by Patricia Thornton, PhD

Just Announced! New ADAA Live Webinar with ADAA members Drs. Kissen and Greene - What Are Intrusive Thoughts and How Can You Deal with Them? November 5 - noon EST. 

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!

Just Announced! New ADAA Live Webinar with ADAA members Drs. Kissen and Greene - What Are Intrusive Thoughts and How Can You Deal with Them? November 5 - noon EST. 

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.

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 you are definitely not alone. How are you doing? I too suffer from these thoughts. It’s one of the most frightening things. I don’t know what’s more scary the thoughts or the urges or sensations that o get when I have these thoughts. They upset me so much, I find that they get worse when I not busy or around people. Even though I just want to avoid them. I hope you get better my email is if you want to communicate more about it!

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

I’m a 19 year old college student. I have been struggling with this issue for over 2 years. I can’t feel sexual sensations due to this and I usually stay on the toilet dribbling pee for close to an hour. The urge to pee never goes away. It is a living hell. I was very close to suicide last year because of this problem. I hope we can help each other. If you want to email me my email is thanks...

Hi rebuke,
I am having similar condition for as long as I remember. I am now 28 years. It is so debilitating when I was a child. I remember It very vividly when I was doing 6th grade. Everytime I go to the class, I have this intense urge to defecate. I could feel the sensations in my stomach through out the time in classroom and it was very anxious. To make matter worse, the toilet facility in my school is extremely bad and it's almost like open defecation. Due to financial conditions and parents compulsion, I couldn't able to find a good school. I consulted a GP, who took advantage of my condition and prescribed more tests and unwanted medications every time I visited him. It happed for many years before he had his mind think about psychology causes and prescribed me a psychiatrist. That psychiatrist is even worser than him. He is extremely judgmental and told my parents that I would become psycho. Things went really bad for next four years. Making a balance between my illness and education seemed a very hard task. Believe me, at home I never felt same urge. So, I keep on absconding. My illiterate parents as well as literate teachers always blamed me as if I was acting and some times,even made me to think what if I was acting and ruining my life. At one point, every thing become so unbearable and I tried to kill myself. But never able to do it because the very anxiety that caused all this, had never let me to do it. So I tried to sort things out and I started from little things. After a good search, I found a good psychiatrist. He treated me for this condition. An SNRI, seemed to work well. I discontinued the college for a year. After a year, I become much better. My symptoms reduced to the extent I can able to maintain myself well outside of home. Slowly, things got better. Even today, I experience same symptoms, only when I was going for a long travel in bus. Other times I don't feel them at al. I know it's a long time since you queried. I would like to know how you are doing.

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

I’ve suffered from OCD since I was a kid, but was diagnosed when I spent six months in a rehab center for anorexia nervosa. One night halfway through my treatment I started having a panic attack because I was scared I was gonna wake up in the middle of the night and hurt someone in my family and these disturbing thoughts just kept popping up and I couldn’t stop them. They wanted me to talk to my assigned therapist but I couldn’t because I was also having sexual thoughts about her that I couldn’t stop. Once I was diagnosed things started making more sense. Growing up I would sleep on the couch because I could see the back and front door and check the locks every hour because I was so terrified someone would break in. Every day something new pops up and I try to get rid of it and it becomes a sweet relief for a little bit and then it stops and comes back. I’m 19 about to turn 20 and things have never been worse. I want to tell someone, like my friends but I know I can’t because I’m so embarrassed and ashamed. I’m scared of myself and would never want someone to feel the same way or feel uncomfortable around me. It’s like a bully in my head that no one else can see. The only other person I told was a girl I grew up with and became best friends and she told me I would grow up to be a murderer. Things aren’t easy, but I found this page with everyone’s comments and for the first time I don’t feel completely alone.

