Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Could my constant blinking be a mental health problem? 

By Grant Stoddard

Jun 7, 20239 minute read

Reviewed byPatrick McGrath, PhD

The average person blinks 15-20 times per minute. That equates to having our eyes closed for around 10% of the time we’re awake! We humans blink so often, in fact, that scientists have suggested that this body function does something more than just lubricate the surface of our eyes and keep them free of dust and dirt. One evidence-based theory is that by cutting off visual stimulation for a split second, blinking enables us to focus our attention—a sort of mini-mental reset.  

We can safely say that not blinking enough can have a host of negative consequences, including irritated eyes and, potentially, a discombobulated mind. Blinking too much, on the other hand, can often indicate that something is amiss. Specifically, it can be a window into our mental well-being.

In this article, we’ll explore the link between excessive blinking and mental health conditions, learn about when excessive blinking could be a type of tic disorder or a compulsion related to Obsessive-Compulsive Disorder (OCD), and investigate potential treatment options for both.

Constant blinking as a sign of a tic disorder

“There are several physical and mental conditions that can cause excessive blinking, but the first thing that comes to mind is tic disorder,” says therapist Nicholas Farrell Ph.D.

Tics, Farrell explains, are behaviors that sufferers experience as being outside of their conscious control. Blinking, facial grimacing, head jerking, shoulder shrugging, or limb movements are all examples of motor tics. Vocal tics, as the name suggests, involve the production of various sounds, words, or phrases without purposeful intent. 

Tics are typically preceded by an uncomfortable sensation called a premonitory urge, which is relieved momentarily by performing the tic. They can be exacerbated by stress, anxiety, fatigue, or excitement, often decreasing during focused attention or sleep periods.

The most commonly known tic disorder is Tourette’s Syndrome, which is diagnosed when both motor and vocal tics have been present for more than one year, although not necessarily concurrently. 

The onset of tic disorders, including Tourette syndrome, typically occurs during childhood or adolescence. In many cases, the first signs of tics appear between the ages of 5 and 7, with the average age of onset occurring around six years old. Most people with tic disorders experience the onset of tics before age 18. However, tics can develop at any age and occasionally emerge in adulthood.

“Kids often grow out of tic disorders,” explains Farrell. “That’s often referred to as transient tic disorder, so we can only offer a reliable diagnosis after a year has elapsed. However, without proper treatment, tics that appear in childhood or adolescence can linger into adulthood.” 

Excessive blinking can negatively affect people in several ways. 

“One area that I think is underappreciated, especially when we’re talking about motor tics, is fatigue, the pure physical exhaustion of this repetitive action,” says Farrell. “I’ve had many clients over the years talk about the raw pain of doing something over and over again.”

“But there’s also the social stigma often associated with these things. I see a great deal of embarrassment and humiliation associated with the expression of these tics and, consequently, a lot of avoidance of social scenarios. As we said earlier, tics usually appear in children, so you can imagine how kids with the disorder could become easy targets of bullying and teasing at school and in other settings.” 

We’ll look at an effective treatment approach for motor tics in a moment, but before we do, let’s look at another mental health disorder that can result in excessive blinking. 

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Constant blinking as a symptom of OCD

Obsessive-Compulsive Disorder (OCD) is a serious but commonly misunderstood mental health condition estimated to affect between 80 and 160 million people worldwide. OCD is characterized by obsessive thoughts and compulsions intended to neutralize the anxiety those thoughts provoke.

The diagnostic criteria for OCD include the presence of obsessions (recurrent, intrusive thoughts or urges) and/or compulsions (repetitive behaviors or mental acts performed in response to the obsessions), which are time-consuming, cause distress, and interfere with daily functioning. Furthermore, these symptoms can’t be attributed to another medical condition or the effect of a substance. 

Central to the experience of having the condition is something called the OCD cycle which typically looks like this: 

  1. Obsession: At the cycle’s core lies a specific thought, image, situation, or feeling that triggers anxiety or distress. These obsessions manifest as intrusive and persistent thoughts, images, or urges, causing significant distress. Often irrational and unwanted, these obsessions clash with personal values and beliefs. Examples include fears of contamination, doubts about safety, or concerns about harm to oneself or others.
  2. Anxiety: The presence of obsessions leads to the emergence of intense anxiety or fear, intensifying the grip of OCD on the individual’s mind.
  3. Compulsion: To alleviate the distressing level of anxiety, people engage in compulsive behaviors or mental rituals. Compulsions are repetitive actions or mental acts that one feels compelled to perform. Common examples include excessive hand washing, checking, counting, or seeking reassurance. These compulsions aim to reduce anxiety or prevent perceived harm.
  4. Relief: The performance of compulsive behaviors provides temporary relief, reinforcing the belief that these actions are necessary to avert harm or alleviate anxiety. Consequently, the cycle restarts, strengthening the connection between triggers, obsessions, and compulsions. 

