Somatic OCD: Definitions, Symptoms, & Treatment

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 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

Other types of body/health-focused disorders that can overlap with 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

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

The OCD symptoms of somatic OCD 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 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 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
• 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 gets worse, 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 significant practice to stop.

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.

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 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.

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.

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 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.

Exposure and Response Prevention

Exposure and response prevention (ERP) 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.

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. Taking a mindful approach to this and allowing yourself to feel your body as you body scan can help. Mindfulness meditation 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)

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 aren’t going away is the first step in getting help. Somatic OCD is treatable with ERP therapy alone or combined with medication. You don’t have to face OCD on your own.