like our therapist is suggesting.

Kind regards

Ps: Thank you so much for your podcast and sharing your knowledge and kindness. It’s been a great help to me (and I’m sure plenty of others) many times🙂Response:

Thank you for this question. This is a very vulnerable topic, so I commend you for being brave by bringing this up, even though it seems like you haven’t been supported in the way that you would have liked so far.

Consent is a term that we hear talked about quite a bit these days, which is amazing. However, I don’t know that it’s always defined well, so I’d like to start by talking about consent before addressing your specific concerns.

Consent is defined as mutual agreement or permission given by all parties involved in a specific situation. In this case, we are talking about sexual activity. Consent is about respecting each person’s autonomy and boundaries, and ensuring that everyone who is participating is willing and enthusiastic.

As I mentioned, consent needs to be enthusiastic. It also must be informed and without pressure or manipulation. If someone is unable to adequately understand a situation due to being under the influence or other limitations, such as cognitive limitations, they are not able to give consent.

You may have seen the term “consent is sexy” thrown around on social media before. That’s because it is. It’s not just about avoiding negative behaviors. It’s about creating a situation where connection is comfortable and safe. With enthusiastic consent, many exciting things are possible.

In your situation, you said that there is a pattern of your partner violating your personal boundaries regarding sex, which is not acceptable. Within a relationship, there can certainly be room for misunderstandings due to communication issues, but you are talking about a pattern here and it has gotten to the point that you don’t feel as safe as you would like to feel with your partner. That is indicative of an issue.

I will say that it is important that your boundaries are explicitly stated and that consent is clearly given or withdrawn when possible. Obviously, that’s not possible when you are asleep or blackout drunk. If you have ever said, “I don’t like that,” or “I’m not ready for that,” or “I don’t want to be touched like that without talking about it first,” these are all ways of placing boundaries and noting that you do NOT consent to certain activities. That’s not a license to just try again another time and keep pushing the boundaries.

I am very sorry that you were taken advantage of by your partner in positions where you could not provide consent. I know you care about this person and you want things to improve. It’s possible that they can. But no progress will take away what happened.

There are a lot of things that you have done well here. I think it’s totally valid to give someone that has demonstrated care in you the benefit of the doubt with an isolated incident. I’m sure you thought it would be a wakeup call that his escalations are not acceptable. But it happened again and you insisted on learning more about consent and even going to therapy.

The experience that you had in couples therapy is an interesting one. I think I may know why that happened. Your therapist was clear that violation of boundaries and consent are not acceptable. But when you expressed that it hurt and you wish it never happened, they didn’t jump in to agree. Instead, it seems like they tried to make it more of a mutual issue.

I’m not saying whether or not I agree with the approach here, but I think that this could be due to the type of therapy. In many couples therapy modalities, you are taught to see the dysfunction as coming from the relationship rather than one individual or the other. There is often a temptation to align more closely with one partner (or family member in family therapy), so therapists will work to avoid showing an allegiance.

I think that the therapist here may have made you feel invalidated or like the situation isn’t as serious as it is by sort of normalizing the experience and stating that your partner doesn’t understand boundaries. If your partner has some type of neurodivergence like autism, I could see some gray area here, but not understanding consent after having it explicitly laid out for you and even learning about it through books etc. is not acceptable.

The therapist issue is one of the reasons that I will often suggest that couples also see individual therapists on their own, so they can have feedback and empathy from someone that does not have any relationship with the other partner. So, if that’s not happening right now, you might consider that. I’m not sure what “traumatizing” means for you in particular with these circumstances. But even if you haven’t been traumatized by them in the clinical sense, you may still need a significant amount of time and consistently appropriate behavior from your partner to rebuild the trust that has been eroded.

You aren’t doing anything wrong by being unable to “forgive and forget”. That wouldn’t be a reasonable expectation of you. Research shows that sexual assault from a partner can have long-lasting effects on individuals and relationships. They can cause shifts in power dynamics within a relationship and emotional impacts such as depression, PTSD, and difficulties with intimacy are common.

Since relationship dynamic changes and disruptions in trust and communication are common in situations like this, your partner needs to have some patience. It will take time for your relationship to recover from this if it can. I also want to make it clear that you don’t HAVE to make this relationship work out. I would say that moving in with someone often reveals concerns that you weren’t aware of before.

You are allowed to change your mind about your partner. That doesn’t mean you don’t love him or that what you have experienced together was not real. You are simply allowed to value yourself and have deal-breakers, especially if they were communicated repeatedly and not respected. If you want to continue working at the relationship, I highly suggest individual therapy for you both and a clear plan to work toward re-establishing trust. There needs to be a recognition that this isn’t going to spontaneously be better in a matter of one week.

You can use this as a prompt to work on all facets of the relationship and build trust and intimacy in a way that is not sexual, so that you might feel comfortable exploring sexually with this person again. In the end, if you are not able to or you are not willing to feel comfortable with him again, it is not your fault. You’re not the one who did something wrong here. It’s not on you to be forgiving. You are not being dramatic.

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