Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fear of proximity

By Andrew Moeller, LMHC

Sep 30, 20226 minute read

Reviewed byTaylor Newendorp

One manifestation of the subtype of OCD known as Sensorimotor/Somatic OCD involves fears about proxemics–that is, the use of space and the meaning behind it. Individuals who struggle with this theme might find themselves worrying significantly about being in proximity to others; whether it be too close to or too far away. They may find themselves obsessing over the “right amount” of space to have from other people in social settings. There might be an excessive amount of time and energy spent interpreting the meaning of this space and the implication of proximity and personal space in general.

Sensorimotor obsessions involve either a focus on or hyper-awareness of some automatic bodily process or sensation. When speaking of proxemics specifically, that process or function is how we interact with the space of others. Usually, this process is managed automatically without much conscious thought. You don’t usually have to think about how close or far to stand from someone on line at the grocery store, or why a person might be standing closer to or farther away from you in any given situation.

For people with discomfort regarding proxemics in OCD, this is quite the opposite. They find themselves obsessing over these thoughts and unable to let go of the fear and uncertainty these obsessions bring. They might find themselves worrying about standing too close to someone in public. They might become locked into thoughts about someone who passed by them at a distance slightly further than seems “normal.” To the individual with OCD, these thoughts and fears feel as real as any concrete threat. This is the devious nature of OCD. OCD convinces individuals that these obsessive thoughts need to be treated as legitimate threats.

Individuals who suffer from Sensorimotor/Somatic OCD might find themselves doing compulsions to “manage” or “deal with” these obsessions in a number of ways. They might spend excessive amounts of time on internal debates about matters of space and proximity: “I wonder why that person passed by at such a distance earlier today?” “Was I making that person at the store feel uncomfortable with how close I was to them?” “Is the way that I’m standing in line right now correct or right?” These debates might take up hours of their day and they might find it impossible to leave the topic alone. Others might actually ask others for reassurance on these matters: friends, loved ones, and sometimes even strangers. Some individuals might even entirely avoid social situations in order to prevent these worries from coming about.

The problem with these behaviors is that they prevent the individual from challenging these thoughts and end up reinforcing their fears. Exposure and Response Prevention therapy (ERP) is a specific type of Cognitive Behavioral Therapy (CBT) that focuses on challenging these compulsions and changing the way one relates to their thoughts. The goal is for them to learn to tolerate uncomfortable feelings and also choose how they respond to obsessive thoughts and worries.

  • Am I standing too close or too far away from this person?
  • Why was that person standing so close or far away from me?
  • Am I making someone feel uncomfortable with the way I’m moving around them?
  • What is the reason this person is standing so close or far away from me?
  • What if other people think X because of the way I’m moving or standing right now?
  • What if the reason that person was standing so far from me is because they hate me?
  • What if the reason that person is standing so close to me is because they’re interested in me?
  • What if I’m giving off the wrong message based on how close to or far away I am from this person?

Common triggers

People with proxemic obsessions in OCD may be triggered by situations involving other individuals or personal space in general. This might include being around either strangers or known individuals. It might involve any space where others might be within range of “personal space.” This might also be triggered by situations that require closer proximity to others; concerts, restaurants, doctor appointments, public transport, etc.

Triggers for people with OCD proximity fears include:

  • Going to restaurants
  • Eating in others’ homes
  • Sharing groceries with roommates or family members
  • Eating with utensils or dinnerware that are not first sanitized or checked for contaminants
  • Having a stomachache or feeling nauseated
  • Using chemical cleaners in their kitchen

How can I tell if it’s obsessional fears of proximity in OCD and not anxiety, stress, or inappropriate behavior?

Although OCD has a large degree of overlap with aspects of anxiety and stress, there are some specific criteria that must be met.

For something to be OCD rather than anxiety or stress, there must be the presence of:

  • An unwanted or persistent thought, image, urge, or sensation
  • Distress, anxiety, discomfort or other negative emotion resulting from the unwanted thought, image, urge, or sensation
  • Compulsive or safety-seeking behaviors done in an attempt to resolve the distress, anxiety, or discomfort

Anxiety might present with some distressing thoughts and worries and usually makes individuals feel very uncomfortable, but tends to lack any concrete compulsive behaviors. This feature distinguishes OCD from other anxiety disorders. Obsessions in OCD are also more intrusive, and occur without any intention or choice.

Common compulsions

When people with fears surrounding the idea of proximity in Sensorimotor/Somatic OCD experience intrusive thoughts, images, feelings, or urges that cause distress, they may do whatever they feel is necessary to manage these feelings and prevent possible negative outcomes. This might include elaborate rituals or mental “gymnastics” in order to avoid negative feelings. It might also involve concrete avoidance or reassurance-seeking from others. 

  • Avoidance of social situations or situations that might trigger obsessive thoughts
  • Seeking reassurance, either by telling oneself that nothing wrong has happened or sometimes asking directly from someone who is the subject of the obsessive thought
  • Extensive and excessive research regarding the “right” amount of space to be standing from someone
  • Thinking excessively (ruminating) on situations involving personal space or triggers experienced throughout the day
  • Comparing the space used to others throughout the day
  • Purposefully changing the space between oneself and others in order to “feel better” about interactions with them

How to treat fear of proximity

OCD can be debilitating for people who struggle with it, but it is highly treatable. By doing exposure and response prevention (ERP) therapy with a trained therapist, anyone can change the way they relate to their thoughts. 

Treatment would focus highly on understanding the presentation of OCD and building both awareness and insight. This involves the development of exercises, or exposures, meant to challenge compulsions. The goal of exposures is to voluntarily confront the discomfort brought on by triggering situations, while limiting or eliminating compulsions done in response. 

Both you and your therapist would work gradually and slowly through exposures, starting with those that trigger the least distress. ERP focuses heavily on learning to tolerate negative emotions and thoughts while controlling your actions in the face of them. ERP aims to build your ability to assess danger when triggered and accept uncertainty.

Exposures would involve doing some difficult and triggering things. Perhaps you would stand in line behind someone a few inches closer than feel “comfortable.” Perhaps you would walk past someone on the street a foot closer than usual. These actions could be scary, but they would present the opportunity to face your fears, sit with discomfort, and eventually gain freedom from compulsions.

If you’re struggling with OCD, you can schedule a free 15-minute call today with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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