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.

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..