“When I see excessive blinking in people with OCD, it’s often attributable to one of two OCD subtypes,” explains therapist Cody Fournier, LICSW. “The first is something called magical thinking OCD.” 

The hallmark of magical thinking OCD is the irrational belief that one’s thoughts or actions can influence external events. People with this condition may engage in repetitive rituals or compulsions to prevent perceived adverse outcomes associated with their magical thoughts.

“I’ve had members who felt that, by blinking ten times, they could prevent a family member from dying,” says Fournier. 

The second OCD subtype Fournier associates excessive blinking with happens to be the one he has himself. 

“Sensorimotor OCD is characterized by intrusive thoughts related to bodily sensations or movements,” he says. “People with the condition have obsessions related to a hyper-awareness about bodily functions like breathing, swallowing, and blinking. An intrusive thought might be, ‘I’m noticing my blinking, and now I will notice this forever.’ They’ll kind of get hyper-fixated on this, and we’ll start to like focusing a lot of their attention on blinking. Their core fear is that their fixation will be permanent, prevent them from living a normal life, or hinder their ability to be present with their loved ones. Often, it’s a self-fulfilling prophecy.”

If you suspect that your or a loved one’s constant blinking can be attributed to either tic disorder or OCD, you’ll be pleased to know that NOCD therapists offer effective therapy for both. Let’s take a look at each of these specialized approaches in turn. 

Habit Reversal Training (HRT) for tic disorder

Habit reversal training is an evidence-based psychotherapy for people struggling with tic disorders and body-focused repetitive behaviors (BFRBs), including skin picking and hair pulling.

“HRT has two fundamental components,” explains Farrell. “The first part is about helping people become aware of the antecedent warning signs—the premonitory urge—that happens before the motor tic.”

“The second part is what’s known as competing response training. Think of it as implementing some action or behavior designed to compete with how a tic is expressed. Let’s say I was a person experiencing a tic where one or both of my arms would sort of impulsively shoot up in the air. An HRT therapist would probably encourage a competing response of crossing my arms over my chest. If I do that pretty firmly, it makes my arms shooting up in the air impossible or, at least, a lot more difficult.” 

A supplementary component of HRT is something called stimulus control. “Stimulus control is about gaining better recognition of how the environment influences the expression of tics,” he says. “If, for example, a child’s tics are more frequent or pronounced when sitting at the back of the classroom and feeling unengaged, his teacher may employ stimulus control by moving him to the front of the class and/or calling on him more frequently.” 

Farrell explains that a course of HRT is typically 10 to 15 weeks, with 60-minute sessions taking place once or twice a week. “I don’t want to say that there’s an immediate benefit, but when you look at the session-by-session change in research studies, as well as the data that we collect at NOCD, we tend to see a lot of good reduction in symptoms early on.”

Exposure and response prevention (ERP) for blinking caused by OCD 

Exposure and Response Prevention (ERP) therapy is highly effective in treating OCD symptoms—including constant blinking—with response rates ranging from 65-80% across multiple studies. 

“Whether a member’s constant blinking is related to magical thinking OCD, sensorimotor OCD, or some other OCD subtype, ERP is going to be the best approach to managing symptoms,” says Fournier. 

ERP involves gradually exposing you to situations that trigger obsessive thoughts or fears (exposures) while preventing you from engaging in compulsive or avoidant behaviors. It aims to help you develop other ways of coping with your distress that reduce the power of your obsessive fears rather than reinforcing them and strengthening them over time.

“With magical thinking OCD, we would use exposures to gradually disrupt the belief that their blinking or any other ritualized behavior has no bearing on events playing out in the world,” says Fournier. “With sensorimotor OCD, we might strategically induce the sensations or physiological processes that the member might fear. For instance, a member could be asked to blink continuously for a minute and lean into that experience instead of pushing it away. We can kind of beat OCD to the trigger of the anxiety and, over time, neutralize it.”

Getting help 

If you think you might have a tic disorder and/or OCD and are interested in learning more about how they are treated with HRT and ERP, I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD Care team.

Our therapists specialize in both conditions and receive-specific training for treating them. You can also get 24/7 access to personalized self-management tools built by people who have been through these conditions and successfully recovered.

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