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Contamination concerns and checking remain two of the most prevalent forms of presentation in OCD, reported by 25–50% of sufferers, with checking the most common compulsion. Since they cover a broad spectrum of concerns and complexity, the assessment and treatment of contamination and checking carries its own challenges for the therapist. This chapter explores the nature of contamination and checking concerns and provides an overview of recent research. Practical advice and guidance will guide the therapist from initial assessment to formulation and the development of an effective treatment protocol. The prevalence of covert safety-seeking behaviors such as rumination is discussed as a frequent obstacle in treatment. It advocates a move away from graded hierarchies for exposure and considers what effective exposure should consist of, encouraging the use of creativity and playfulness. A range of both common and less common presentations is used to illustrate key concepts.
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