How much body awareness is a good thing before it becomes obsessive? Our awareness of somatic sensations or bodily functions can range from negligible automated processes to hyper-focused fixation. In the latter case, we see somatic OCD, consisting of obsessions with automatic somatic behaviors that keep our body functioning. Sufferers of somatic OCD are not worried that their bodies aren’t functioning normally but rather distressed because they notice them happening
What Is Somatic OCD?
Somatic, or sensorimotor, OCD is the obsessive awareness of routine autonomic bodily functions that keep us going. People with somatic OCD struggle with being unable to “not notice” or “pay attention” to somatic sensations after noticing them. Once the awareness sets in, it is hard to stop, as trying not to think about something is the same as thinking about it, so trying to suppress the thoughts won’t help them go away. The hallmark of obsessions is uncertainty. Obsessive behaviors are almost always about things that the person can’t prove. People struggle both with the content of the focus and the constant distress of not being able to “get to the bottom of it.”
People can develop mental rituals along with obsessive thoughts, such as trying to control the pattern of their thoughts, counting how many times the behavior occurs, or attempting to distract away from their views. These rituals are not helpful because they focus further on the ideas and desire to control them.
Other types of body/health-focused disorders that can experience somatic OCD include:
- Orthorexia(i.e., lifestyle devoted to excessive pureness of food/eating)
- Body dysmorphia (i.e., imagined ugliness)
- Muscle dysmorphia (i.e., not having a “big” enough physique)
- Emetophobia (i.e., fear of vomiting)
- Somatic symptom disorder*
Of note, somatic symptom disorder is also known as hypochondriasis, and is characterized as experiencing intrusive and distressing thoughts related to health/illness. According to Kroenke, 40-50% of patients with somatic OCD arrive at appointments having medically unexplained symptoms 1
.
Other common OCD subtypes similar to somatic OCD include the following:
- Harm OCD
- Contamination OCD
- Scrupulosity OCD (i.e., moral perfectionism)
- Sexual orientation obsessions (i.e., fear about the uncertainty of their sexuality)
- Relationship OCD
- Just Right OCD(i.e., sense of incompletion that causes repetitive behaviors or being stuck in place until the “right” feeling is achieved)
- Symmetry OCD
- Superstitious obsessions (i.e., special significance to numbers, colors, dates, words, and cultural practices that need to be performed flawlessly)
Cyberchondria & Somatic OCD
Cyberchondria is an emerging health-related disorder, which is defined as excessive and repetitive researching online health websites for answers to real or obsessive health-related issues that cause distress. One study found that those struggling with cyberchondria tend to type of compulsive behavior triggered by somatic OCD. It also causes people to make medical appointments based on information found online for medically unexplained symptoms 2
.
Somatic OCD Symptoms
The OCD symptoms of somatic OCD are persistent awareness of bodily functions that are usually unconscious since they run on autonomous mechanisms. There is no need to be aware unless something affects their functioning due to health reasons. Somatic OCD becomes a clinical problem when it starts interfering with life and when the distress level becomes unmanageable due to the inability to focus on anything else.
Somatic OCD Obsessions
Somatic OCD involves obsessions revolving around:
- blinking
- looking/staring at someone
- too much eye contact when talking to people
- swallowing
- breathing
- heart/pulse rate
Examples of somatic obsessive thought include the following:
- What if I never stop noticing these body actions?
- I worry I will go crazy if it doesn’t stop.
- What if I don’t chew my food enough and choke?
- Am I noticing these sensations because there’s something wrong?
- I feel like my thoughts are out of control.
- Maybe there is a reason I am supposed to notice the behavior.
Somatic OCD Compulsions
Somatic OCD compulsions due to trying to focus on or avoid the obsession include:
- Distraction
- Avoidance behavior
- Compulsive counting how many times the symptoms are happening (e.g., blinking, swallowing, heart rates, or breaths)
- Counting and checking pulse rate
- Staring
- Asking other people if they notice the behavior
- Seeking reassurance that they are OK and there’s nothing to worry about
Effects of Somatic OCD
The effects of somatic OCD can be devastating in terms of quality of life. When somatic OCD persists or decompensates, seeking help is recommended. A decreased ability to focus and function indicates that the problem will persist. The repetition of behaviors may develop into a habit that will take practice to stop.