How could someone you grew up with believe and say something like that to you? Does she not realize the kind of distress her words can cause you? I'm sorry that you're going through this. Since January 19th, 2019, I've been dealing with violent intrusive thoughts and urges. They have done nothing but terrify me to the point where I would cry almost everyday. This has been the hardest thing I have ever been put through and it has taken a huge toll on me mentally, emotionally, and physically. I haven't found a therapist / psychologist / psychiatrist that could diagnose or help me quite yet. I really hope I can find help soon because this is too stressful. You're not alone in this! There's hope for us all!

It started as when people would make me made I would get this thought. I would see red and I would want to shove them against a wall and dig my teeth into their neck. I had a physical urge to do so underneath my canine teeth. It used to go away by eating meat. Now it’s worse. I feel the urge almost every day, and now I feel an urge to punch people and beat the crap out of them. It isn’t even people who make me mad it’s friends and family members now too. Hell I just about did it to one of my friends out of nowhere. I don’t know what to do and it’s really starting to affect me mentally: I almost want to cry every time it happens now. Please help before I do something god awful.

I had violent ocd thought too and they got so bad that i would not leave my flat anymore. I was sacred of hurting my family and even strangers or kids on a playground. The thoughts and urges were so graphic and real. I went to therapy and they helped me realise that while the thought and urge is there i would never actually go through with it. I had to expose myself to situations that would trigger the worst thoughts and would have to write down what im thinking as time progressed. The urge and the fear eventually fade away if you dont try to fight it and try to "think" against it and stop the thoughts. The first few times "embracing "the thoughts was awful. Id have full blown panic attacks and would try to leave the room. The more i confronted myself and my fears though, the more irrational they became and eventually sort of dropped away. It sounds too easy, but it really isnt, it took me well over 6 months regular exposure. But the therapy really, real, helps. It is so hard to let go and accept the possible worst, but trust me you can do it. You wont ever hurt someone. Its just in your head. You have a feeling but you are not that feeling. You have a thought but you are not that thought. Try not to let it consume you. I wish you the best, you can do it. Sure, i sometimes still have a violent thought pop up, but it doesnt unnerve me anymore and i can see it for what it is. Took me 8 years to seek Help, but have been blessed with hardly any ocd thoughtd and no symptoms für the last 13 after the therapy. Dont wait as long as me and dont think people wont understand or be accepting. I found the opposite to be true

You won't do it. That's where the fear is coming from, the thought that you might. That's what gives it its power. You're so convinced of what it might mean about you. Guess what people who do bad things care about? Nothing..... they have no remorse, they don't feel bad about anything, they're not worried about following through on a violent impulse. A moral anxious OCD ridden person does, which is how it becomes an obsessive thought in the first place. You're ok....WE are okay. Even if our brains are telling us otherwise.

I have struggled with ocd my whole life,i an 24 and last year I adopted my daughter.since that my symptoms and fears have grown exponentially and sometimes I can’t tell the difference between something I actually see as attractive and something I don’t intrusive thoughts cause arrousal and thoughts that should don’t and I find myself thinking of things I don’t want to just to b able to feel good,which is followed by shame and thoughts of taking mylife,because I feel my thought gave actually turned me into this disgusting person,I currently have no health care and am drowning in this on my own


April 22, 2020

In reply to by Kendra

There are great Podcasts and very helpful Videos on YouTube about ocd and a surprising amount of them deal with violent or sexual ocd thought ( as a first help).
I found ocd is like a weird upside down mirror. You think about somebody coming to harm or being a victim or something randomly, knowing it to be a horrible thing completely against your morals, than you question wether you would be capapble of something like that then your ocd suddenly attcaches, flips the script and shows you thought of you doing it in your head. Then you are so appalled by the thought that you fight it with all your might which just keeps making its bigger and bigger and everytime you see that person it pops up again. Anxiety flares up, attaching more and more meaning to that distorted mirror Image thought. But you have to remember these are just thoughts, they cant make you do anything. Its not a reflection of yourself or your desires, its just intrusive thoughts. You wouldnt be suffering so greatly if you agree with the the thoughts and sensations, your are aware that this is not right and you dont want to have them. So no, you are Not disgusting your mind is just throwing up the absolute worst scenarious it can think of. Educate yourself as much as you can about ocd and its manifestations. Learning to seperate the ocd from the rest is a first Major step and a lot of the time reading about the symptoms and identifying them in you life really helps, even if you cant have professional Help yet.

