Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Your Complete Guide to Somatic OCD

By Nicholas Farrell, Ph.D

Feb 23, 20248 minute read

Reviewed byPatrick McGrath, PhD

Somatic obsessive-compulsive disorder (OCD) is an OCD subtype characterized by ongoing intrusive thoughts and compulsive behaviors around one’s somatic experience — the physical sensations they can’t control. For example, someone with somatic OCD may be fixated on the pace and/or size of their breaths or the rate of their blinking or heart beating. These intrusive thoughts can take over a person’s ability to think about anything else and lead to intense fears about the severity of their condition (“If I am not blinking enough, I could lose my ability to see.”). In an attempt to stop these intrusive thoughts, people with somatic OCD will engage in compulsions aimed at making them go away (e.g., carefully monitoring their blinking to “check” if it is frequent enough).

Somatic OCD symptoms 

An individual’s fixation could revolve around counting or noticing a sensation (e.g., counting one’s breath) or concern that something is wrong (“What if I forget how to breathe? What if I’m not chewing properly?”). Someone may find that they simply can’t stop noticing their own breath. Breathing used to happen naturally, but it’s become the only thought this person’s mind can focus on. Their breath now seems excessively loud, and it drowns out all their other thoughts. They might wonder, “Did my breathing always sound this way?” Even watching a movie or speaking with a friend will not make this person’s mind stop noticing their own breath. 

These intrusive thoughts can be highly distressing and make a person feel a lack of control over their life. They may try to distract themselves or figure out a way to stop their thoughts. Often, failed attempts to prevent these thoughts or stop one’s fixations can lead to even more concerning thoughts (“What if I never get over this? What if I lose my job because I can’t focus?”)

Examples of Somatic OCD obsessions

People with somatic OCD—also known as sensorimotor OCD—experience obsessive thoughts, images, and urges focused around their somatic experience. Here are some examples of common themes:

  • Paying attention to the movement of your wrist and fingers every time you’re typing
  • Focusing on the movements your eyes make when you’re reading and being unable to pay attention to anything else
  • Noticing each time you move your head and being unable to stop keeping track of each movement
  • Noticing how the bottom of your feet feel each time you walk and being unable to focus on anything else

Somatic OCD obsessive thoughts: 

  • Why is my breathing so loud?
  • I can’t stop noticing my breath.
  • How often am I blinking? Am I blinking the normal amount of times?
  • Am I chewing the right way? What if I forget how to chew?
  • How do I know when to swallow? I’ve never thought about this, but now I’m worried I’m not going to swallow correctly.
  • How many times is my heart beating every minute? I need to count.
  • I can’t stop paying attention to my heart beating. What if I have a heart attack?
  • I can feel my nose and I can’t stop focusing on how it moves when I talk. Why does it do that?
  • My breath doesn’t feel deep enough. I’m not breathing correctly. 
  • Am I making eye contact when I’m speaking? I think so. But am I looking at the person I’m talking to, or looking away? Where are my eyes looking?
  • How will I ever live a normal life if I can’t stop thinking about my breathing?
  • What will become of my relationship with my partner if these thoughts don’t go away? Will I ever be able to feel present with her again?
  • What if I never stop being fixated on my breath?

Examples of somatic OCD compulsions

In response to their obsessive thoughts, a person with somatic OCD will engage in compulsive actions as an attempt to alleviate their anxiety. Here are some examples of what that might look like:

Distraction: People with somatic OCD may try to distract themselves in an attempt to make their intrusive thoughts go away. They may try to immerse themselves in a movie, book, or exercise as an attempt to focus their mind on something other than their physical sensations. This is often unsuccessful and strengthens the severity of their intrusive thoughts. 

Excessive research: A person may spend hours online researching their condition. They may search online forums for solutions to stop their intrusive somatic thoughts. They may immerse themselves in every detail of stories they read online to determine if their experience is normal.

Mental review: Someone with somatic OCD may find themselves thinking back to a time when they were free from these obsessive thoughts. They may feel nostalgia and ruminate on the time in their life that now feels inaccessible. 

Self-reassurance: An individual may try to reassure themselves that these thoughts are not a problem and that they will go away on their own. They might tell themselves, “Don’t worry. I’ll stop thinking about my breath eventually. It’s not such a big deal.”

Reassurance seeking: A person may turn to family or loved ones in an effort to make sense of their experience. They may ask questions like, “How often do you notice yourself breathing?” or, “Do you ever find that you’re unable to stop paying attention to your heartbeat?”

Avoidance: Individuals may avoid certain situations they feel will make their somatic OCD unmanageable. They may avoid going to eat in a restaurant with friends because they know they won’t be able to stop paying attention to their chewing and will suffer through the evening as a result. People may also avoid places where they have come to believe their somatic OCD began. They might think, “That park is where I started being hyperfocused on my breath. I remember it so clearly. I’ll never go to that park again.” 

Somatic OCD ERP therapy

The best course of treatment for somatic OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment and has been found effective for 80% of people with OCD. Interestingly, using virtual ERP, the majority of people with OCD experience results significantly faster than they do in traditional, in-person treatment. As part of ERP therapy, you will track your obsessions and compulsions and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.

The idea behind ERP therapy is that exposure to these thoughts is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety. 

Examples of Somatic OCD exposures

If you’ve ever tried not thinking about something, you know how difficult it is to stop your mind from focusing on something specific intentionally. ERP therapy takes the opposite approach. Instead of trying to make yourself stop your obsessive thoughts, you welcome them. 

Let’s say you can’t stop thinking about the sound you make when you chew your food. Every time you eat, the sound of your chewing is the only noise you can hear. If you’re eating with other people, it’s nearly impossible to pay attention to them. You anticipate this will happen during social events, and the anxiety causes you to avoid eating with others.

An ERP therapist may ask you to welcome the sound of your chewing while you eat. You might think, “Welcome it? Why? All I want is for the noise to stop!” But instead of trying to suppress them, a therapist may ask you to put your full attention on these thoughts. This teaches your brain a new response to your intrusive thoughts and shows you that they do not necessarily have to be a source of intense anxiety. 

As part of ERP treatment, you may be asked to join a group of friends for dinner. In order to avoid becoming overwhelmed, you’ll work with a therapist to come up with a hierarchy of anxieties and related exposures and gradually work your way through them. For example, if eating with others is too stressful at first, you may start by fully paying attention to the sound of your chewing for one minute. Then you might work your way up to five minutes. Eventually, you may find you’re able to hear the noise your chewing makes without experiencing an unbearable amount of stress. Once you habituate yourself to this sound and consistently refrain from trying to prevent it, it will eventually become background noise in your mind. Eventually, you’ll be able to eat a meal with friends again and contribute to the conversation without feeling stress. 

How to get help

When somatic OCD is untreated, it can take over a person’s ability to think about anything other than their somatic experiences, lead to isolation from others and a sense of hopelessness about their life. If you’re struggling with this subtype of OCD, there is help available. As an OCD specialist, I’ve used ERP to help many people regain their lives from OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.

All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is.

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