Somatic OCD involves obsessions with automatic bodily functions, such as breathing, blinking, or swallowing. People with somatic OCD are not worried that their bodies aren’t functioning normally, but rather distressed because they notice these functions happening and can’t fix their attention elsewhere. Fortunately, somatic OCD is treatable with exposure and response prevention therapy.
What is the best therapy for Somatic OCD?
Exposure And Response Prevention Therapy (ERP) – Do live video sessions with a therapist specialized in ERP, the gold standard treatment for OCD. Treatment from NOCD is covered by many insurance plans. Start With A Free 15 Minute Call
What Is Somatic OCD?
Somatic OCD, also called sensorimotor OCD, is the obsessive awareness of the routine autonomic bodily functions that keep us going. People with somatic OCD struggle with being unable to “not notice” 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 intrusive thoughts won’t help them go away.
The hallmark of somatic 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 also 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 themselves. These rituals are not helpful because they focus further on the ideas and desire to control them.
According to recent research, 40-50% of patients with somatic OCD arrive at appointments having medically unexplained symptoms.1
Cyberchondria & Somatic OCD
Cyberchondria is an emerging disorder defined as excessive and repetitive research online for answers to real or obsessive health-related issues that cause distress. One study found that those struggling with cyberchondria are often triggered by somatic OCD obsessions. It also causes people to make medical appointments based on information found online for medically unexplained symptoms.2
Somatic OCD Symptoms
Somatic OCD symptoms involve persistent awareness of bodily functions that are usually unconscious. 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 Obsessions
Somatic OCD involves sensorimotor obsessions revolving around:
- Blinking
- Looking/staring at someone
- Too much eye contact when talking to people
- Swallowing
- Breathing
- Heart/pulse rate
- The way the mouth moves during speech
- Excessive awareness of a certain body part or parts
Examples of somatic obsessive thoughts could include:
- 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 Compulsions
Somatic OCD compulsions due to trying to focus on or avoid the obsession include:
- Distraction: Distraction may look like using certain sensory experiences to avoid the pain around somatic obsessions. For example, someone may use television shows, music, or engaging in another activity to avoid focusing on bodily sensations.
- Excessive research: Someone may begin to research possible signs and symptoms of health conditions related to their somatic obsessions. This is often done in an effort to find reasoning behind their somatic sensations and may provide short-term relief, but long-term can cause more significant distress around the “why” behind bodily sensations.
- Mental review: This compulsion may look like rumination on a time where obsessions were not so prevalent, or it may look like reviewing life experiences that “prove” somatic sensations are not a concern. For example, someone might think of life situations where they felt healthy or unbothered by somatic OCD obsessions.
- Self-reassurance: Self-reassurance can vary from repeating comforting affirmations such as “I am okay” to making mental lists of why somatic obsessions are incorrect, or unfounded.
- Reassurance-seeking from others: Someone can seek reassurance from their support system around why their somatic sensations are occurring. They can also seek reassurance from doctors and other medical professionals around diagnoses, sometimes scheduling excessive appointments or consultations.
- Avoidance: Avoidance looks like avoiding people, places, or situations where triggers for obsessions may occur. Since somatic sensations occur in the body, people will avoid triggers focusing on those body parts. For example, someone who struggles with over-focusing on swallowing may avoid going to the dentist.
Treatment For OCD
NOCD: Online OCD Treatment Covered By Insurance – Regain your life from OCD. Do live video sessions with a licensed therapist specialized in treating OCD. Treatment from NOCD is covered by most major insurance plans. Learn how you can use your insurance benefits. Visit NOCD
Talkiatry: Is OCD Medication Right For You? Speak with A Doctor – Talkiatry can match you with a psychiatrist who takes your insurance and is accepting new patients. They’re in-network with major insurers and offer medication management with supportive therapy. Free Assessment
Effects of Somatic OCD
The effects of somatic OCD can be devastating in terms of quality of life. 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 significant practice to stop. When somatic OCD persists or gets worse, seeking help is recommended.
Relationships may also be affected long-term if someone is constantly seeking reassurance from their partner, spending too much time researching their symptoms, or unwilling to participate in intimate activities due to their obsessions and compulsions.
Is Somatic OCD Dangerous?
Although somatic OCD can cause someone significant distress, the symptoms themselves are not dangerous. People with somatic OCD tend to over-focus on natural bodily sensations, such as swallowing, blinking, breathing, or chewing. Although this is distressing for the person, it is not inherently dangerous to draw attention to these sensations.
The only way somatic OCD could become dangerous is if someone attempted to alter these sensations in an unnatural way, such as forcing themselves to breathe at a quick pace for extended periods of time. Other behavioral compulsions taken to extreme lengths, such as taking medications to alter physical sensations, could also make the disorder dangerous. Additionally, if someone left somatic OCD untreated they may begin to suffer from high stress levels, which are linked to a number of negative health outcomes.
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.
Here’s another example of hyper-awareness:
A woman with somatic OCD might have trouble at work and in her social life due to her fear that when she talks to women, she will be perceived as inappropriately staring at their breasts. Although she continues to perform at an excellent level at work, the quality of her life suffers due to the high level of distress she experiences 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.
How Do I Know I Have OCD?
It can be hard to know if you have OCD, but asking yourself some questions can give you some insight into where your concerns may be coming from.