Dear Kendra
I’m only 15 but I have experienced the same things as you with OCD, such as being aroused by the worst intrusive thoughts, trust me I understand how uncomfortable it is. Getting aroused by an intrusive thought is a common thing that links to OCD called groinal response. I was so afraid before I found out I had this before too. Just know that there is help to get, therapists psychiatrists etc that will do their best to help you. You should also know that OCD takes out so much hapiness in peoples lives that it shouldn’t. The trerrible thing about OCD is that it doesn’t care about your morals or what you think is right or wrong, it wants to hurt you mentally where it knows you’ll be the most miserable mentally. Today I met with a psychiatrist for the first time because my OCD is not good and I know there is help to get. Another terrible thing about OCD is that it can completely make you think the thoughts are true especially from those physical sensations that you get, but usually they aren’t you are just scared

When I was young my parents took my to a psyche because I had the constant need to suck my tummy inward in sharp inhales, I would get stuck doing it in spurts so often that my ribs would hurt and my stomach would make weird noises. But the most important thing this doctor called to attention was that I was able to consciously control the urges if it thought about it. They diagnosed me with OCD and I didnt believe it, I had convinced myself I had some form of tourretts. It is not till reading this that I am starting to believe that doctor's diagnosis. Emarrassingly, I also had/have the physical urge/need to grab and adjust my..privates.. when I feel anxious or are wearing tight pants. I hate this urge the most. But if I fixate on trying to not act when I have these physical urges and feeling, my sensation of need increases. I'm glad I'm not alone.

I have these urges to kiss someone no matter who it will never happen but how do you mitigate the thought...i think to some childhood drama i went through need help desperately....i know who i am sexually ( heterosexual)

Try to let the thought be. You know it wont happen, its just your ocd thought. I you dont try to stop it, fight it or think against it, you will subconsviously stop attaching that much meaning to it, and it will start to pop up less. If i have a violent ocd thought, i do just that, " ah, there it is again, hello ocd, i heard you but lets move on focus on something else". I dont try to negate it or Entertain it but accept it and leave it behind.

Yes, but man it's hard after being stuck in a cycle for 30 years. Would it work with "Guilt" OCD? I suppose it's a case of training your mind to ignore it. I'll certainly start this technique.

Thanks Benjamin :)

Hey I totally get you. My OCD propels me into a full belief that just because some is nice to me that they must fancy me and therefore I feel the urge to make out or sometimes just make a move on them i.e touch of a hand, groin, ass etc. I have come to see it as a thought process that ignites when I am uncomfortable and feel most vulnerable, as though I am going to be exposed some way or other. Nowadays I welcome the thought, laugh at their absurdity and establish what "is" actually happening in reality that is making me uncomfortable. Usually its connected to self destructive idea of "I'm not good enough" etc etc. I log the event and meditate on them at night via self loving, self-acceptance, self-compassion or some metta mediation. I still get intrusive thoughts but as I said above now I welcome them as each time I am triggered its an opportunity for me to confront my fears and in the words of Joe Campbell "Defeat my Dragon".

I worry that what I'm thinking is not OCD especially when I get weird feelings and urges. I have a horrible unwanted thought about a family member and I hate it. It fills me with dread everytime I'm around this person. When I'm being intimate with my boyfriend an image of the family member will flash into my head and the more I try not to think about it the worse it gets. Its now got to the point where I've started to avoid the person as best I can. I don't even like being alone with them and I feel like they can read my mind. One really scary turn this thought has taken is that when I cannot avoid them I look at them to check that I'm not thinking they resemble my boyfriend in anyway? This is new and has freaked me out. I then look at my boyfriend to check I am not thinking he resembles my family member. Its making me doubt I have OCD. My mind is in turmoil right now.

Yes, the article shows that she has some pretty good insight about lesser known obsessions and compulsions but the knowledge means nothing if she doesn’t take the time to respond to people asking for help. Why even have comments open?

