Feelings of being contaminated after sexual violence or abuse

Many survivors of sexual violence, especially those who experienced childhood sexual abuse, experience feelings of being contaminated (FBC). These can last for many years and even decades after the event. A study found that 60% of women who had previously experienced sexual violence described feelings of "mental pollution" along with strong urges to wash their bodies. Speaking to the strength these feelings can have, on deliberate recall of the traumatic memories, nine out of the 50 women reported actually washing their hands.

Feelings of being contaminated can be experienced in different ways

These feelings differ from person to person but can include:

• A sensation like dirt on the skin that remains despite cleaning efforts.
• Some similarities to the feeling of physical dirtiness, such as the feeling after potting a plant or touching rubbish.
• A sense of disconnection from your body or specific body parts.
• The belief that remnants of the perpetrator's bodily fluids linger on the skin or within the body.
• Vivid mental images depicting the body as slimy or dirty, with perceived contaminating substances in certain areas.
• The conviction that others can see or smell this contamination.
• Beliefs linking feelings of contamination to worthlessness, badness, or unlovability.
• Triggers such as touching or looking at your body, certain scents, traumatic memories, or sexual intimacy.

Common behaviours in those experiencing FBC

Feelings of being contaminated can lead to:

• compulsive washing
• withdrawal from social situations when FBC are triggered
• avoidance of touching or looking at your body
• difficulties with sexual intimacy

Common emotions related to FBC

Emotions for individuals experiencing FBC include:

• shame
• guilt
• self-loathing
• disgust towards your body, particularly the genitals, and following oral penetration, the mouth and throat

Ways to feel cleaner

Feelings of being contaminated are closely linked to symptoms of post-traumatic stress disorder (PTSD). For those experiencing these symptoms, it is advisable to pursue evidence-based treatments for PTSD, such as trauma-focused cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing (EMDR), or narrative exposure therapy (NET).

Jung and Steil (2012) developed a two-session intervention specifically aimed at overcoming FBC. This approach, called cognitive restructuring and imagery modification (CRIM), combines two powerful psychological elements: cognitive restructuring and imagery modification.

What is CRIM?

1. The cognitive restructuring (the 'CR') component helps individuals examine and potentially reshape their beliefs regarding the FBC. This technique engages the conscious, rational mind through discussion, employing methods from cognitive behavioural therapy, including Socratic questioning.
2. The imagery modification (the 'IM') component engages the unconscious, emotional mind via developing personalised guided imagery. This is an effective method to move more helpful or accurate beliefs about the traumatic event and the FBC from “head to heart”, so you can start really feeling like you are free from contamination rather than just rationally knowing you are not contaminated (a common experience).

Jung et al. also presented two stories of clients who had completed CRIM. After the intervention, one client, Monika (not her real name) reported feeling “absolutely surprised” by the intervention and “astonished” by the pleasurable characteristics of her skin. Whilst Tamara (also a pseudonym), highlighted that understanding her feelings of being contaminated were rooted in memory, not in her body, gave her greater control over these sensations. The researchers also, unexpectedly, found that the intervention also reduced PTSD symptoms in general, despite not directly targeting these.

The effectiveness of CRIM was further tested in a randomised controlled trial (RCT) involving thirty-four women who had PTSD due to childhood sexual abuse. The results demonstrated that completing CRIM led to a significant reduction in the intensity, vividness, distress, and uncontrollability of the FBC.

Another benefit is that this two-session intervention is flexible and can be integrated into a longer PTSD treatment program or delivered stand-alone by a practitioner who is proficient in cognitive therapy.

Enduring feelings of being dirty, contaminated, or polluted after experiencing sexual violence or abuse are common and can persist for decades, affecting various aspects of life, including social interactions, sexual relationships, personal hygiene habits, self-esteem, and body image. A two-session intervention called CRIM has been developed that specifically targets these feelings. It has been found to be effective in a randomised controlled trial and can be delivered on its own or as part of another course of therapy.

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. Behav Modif. 2012 Jan;36(1):67-86. doi: 10.1177/0145445511421436. 
• Fairbrother, N., & Rachman, S. (2004). Feelings of mental pollution subsequent to sexual assault. Behaviour Research and Therapy, 42(2), 173–189. https://doi.org/10.1016/S0005-7967(03)00108-6
• NHS: Treatment - Post-traumatic stress disorder, available at: https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/treatment/
• 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 posttraumatic stress disorder. Psychother Psychosom. 2013;82(4):213-20. doi: 10.1159/000348450.