OCD subtypes
Somatic OCD

The Best Treatment Options for Somatic OCD

4 min read
Keara Valentine
By Keara Valentine
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety
Obsessive-compulsive disorder (OCD) affects people in many different ways. One of the less-common subtypes is somatic OCD, from the Greek “soma,” meaning “body.” 

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‌Somatic OCD is challenging because it takes an everyday experience — suddenly being aware of your bodily functions — and intensifies that awareness to a level such that you struggle to think of anything else. Having somatic OCD can feel like you’re trapped in your own body. Fortunately, there is a way out, and it’s more accessible than you might think.

What is somatic OCD?

When you have somatic OCD, you’re more likely than most other people to fixate on your breathing, blinking, swallowing or other normal bodily functions. Instead of having a passing thought such as, “Wow, I’m breathing loud in this quiet room,” your hyperawareness takes over. 

You think: “I’m breathing too fast. What if I hyperventilate?” or “That was a long time between breaths. I might stop breathing. Is my breathing slowing down?”

With somatic OCD, these aren’t just thoughts that arrive and then pass on their own. Sometimes they take so much of your focus that they take over your daily life.

You might also be prone to worries about:

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  • ‌Whether your heartbeat is regular and healthy
  • ‌Whether you’re blinking too much, not enough or unevenly
  • ‌If you’ll be able to swallow your food properly

With somatic OCD, these aren’t just thoughts that arrive and then pass on their own. Sometimes they take so much of your focus that they take over your daily life. Other times, somatic OCD causes such high anxiety that you feel compelled to stay focused on your body. You believe that if you don’t, you might stop breathing or fail to swallow your food.

If you’ve been struggling with the symptoms of somatic OCD, you’re not alone, and there is hope.

What are effective somatic OCD treatments?

The gold-standard OCD treatment, including for somatic OCD, is exposure and response prevention therapy (ERP).

What is ERP therapy?

ERP is a specialized form of cognitive behavioral therapy (CBT) that asks you to do two things:
  • ‌Experience the situations that activate your OCD symptoms
  • ‌Choose a response other than avoidance or a compulsion

You go through each ERP therapy exercise with the support of a therapist, who helps create an exercise that is challenging but not overwhelming, and gives you a strategy for success.

For example, imagine that your somatic OCD causes you to fixate on your swallowing. You have the intrusive thought that you’re not swallowing normally and you’re going to choke on your food. Ordinarily, when you have this thought, you swallow 10 times in a row before taking a bite of food, “just to make sure” it will work.

When you work on this situation in ERP therapy, your therapist will guide you into a situation where you’re likely to have this worry. At first, it won’t be something big like eating an entire meal, but something small — maybe drinking a sip of smoothie. 

Somatic OCD can cause such high anxiety that you feel compelled to stay focused on your body. You believe that if you don’t, you might stop breathing or fail to swallow your food. Photo via Egor Vikhrev/Unsplash
Your therapist will ask you to take that sip without swallowing 10 times or walking away. It will be challenging, and you may still experience anxiety, but you’ll choose to tolerate it and focus on your goal behavior rather than your habitual compulsion.

With ERP, you work your way up from less anxiety-producing situations to more intense ones. With time, your OCD symptoms become more manageable, and your anxiety decreases because you’ve stopped trying to run away from it. 

How does ERP therapy work?

ERP therapy is powerful and effective because it works on your behaviors, not your thoughts. Unlike other forms of therapy, it won’t ask you to stop being anxious or talk yourself out of your OCD worries. That way lies frustration.

Instead, ERP therapy teaches you to accept your intrusive thoughts and anxieties. Before starting ERP therapy, most people with OCD try to avoid situations that trigger their symptoms. It feels like the best option, but it actually starts a vicious cycle.

When you avoid anxiety-producing situations or try to talk yourself out of anxious thoughts, you tell your brain that those thoughts are rational and worth engaging with. Also, the harder you work to avoid OCD-triggering situations, the less capable you are of handling them when they inevitably arise in the “real” world.

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ERP therapy puts you back in control. It teaches you that your anxieties and intrusive thoughts aren’t in charge and that you’re capable of tolerating them and making a different choice. With the lessons you learn in ERP therapy, you can go out into the world and live the way you want, even when OCD tells you to fixate on your body.

How do you get started on somatic OCD treatment?

NOCD has a team of experienced therapists trained in ERP therapy for people with OCD. Your therapist will design a program that specifically targets your somatic OCD, as you experience it.

Schedule your free introductory 15-minute call today, and you could be on your way to feeling better in just eight weeks.

Keara Valentine

Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.

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NOCD Therapists specialize in treating Somatic OCD

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Taylor Newendorp

Taylor Newendorp

Licensed Therapist, MA

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Licensed Therapist, LCMHC

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Tamara Harrison

Tamara Harrison

Licensed Therapist, MA

I have personally struggled with OCD and know what it's like to feel controlled by intrusive thoughts and compulsions, and to also overcome it using the proper therapy. I’ve been a licensed therapist since 2017. I have an M.A. in Clinical Mental Health Counseling, and practice Exposure and Response Prevention (ERP) therapy. I know by experience how effective ERP is in treating OCD symptoms.

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