by Patricia Thornton, PhD

We conceptualize OCD as a biologically based mental health disorder whereby a person experiences intrusive unwelcome thoughts (obsessions) and engages in rituals (compulsions) to get rid of the anxiety (or any uncomfortable feeling) associated with these thoughts.

Often overlooked in conceptualizing OCD are the physical sensations that folks may focus on, rather than a primary disturbing thought.

These physical sensations are uncomfortable and fear inducing, but they don’t resemble the intrusive thoughts that most persons focus on when they have OCD. Generally, these sensations give false signals that the person perceives as being important and because they are physical sensations, the person generally assigns tremendous importance and validity to these sensations, because they “feel” them. There is usually an accompanying obsession that is disturbing, but the patient may be unaware of it.

For example, I have treated patients whose primary OCD symptom is experiencing the frequent urge to urinate. The patient detects a sensation that he/she needs to urinate and the compulsion is going to the bathroom and urinating. One of my patients, a graduate student in his late twenties, was referred to me after visiting medical doctors (including urologists) to determine the cause of his urge to repeatedly empty his bladder throughout the day and also during the night. This patient woke up many times, felt the urge to urinate, and then would get out of bed to use the bathroom. He became so sleep deprived that he was having difficulty functioning productively during the day and was in danger of dropping out of graduate school. His medical doctors could not find any physical cause for these symptoms.

After my evaluation I suggested that he was suffering from OCD. However, this patient had a difficult time believing that. He would say, “But I feel this urge. It’s physical!” I explained that sometimes OCD gives false physical urges, as well as false thoughts.

I utilized Exposure and Response Prevention to treat his OCD, as I would in treating any other OCD content. In this case, the patient needed to experience the uncomfortable physical sensations of feeling the need to urinate and not run to the bathroom to relieve himself. At night, when he woke up, he would need to stay in bed with that uncomfortable sensation. In addition to feeling physical discomfort, he needed to experience the anxiety generated by his thought (the obsession) that he might indeed wet the bed. Sometimes he would delay the compulsion to get up for as long as possible, but would eventually get up. To help him return to bed, he constructed a sign and posted this on his bathroom door that read, “Go back to bed!”

We established a schedule of times he was permitted to urinate and modified this schedule as he was able to tolerate greater discomfort. We did this for urges he felt during the day, as well as nighttime. By doing this, his use of the bathroom was predetermined and was not dictated by OCD, and therefore urination was no longer a compulsion. 

Once he realized he could have false physical urges that didn’t need to be acted on and also accepted the uncertainty that he might wet himself, he woke up less frequently and rather quickly was able to sleep throughout the night. Other physical sensations can manifest as symptoms that an OCD patient might present with and be very disturbed by. These include “sexual sensations” that a person suffering from harm/pedophilia OCD may experience and then use as misguided “evidence” that they are in fact dangerous deviants and not suffering from OCD.

Or OCD can revolve around becoming hyper aware of natural bodily processes, such as breathing, swallowing or walking. The patient’s hyperawareness propels them to check how they are breathing, walking or swallowing and then they compulsively try to adjust themselves to make those behaviors more perfect. But by doing so, the natural course of these automatic functions is inhibited and they can find themselves creating a situation in which their compulsions are actually creating difficulty with breathing, walking and swallowing.

In all of these cases, I explain that just as the brain can generate “noise,” the body can generate noise too. You might be aware of it, but you don’t need to do anything about it. It doesn’t have to “mean” anything and it is not more important because you “feel” it. It’s just OCD’s tricky way of getting you to look for evidence that will propel you to believe that something bad will happen and to convince you to do everything you can to avoid that bad thing from happening.

If you can accept uncomfortable physical sensations, as well as intrusive unwelcome thoughts, without doing anything to mitigate them, you are on your way to conquering OCD!

About the author:

patricia_thornton_picture_0.pngPatricia Thornton, PhD specializes in the treatment of anxiety disorders and OCD. She practices in New York City.

Dear Patricia,
The most horrible thing in all of this converning harm OCD is the urge. The feeling is so strong that at times you try to understand what really stops you ...but you don't know.
Once I had the thought of harming a baby I love. I wanted to prove muself that deapite the urge I would never hurt her. I barely touched her and instead the urge magnified, doubled! I don't know what stopped me! I don't know! I felt like I had no brakes othee than sky high anxiety!
That is the doubt you have to live with afterwords while crying and suffering just thinking about it!

I know how it feels I have the same issue I think, intrusive thoughts, urges, sensations, its really shit,
its based around a pet dog anyway you will get better, maybe try CBT and or just try & relise they
are just silly thoughts same with the urges just part of the thoughts looking for
attention nothing more. hope this helps :)

OCD Sufferer

July 10, 2019

In reply to by Darragh

They are all really shit. I had an intrusive thought of rubbing my sisters cat against my groin, which is so embarrassing. I just popped into my head. Then I thought, well that feeling would be nice, because of that thought my anxiety got so so bad. I thought I was actually capable of doing it. When I went to my sisters I went to pretend to pick up the cat to see if I would get the urge and I did. I just now avoid the cat at all costs.
I feel like I’m capable of doing it now and don’t know what to do.