Some questions to ask yourself if you suspect you may have somatic OCD include:
- Do I have unwanted and compulsive thoughts that stop me from doing things I need to do?
- Do I have fears around certain things like contamination or germs?
- Can I sit with uncertainty?
- Do I need things in a certain order or in a certain way?
- Do I need to check things multiple times before I leave the house?
- Can I manage my aggression when it comes up?
Regardless of what insights you may learn from your answers, if you are struggling, it is important to seek professional help from a licensed therapist.
Do I have Somatic OCD?
The first step to getting help is an accurate clinical assessment and diagnosis. NOCD’s therapists will provide a comprehensive assessment of your experience. If they find that you do not meet the criteria for OCD, they will still help assist you in identifying what you may be experiencing. Get Started With A Free 15 Minute Call
How Is OCD Diagnosed?
OCD can be diagnosed by a primary care provider, psychiatrist, or therapist. It is typically diagnosed through a clinical interview, where the provider discusses your symptoms and current life factors related to the history of your symptoms. A medical doctor may also want to rule out medical conditions that can mimic or cause symptoms of OCD, such as Parkinson’s disease or brain injuries.
Although it is not used for diagnosis, a common tool used to rate the severity of OCD symptoms is the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The Y-BOCS essentially reviews certain features of OCD and the intensity of your experience of these symptoms. Your provider may also use the Dimensional Obsessive-Compulsive Scale (DOCS) to gain more insight around symptoms related to germs, harm, unacceptable thoughts, and symmetry.
Will I Get an Official “Somatic OCD” Diagnosis?
You cannot receive a formal diagnosis specific to somatic OCD. OCD subtypes were born out of conversations and research of mental health professionals and the OCD community. The DSM-5, which is used by mental health professionals for diagnoses, has a general diagnosis for Obsessive-Compulsive Disorder. A therapist or psychiatrist may speak with you regarding identification with somatic OCD symptoms and how to approach them for treatment.
Somatic OCD Treatment
When somatic OCD persists or if it is getting worse, finding OCD treatment is recommended. Decreased ability to focus and function indicates that the problem will persist and that you need professional help. The gold standard treatment for obsessive compulsive disorder is exposure and response prevention (ERP), and medication may be prescribed for some people as well.
Exposure and Response Prevention (ERP)
ERP 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.
ERP Exposure Examples for Somatic OCD
Exposures for somatic OCD involve finding a balance between awareness and attention of bodily sensations. Since people with somatic OCD often become hyper-aware of physical sensations, exposure therapy strategies may help them learn to notice these sensations without ruminating or fixating on them. If one of their compulsions is to avoid any triggers for these bodily sensations, they may be asked to begin to approach these triggers in gradual ways.
Most exposures will focus on the bodily sensation you are uncomfortable experiencing. It is highly advised to see a medical doctor who can rule out any complications prior to enlisting yourself in exposure therapy. Once the exposure starts, it is important to prevent any compulsions in response and learn to sit with and tolerate the anxiety until it subsides.
Here are some potential exposures that an ERP therapist might have someone with somatic OCD engage in:
- Breathing: Notice your breathing without changing or altering it
- Chewing: Notice another person chewing during a meal
- Blinking: Avoid counting the number of times you blink
- Swallowing: Eat a food you are afraid of choking on
- Breathing: Breathing the “incorrect” way (either over- or under-breathing for a minute)
- Textures on Skin: Wear a type of clothing that feels uncomfortable for a limited period of time
- Bladder/Bowel: Avoid using the restroom for a limited amount of time
- All: Engaging in social activities, which force being around others who trigger the obsessions, such as going to a lunch date and being present with someone else chewing
- All: Imagining the consequences of living with hyper awareness forever
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.
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.
Body Scanning & Mindfulness Practices
Working on connecting more with your body is an important step to combat somatic OCD. Body scanning to become more attuned with each body part is a great way to help you feel you have control of your body, though it should be done with a licensed professional who can keep this practice from becoming compulsive. Mindfulness meditation for OCD is another way to ground yourself when you have intrusive thoughts.
Medications for Somatic 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 psychiatrist services can still assess your need for a prescription.
Examples of medications used for somatic OCD include:
- Escitalopram (Lexapro)
- Fluoxetine (Prozac)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Sertraline hydrochloride (Zoloft)
Getting Help for Somatic OCD
Be sure to find a therapist who has experience treating OCD. You can also ask your insurance company or health provider to provide a referral or search for OCD resources to find someone who offers exposure and response prevention, habit reversal training, or acceptance and commitment therapy. You can also find a therapist who’s right for you using an online therapist directory or a specific online OCD treatment platform like NOCD.
Does Sensorimotor OCD Go Away?
Sensorimotor OCD obsessions and compulsions do not usually go away without treatment. However, a combination of therapy and medication can help you learn how to live a functional life with sensorimotor OCD. Much of the distress caused by the disorder is from an over-focusing on the obsessions, so therapy helps you learn how to accept and tolerate unwanted thoughts, images, and urges without using compulsions.
Through repeated exposures to triggers without using compulsions, you can retrain your brain to tolerate the distress of bodily sensations. Sometimes, the frequency and intensity of symptoms lessens as you become more unafraid of the content of your obsessions. Medication can also help you biologically cope with underlying imbalances of neurotransmitters which might contribute to symptoms.
Additional Resources
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OCD Therapy
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Treatment From An Online Psychiatrist
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