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 :)

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 nick.knack9@gmail.com .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 again...it 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, etc....it's more than likely OCD.

Good luck, everyone :)