Hello, I suffer from intrusive thoughts about hurting my child, dog, sister, partner..anyone that i love. At one point i would have to cat out the thought in my head as if i was imagining doing the harm, until i felt disgusted with myself. This relieved me for a short while until i began worrying that i would actually carry out this urge/thought. I still worry about it now sometimes, but what has really helped me is Exposure, Prevention and Response. It really does work! I wouldn't say i am completely free from OCD, but it is most certainly more manageable :)

Hi Patricia, I came across your blog. I have a similar issue, I have constant urge to defecate for which I consulted many gastrologists but apparently it's OCD, but I have hard time believing it since I can feel it. I really need your help,I have tried fighting it but am at my wit's end now I just stopped going out out of fear of defecating in public and it has made my life hell. Any kind of help would be appreciated. My email is .Thank You

I have this exact thing .I have had ocd and I have the urge to punch people .It make my anxiety spike tremendously.Im very scared ok f it and am trying to escape its grasp!

Is it necessary to see a therapist for hyperawarness ocd if you are already taking medication for it?

I've been suffering from OCD my entire life, but it got worse after my daughter was born. My OCD manifests in completely different ways from one year to the next. There was a point I was absolutely obsessed with feeling dissociated and depersonalized. After working with a psychologist online (my local therapist wasn't educated in OCD and told me my dissociation could be a form of amnesia....suffice to say, I never went back to that therapist), I realized that is was simply hyper awareness OCD. I was so hyper focused on feeling dissociated that it was pretty much all I could think of and feel throughout the day. Once I convinced myself that I could feel completely totally dissociated and nothing would happen, it slowly lifted away.

Unfortunately, as with most of my OCD, it switched from dissociation to health OCD. In any given week, I either feel like I have some type of disease, cancer, infection or major underlying problem. There was a point last summer where I was hyper focused on my breathing and would feel as though I would stop breathing at any moment. I hyper focus on the way my throat feels, often thinking I have something caught in it. I hyper focus on dizziness, often creating my own dizziness issues (which I went to urgent care for and was referred to therapy because there was nothing physically wrong). I have a dreadful fear of type two diabetes and have actually had fingers and toes go numb despite having normal blood sugar. The reason I landed on this article tonight was because my OCD has focused on feeling like I have to pee constantly and this article popped up. I've had this sensation before in the past and the more I think about having to pee, the more I have to pee despite going 20 times throughout the day. Miraculously, if I get myself super busy and my mind off of having to urinate, I can go hours and hours without using the bathroom. I don't have a UTI or anything else. Maybe a slight bladder prolapse from having my daughter, but seems to be focused on when I become obsessed over thinking about having to pee.

To anyone reading this who has dealt with OCD or is currently struggling, just remember that OCD can very much cause real bodily sensations. It makes you think there is genuinely something wrong. Mental and physical urges and weird sensations are felt. The way that I've been able to decipher OCD from actual problems is by getting my mind off of what's bothering me. If I'm able to go a minute, hour or day keeping myself 100 percent mentally engaged in something else and all of a sudden my issues disappear or get drastically better, it is OCD. Another way I can tell it's OCD is if I become 100 percent obsessed over the issue. I've had real medical problems in the past, and they are more an annoyance or inconvenience than anything else. But if I find myself Googling symptoms, checking forums, looking at other people's opinions, looking for products to try to alleviate the symptoms, checking in on how I feel, reading up on remedies, causes, etc, etc,'s more than likely OCD.

Good luck, everyone :)

My OCD can sometimes be serious and have urges fro harm OCD to suicide. Other times I get worried about saying a word over and over to making boss fire me. Not a lot of people understand and think OCD is just little pointless rituals.

Omg Kat! You sound a lot like me. How did you stop obsessing over depersonalization and dissociation? Mine has gone away the actual depersonalization. It was so scary to me it caused me to lose weight and muscle mass because I was in a constant panic and couldn’t think of anything else . Now it’s gone but still think about it. How did you overcome it?

Hey Kat,

Your comment was interesting because I have been searching the web for more information on depersonalization. My bf has OCD and he describes it as more intrusive thoughts and somatic OCD with depersonalization than compulsions or rituals. Even the definition of somatic OCD doesn’t fit what what he describes what he feels. He’s just hyper aware of white noise type of loud sound in his head and objects or people moving around him. He feels physical pain from it. Unlike yours, his OCD hasn’t changed much from year to year, he states that’s it’s gotten compared to prior years but that’s without the help of medication (which he refuses to take) and only a few therapy sessions.