Hi Pivi,

Please note that the comments feature for the ADAA blog posts is to allow readers of the posts to share their thoughts/experiences with each other. Our posts are written by our professional members as educational tools and for our website community to read/share their thoughts with each other.

Thank you!

The ADAA staff

I think I have ocd, I’ve been trying to figure this out for a couple of years. I bite my tongue compulsively without any thought. I only catch the fact that I have been biting my tongue when it’s too late. At the point when I catch it I’ve already gotten hooked on it, and my tongue with have a white sore. Sometimes it gets so bad that I’m unable to talk, eat or move my mouth without triggering myself. I visited a doctor at 7 years old and they had never heard of it before. I’ve tried a few things to suppress my urges, but none seem to be too effective. If anyone experiences something like this, please let me know if you can stop yourself.

I just have weird sensations and strange thoughts that just are very fleeting through my mind nothing horrible ...I will say or hear something and some quick weird thought goes thru my head ....I can't really explain it ....but it scares me I've suffered from panic and anxiety all my life ...these feelings are I going crazy.
I sleep with the TV on and pull things I hear subconsciously that come back to me later in waking hours I nuts ????

I promise you, you are ok. Babies listen to mozart in there sleep so the take it in subconsciously. And don't worry about the quick thoughts. Just anxiety trying to press you into feeding it your fears.

It breaks my heart reading all the posts of people who have intrusive thoughts of harm.
I have had those types of thoughts since I was a little girl. I have always done praying rituals, sometimes for hours a day. I became very good at praying while working or speaking to people or anything else I had to do. My mother also had OCD. I used to have thoughts of someone I loved being hit and killed by a vehicle. I prayed many times about this until one night I received a call from my Dad saying that my was run over by a snowplow while she exited a favorite store she shopped at. That was the second I realized that all the rituals In the world had no power. My bad thoughts had no power. I did not kill my mother by having bad thoughts, the truck driver killed her. I no longer give my bad thoughts power. I would rather stay a little uncomfortable for a short amount of time than spend a lifetime of fear.

I tend to focus so much on my breathing which makes me feel bad and keep checking on it. How can I conquer this uncomfortable feeling. Thanks

I’m really struggling with my everyday life because I think there’s something wrong, from the time I wake up to the time I go to sleep I’m constantly poking and touching my body looking for new things. Always asking everyone around me to feel these “things” I’m feeling. I’m just wondering how I can over come this as it’s taking over my life :(

I usually have an urge that whatever feeling or sensation I have had on the left side of my body, I should also have it on the right side and vice versa. And my son said he has similar feelings too! Oh my! If the person right side of my head, face or arm itches and I scratch it, I feel an urge to scratch the left side to make it feel the same as the right side. I did read up once and learnt to use Exposure and Response Prevention. Sometimes I'm able and other times I'm not, but it certainly isn't as bad as it used to be. But I thought I would totally overcome it. I'll still work on it. Thanks for your article.

Its horrible i dont have harmful urges but i have to hold my neck up touch my adams apple and count to 14

I really hate the thoughts i try to get rid of them i domt have them as much but sometimes they appear..

It's easy to read this page and laugh because some urges are so ridiculous but speaking as an OCD sufferer I can relate. I've thought (and felt) everything from feeling guilty for things I've never done to having urges of whistling loudly at someone to annoy them. My main issue is the "guilt" side. It's so depressing. Even though I know it's not true but my stomach just knots up and hurts like anything. Currently I thought of hugging my aunt, who's been dead for 20 years, but the thought turned into something sinister like sexual. It's NOT true by the way but once I thought of it, it sticks and now I'm trying to unstick it.

I have this OCD in Breathing since i was 10yrs old. Im 29 already. Dont know how to get rid of this. The fear that i might die is making me anxious. I also had random hyperawareness in blinking, thinking of my head as if its not functioning, seeing floaters, tinnitus, and hyperawareness in different parts of my body like my hand, feet and chest. So exhausting.