Somatic OCD: Symptoms, Treatment, & How to Manage

What Is Somatic OCD?

Somatic OCD is a type of OCD in which a person has obsessions and compulsions surrounding their automatic bodily functions. An individual with somatic OCD will notice an automatic bodily function, such as the speed of their heart rate, the number of times they blink in a minute, or the pace of their breathing. They will then begin to worry about whether they will ever be able to NOT notice the sensation. Alternatively, they may feel anxious that something is wrong with the sensation (i.e., “What if I forget how to breathe?”).

To cope with these intrusive thoughts, they develop compulsive rituals, such as trying to control the pattern of their thoughts, counting how many times the sensation occurs, or attempting to distract themselves. These rituals are not helpful because they cause the person to focus further on the automatic bodily function.

A person with somatic OCD may obsessively focus on the following autonomic sensations:

• Frequency or sensation of blinking
• Frequency or sensation of swallowing
• Rhythm, depth, or sound of their breathing
• Frequency or pace of heartbeat
• Mouth movement during speech
• Hyperawareness of tension or relaxation in specific muscles or muscle groups
• Position or feeling of the tongue in the mouth

Somatic OCD Symptoms

Somatic OCD obsessions are generally focused on noticing a bodily sensation and worrying about whether the individual will ever stop noticing the sensations. Somatic OCD compulsions involve trying to turn one’s attention away from these bodily sensations and intrusive thoughts.

Examples of somatic OCD obsessions 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.
• What if I am blinking not enough or too many times?
• How do I know if my heart is beating the right way?
• What if I forget to swallow in my sleep?
• Do I need to speed up how I am breathing or slow it down?

Examples of somatic OCD compulsions include:

• Excessive research: Someone with somatic OCD 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 the 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.
• Distraction: A person with somatic OCD may try to use other sensory experiences to distract from their current somatic obsessions. For example, someone may watch television shows or listen to music to avoid focusing on their heartbeat.
• Checking, monitoring, and mentally reviewing: Mental compulsion may look like checking, monitoring, and obsessively ruminating about bodily sensations or experiences. For example, someone might obsessively review the past few days to “prove” their somatic sensations are not a concern.
• 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 obsessively 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.

Harmful Impact of Somatic OCD

The effects of somatic OCD can be devastating in terms of quality of life. Obsessively focusing on a body sensation can make it difficult to focus on daily responsibilities and conversations. Additionally, a person can spend hours completing somatic OCD compulsions, making it very difficult to be productive. Somatic OCD can also impact a person’s relationships 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, focusing on natural bodily sensations is not inherently dangerous. However, somatic OCD could become dangerous 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, such as taking medications to alter physical sensations, could also make the disorder dangerous. Additionally, if someone leaves somatic OCD untreated, they may begin to suffer from high stress levels, which are linked to a number of negative health outcomes.

When to Seek Professional Support

The only way to see a permanent reduction in somatic OCD is by getting support from mental health professionals who specialize in treating OCD. There is an endless number of online OCD resources, such as NOCD, that make finding support easy and affordable. You can also ask your insurance company or healthcare provider to provide a referral or use a local therapist directory to search for therapists in your area who take your insurance.

Somatic OCD Treatment

The gold standard treatment for somatic OCD  is exposure and response prevention (ERP) for OCD, either as a stand-alone treatment or combined with medication for OCD.¹ ERP can be bolstered with other types of treatment for OCD, such as group therapy and mindfulness-based CBT. Every individual is unique, and it is important to find a treatment that works for you.

ERP for Somatic OCD

Exposure and response prevention (ERP) involves focusing on the bodily sensation you are uncomfortable experiencing (i.e., your breath) without turning to your compulsions to cope with the anxiety (i.e., counting the number of breaths per minute). By repeatedly exposing yourself and sitting with the discomfort, you can teach your brain that you are able to tolerate the distress of bodily sensations without using compulsions. The more you expose yourself, the more confident you will become about being able to handle your triggers, and the vicious OCD cycle will begin to break.

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 on a lunch date and being present with someone else chewing
• All: Imagining the consequences of living with hyper-awareness forever

Free Hierarchy of Fears Worksheet

The hierarchy of fears provides a structured plan to gradually face and overcome one’s fears in manageable steps, reducing anxiety over time.

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Other Treatment Options for Somatic OCD

Although ERP is the standard front-line treatment for OCD, there are other types of OCD treatment that you can explore. These alternatives range from acceptance and commitment therapy (ACT) to hypnosis for anxiety.

Other treatment options for somatic OCD include:

• Medication: Medication can help you biologically cope with underlying imbalances of neurotransmitters, which might contribute to symptoms. SSRIs are the first-line medications prescribed for OCD. Psychiatrists typically 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.²
• Habit reversal training: 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.
• Acceptance and commitment therapy (ACT): ACT for OCD 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.

How to Cope With Somatic OCD

Coping with somatic OCD involves learning strategies for dealing with the distress caused by noticing bodily sensations without using compulsions to cope. Mindfulness encourages a person to develop a nonjudgmental awareness of bodily sensations. Establishing a regular routine that includes physical exercise, adequate sleep, and a balanced diet can improve overall well-being. Additionally, it is important to ask for and accept support from friends, family, or support groups

Here are eight tips for coping with somatic OCD:

• Avoid research when triggered: Researching whether or not your body is performing “properly” will only heighten the doubt of somatic OCD. Avoiding researching your sensations will help you have more opportunities to deal with OCD uncertainty in more healthy ways.
• Refraining from checking, monitoring, and ruminating bodily sensations: Individuals with Somatic OCD tend to need to check, monitor, and ruminate on their bodily sensations or experiences. These compulsive actions all keep the cycle of Somatic OCD going. However, stopping these compulsive actions allows the person to learn new ways to cope with the distress of physical sensations over time.
• When a bodily sensation enters awareness, let it “be”: Pushing intrusive thoughts about bodily sensations away from awareness will generally only strengthen the thoughts. Once you become aware of a bodily sensation, practice letting it “be” nonjudgmentally in your awareness.
• Intentionally practicing mindful body scanning: Body scanning is a compulsion often used in Somatic OCD to check and monitor bodily functioning. Intentional body scanning, however, is a mindfulness practice that can gently expose the person to more helpful awareness and mind-body connection.
• Using reminders for the bodily sensation: When someone has Somatic OCD, they usually avoid thinking about bodily sensations. By setting phone reminders or placing sticky notes around that remind you to think about the bodily sensation, you are practicing gentle exposures to the thought. This technique is best used under the guide of a professional who can help you plan these types of exposures.
• Utilizing mindful movement: Mindful movement is one way to practice healthy mind-body connection and awareness. Mindful movement, such as walking, doing yoga for OCD, running, or practicing a sport, can also help you gain confidence and trust in your body again.
• Practicing mindful meditation: Mindful meditation is the practice of gentle awareness in the present moment. Practicing meditation for OCD can help someone with Somatic OCD grow skills to differentiate between awareness and attention of sensations.
• Practicing gentle acceptance and cognitive reframing: When an intrusive thought or sensation comes, practice accepting that you are having the sensation and reframing the thought. For example, if you experience an intrusive thought that you may never get swallowing out of your awareness, you might accept that this thought is occurring and reframe it to include, “I am having the intrusive thought that swallowing may never be outside my awareness and also I am practicing an OCD exposure in this moment which will help me learn to live with the awareness of swallowing.”