I wanted to ask if you tried ERP therapy for the depersonalization? I’m not sure what can actually help with this. His OCD is so unique we can’t find anything the exactly describes it.

My main intrusive thoughts are that something I eat, drink or a medication I take will be poisoned or dosed with a dangerous drug. The way that I handle this is checking my blood pressure and pulse rate. In my mind this will give me early warning that I am in danger. A part of my mind actually believes that this will actually happen one day, and that i will be in real danger of dying. This stress, of course causes my blood pressure to rise, which of course raises my anxiiety and stress levels to increase, ad infinitum, and then I wonder if this will be the day that I will die. I am in psychotherapy, taking Fluvoxamine for the ocd, buspirone and gabapentin and propranolol for the anxiety. Can anyone give me additional thoughts for how to combat the anxiety, including natural treatments for anxiety?

OCD is terrible. I need to get back on the Fluvoxamine. I Also take Propranalol but I am not sure how well that actually works.

I have harm OCD about stabbing my husband. I think a podcast I was listening to triggered it about a woman who was killed by her husband. Anyway, I don't want him near me and I keep picturing reasons why I might want to like his annoyances and that really upsets me because he's not annoying but his annoyances come up more when I'm OCd and helps trigger the thoughts. I'm starting to feel like it isn't even OCD but he says it is because he's had the same thing. Doctor said it is and put me on medication but I'm scared.

Normally after an hour or two of getting up and peeing every 5 to 10 mins I can sleep. After reading this its seemed to make it worse lol. It's like a personal hell. Mix this with my obsessing over ever word I said during they day makes a great insomnia cocktail.

Hi Patricia!
It is great that you included unwanted sensations to Ocd. Apart from sensations and thoughts, could ocd involve also actions or things we said? For example, something we did spontaneously or said spontaneously and then thinking that "since i did that" or "since i said that" then this means i must act accordingly. For example "since i said to a guy that i want us to be together" , now i must be with him. I mean, things we say and haunt us and then fear that there is no way out.

Hello my name is Christian and about this time last year I started having intrusive thoughts about hurting people and that gave me a huge anxiety attack and i didn't think much of it at the time Because i thought it would blow over but it didn't it just got worse and i didn't seek help Because I thought people would think i was crazy so I did some research and came upon OCD and thought that well maybe i have this condition and so from that point on i decided i would just ride it out thinking that this was temporary then Easter came around and i was a little more calm i was a senior in high school at the time i just graduated but before Easter break was about to end one night I was about to go to sleep and out of nowhere i got this overwhelming urge and intrusive thoughts to harm someone and i had a huge anxiety attack but yet again i didn't say anything and then I finally gained the courage to tell my grandma and my grandma is a busy lady and she said that she didn't know what to tell me and i asked if i could go to a doctor and she said that i couldn't Because I was taken off my insurance so i left it alone and just tried to fight it off so then i graduated high school and felt a little happy but not fully and since then my anxiety attacks have increased and my urges i don't want to act on them because I know the consequences and I just want my life back I finally had a huge breakdown in front of my grandma and she finally realized that I was dealing with something serious and she said that she will get me a doctor but there's still this sense of hopelessness and my thoughts arnt even giving me anxiety anymore and that is nerve wracking and I just hope I'm not alone

I know that I have harm ocd and it came from nowhere I have 7 children just imagine my thoughts and suffer daily some days are good some are unbearable but stay positive.

Hi Patricia mam,I am 36 years life was hell after I got somatic OCD of urinary urge at 16 years old.if I follow urinary urge n go no loo comes or little.literally I will force two three drop s of loo to feel emptied.or my OCD makes me so..but just after I return n start my activity ,again same real physical sensation of loo...then I won't go but my mind always on urinary bladder.i suffere this for 5 years ..I tried commuting suicide I am married n no that OCD..but I stopped working , because while going to interviews I used to get this OCD jump interview no job... previous day of interview n on day of interview heavy urine OCD symptoms..finally I stopped going interviews.leading pure house hold homemaker life..can u please give your email id ,so that I do my ERP n ACT or CBT.
Thank you.. please help I want to work..god bless you must

Patricia, you are doing your patients a disservice. Frequent urge to urinate and ocd are symptoms of PANS and PANDAS. His blood serum levels neex to be checked by an expert.

I am suffering from OCD. It's like existential type OCD. I am having weird thoughts of existence like human is nothing in the whole universe as comparable to universe. Every time it's disturbing me. I am trying to ignore but it's coming again and again. It's like comparing human to other big object and it gives me image like human is so small and meaningless in the universe.due to these thoughts I am having problem in sleeping because when I am trying to sleep I am experiencing chest there any solution to this. Please help me out

I have that feeling of a pencil flying next to me. I just can't remove it, no matter how many times I try, it is like I have no control over my imagination. Also, I hate pencils since they produce that weird noise when rubbed to a wall, that noise is very disturbing to the point that it gives me shivers.
Please help