Relationships may also be affected by:
- Frequent reassurance-seeking questions
- Time spent acquiring online information
- Decreased interest in leisure activities
- Lack of intimacy due to distress
Examples of Somatic OCD
Someone with somatic OCD may look uncomfortable or distressed during interpersonal interactions due to being preoccupied with physical symptoms. Someone who is hyper-aware of swallowing may appear to swallow more than usual and may call attention to the behavior.
Examples of hyper-awareness with somatic OCD can include:
- They have trouble focusing <
- They may show repeating behaviors
- They may look distressed
- They avoid or cancel social plans
For example, a woman with somatic OCD might have trouble at work and in her social life due to her fear that when she talked to women, she would be perceived as inappropriately staring at their breasts. Although she continued to perform at an excellent level at work, the quality of her life suffered due to the high level of distress she experienced in the presence of her female co-workers. She then anticipates family and social events with dread since her obsessions cause her to feel disconnected during interactions.
When to Get Treatment for Somatic OCD
When somatic OCD persists or if it is getting worse, seeking help to find OCD treatment is recommended. Decreased ability to focus and function indicates that the problem will persist. Relationships may also be affected by frequent reassurance-seeking questions, time spent acquiring online information, decreased interest in leisure activities, and lack of intimacy due to distress.
Be sure to find a therapist (in-person or online) who has experience treating this disorder. You can also ask your insurance company or health provider to provide a referral or search for OCD resources to find someone who offers cognitive behavior therapy, acceptance and commitment therapy, or habit reversal training. You can also find a therapist that’s right for you using an online therapist directory.
CBT for Somatic OCD
Cognitive-behavior therapyis designed to address problematic thinking styles/beliefs and practice normalized behavior with exposure and response prevention (ERP). Exposure therapy for OCD entails having the person fully face their fears about the consequences of the disorder and resist any thoughts that distract from facing the fear. It also teaches coping strategies to manage stress and emotions.
Habit Reversal Training for Somatic OCD
Habit reversal training targets unhealthy behaviors such as nail biting, hair pulling, skin picking, picking at scabs, or teeth grinding. The techniques of habit reversal help the person do “opposite” behaviors. With somatic OCD, a person using habit reversal would purposely think about the bodily function they are bothered until they learn to normalize and then ignore those thoughts.
ACT for Somatic OCD
Acceptance and Commitment Therapy (ACT) helps you accept that the awareness of your body functions is part of the experience of living instead of fighting it or performing accommodating behaviors. You can “take it with you” wherever you go. Mindfulness is also a primary skill in ACT to objectively describe your experience rather than having a negative relationship to it.
Medications for Somatic OCD
Medications prescribed for somatic OCD are the same for any kind of OCD. Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line medications prescribed for OCD. Psychiatrists typically prescribe these medications, but primary care physicians and nurse practitioners also prescribe these medications. If going into a doctor’s office is too daunting of a task, many great online psychiatrists can still assess your need for a prescription.
Examples of medications used for Somatic OCD include the following:
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Sertraline hydrochloride (Zoloft)
Of note, these medications have a black box warning, the most severe kind of warning from the FDA for the risk of suicidal thoughts and behaviors in certain people. You should talk with your doctor about these risks before starting any of the medications listed above.
Final Thoughts
Recognizing that the obsessive thoughts related to bodily functions don’t seem to go away is the first step in getting help. Somatic OCD is treatable with cognitive-behavior therapy alone or combined with medication. You don’t have to face OCD on your own.
For Further Reading
- Mental Health America
- National Alliance on Mental Health
- MentalHealth.gov
- 11 Best OCD Podcasts
- International OCD Foundation
- When Automatic Bodily Processes Become Conscious: How to Disengage from “Sensorimotor Obsessions”
- Get OCD treatment and support with NOCD
- Dr Steven Phillipson – Somatic OCD (Sensorimotor OCD) (#263) – The OCD Stories
- The OCD Stories: Dr Michael Greenberg – Somatic/Sensorimotor OCD and rumination (#285)
- A Look into Sensorimotor OCD
Somatic OCD Infographics
