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.

Forgive me for talking about me so much, it's just so nice to be able to share with people who can actually get me. You also think about breathing a lot? Is it a fear of dying or a control fear like me? Like you feel trapped by your own conscious control and awareness. It does get better. For me, what helped was realizing the lie/mistake in my thinking. It isn't true you 'have to' think about it. I realized that I could live without thinking about it or being afraid I would. The ocd didn't continue through the years, but it was diminished. Slowly I got more hold of myself, more confidence the danger wasn't real. "I can have happy moments, unhindered by my fear" I repeated myself, not to forget this truth. I reminded myself of those good, ocd-free, moments. It got better and better. When my girlfriend gave me shoulders and back massages to help me relax, I used to think I couldn't relax or that I somehow didn't have a right to, that it wasn't possible. I should specify that I developed the belief through the years that I couldn't be happy, almost like I didn't have a right to anymore. That I was broken beyond repair. Anyhow, that was a lie. I also had trouble enjoying movies at the cinema sometimes, for the same reasons. And other fun activities I liked, such as listening to music. It was like self torture. I managed to change my belief and now I have more confidence that I can enjoy things, unhindered. And live my life! At last!

I'm hyperaware of the clothes touching my skin,specially innergarments, I've tried sizes,nothing makes me feel comfortable, I'm uncomfortable and hyperaware of it all the time.Can anyone feel me? Its just ocd right?

This information has been very helpful to me. For few years now, I've been experiencing discomfort and urges to use the toilet while I'm travelling. It gets worse as I've been constantly aware of the time left until I'm near my destination. I always get this feeling that I could faint anytime. My family wasn't helping either cause they don't understand what I feel. Right now, it was much worse than before. Before I just need to pee but now I also need to take a s***. Everyday I felt pain behind my back and it triggers something inside me that made me need to use the toilet immediately. It gets worse while I'm travelling and was somehow tolerable at home. I was planning to seek a therapist after quarantine but for the mean time I want to do the same treatment you did to your patient. I really want to use this time during quarantine to treat myself. I want to ask if its okay though? Thank you very much.

I have this type of OCD where I feel smthg bad is going to happen if I don't do my daily routine or I do certain things... But my OCD is far much more complex than that... Thus it has come to a point where I am so frustrated in doing things repeatedly and feeling that I am crazy and the thought of me can't be normal just comes together along with the OCD... So I have been hitting myself quite hard in the head several times and it gave me headache and I would often cry about it because I know it's OCD, I know I am not normal, I am frustrated because none of my family members even care that my OCD is getting worse because they did not believe it in the first place and I am depressed that I can't live normally

So I sat down to google on why do I have thoughts of incidents which has never happened. I continuously worry on how the scenario of the home would be if my mother is not around. She has worked so hard and I don't trust anyone not even my father that he will maintain the same way when my mother is around. Selfishness, greediness, the urge to snatch are the fears I see in my family members and hence I trust no one. I am a single parent and my mother is my only friend. I know my mother won't be available always with me and some days I will have to move on but accepting the impermanence of life is so hard for me.

I have had CBT for OCD which involved an intense focus on swallowing. It really helped but I do still struggle with this problem at times. My mind feels like it is glued to the thought of swallowing. My mouth fills with saliva, and my throat feels as though it is desperate to swallow to relieve the sensations. After I have managed CBT to stop physically swallowing. I have a second stage where my throat automatically contracts to relieve the symptoms and obsessive thought. I am currently struggling with doing CBT for my throat contracting, it's almost like it clicks and my Adam's apple literally moves and all of a sudden the anxiety completely goes but then comes quickly back. Any suggestions that may help would be very appreciated, thank you. Also if anyone is really struggling and reading this, I strongly urge you to seek help with therapists it makes it easier when you're not alone.
All the best!!

Thank you so much for this article. I have been dealing with harm OCD and it just completely feels like hell. And unfortunately it's me having OCD thoughts about harming myself and they scare the soul out of my body. I would never EVER want to do the things that I think of doing but at the time when some of the thoughts come there are compulsions and that scares me even more. And the worst part is FEAR IS THE FUEL. I have been dealing with regular anxiety for a number of years and only somewhat recently started suffering from these thoughts. I intend on going to see a psychiatrist or therapist to help me with it. I know deep down I will be okay but it's so hard not to get anxiety and fear from having a thought and an urge that threatens my life. And the kick is, I have an extreme fear of dying. I know everyone is afraid of dying, but this is literally on the phobia level. So my thoughts are trying to constantly fight with each other. It feels like an angel and a demon are sitting on my shoulders sometimes. Because it's an automatic response of "I DONT WANT TO DO THAT TO MYSELF" and follows a little whisper of "yes you do" (not actual hearing voice just in my thoughts voice) This constantly makes me think I'm having suicidal thoughts when I am most definitely not. Before this started happening I was one of the happiest people you would ever meet. (Still technically am just riddled with anxiety and being scared) I love my life, I love my family, I love my pets, I love doing a lot of things in life. In general life never gets me down, I'm headstrong and push through. And if I believe I can make it through, I have faith in anyone who's having problems with OCD.

My mother’s dad who I’ve never known had schizophrenia, one of my sisters is diagnosed with ocd and bipolar disorder. This all started in March, I had thoughts of bestiality not actually doing anything but that I wanted to watch it, it was horrible but after a month or two the fear subsided and I was able to control it I hardly think of it anymore. For the last few weeks after finding out my sister is bipolar and about my grandpa I have had severe intrusive thoughts and even physical feelings about going crazy or developing schizophrenia. I have a thoughts sometimes that I know are forming because of my fear, I’ll think what if the leaves outside were made out of fabric I immediately think omg that’s so crazy to think of your crazy!, the fear is so strong I’m scared that when I look at the leaves I’ll see that they are made out of fabric even when I look at them I see plain and simple they aren’t I still get the fear when I look away like I didn’t just look at them and see they are normal. It also gets triggered when I see a post or comment on a post someone made talking about their family member or friend who had schizophrenia one of them said my mother believed humans weren’t real it scared the crap outta me when I thought about it like What if humans aren’t real came up and I was really trying to dissect and gave myself multiple reasons for why that is not true at all and I’m just overthinking but it’s really scary. I’ve tried to explain this to my therapist but because of my past trauma she believes I have PTSD I’ve read a few articles and I’m really leaning towards OCD does it sound like that to you guys? I’ve been feeling so trapped lately. Please respond I need some relief from these thoughts.

I have had urges to strangle my mum and Camhs worker. I have also had urges to snap my cats neck! Honestly it’s horrible! I want to believe I could never do that but my mind is telling me otherwise it’s making me scared to be near my cats and also I have never met my Camhs worker Yet but my mum said it might be Like me trying to block out the help everyone is trying to give me by imagining and feeling like I’m going to do these things. I have googled a lot of stuff I know which is bad about violent desires and this made me think and go through all the urges and thoughts I’d had and thought what if part of me wanted to do it! And becuase I have urges I am thinking well I must want to do it but my impulse control is strong and I’m getting help soon so I hope I can control this and realise I’m not a bad persona nd stop distancing myself from my mum and cats like the urge is so strong to do it but I never do and it makes me panic and obsess like mad

I have heard that people w/ OCD that have these types of invasive thoughts of hurting others are usually super moral people who would NEVER do such a thing. In fact the OCD part of the mind is trying to make you feel guilty. I've been told it's all about guilt and the OCD is like a bully. The 2 best ways to help OCD are cognitive behavioral therapy (including exposures) and sometimes medication. Please seek good professional help. It makes a world of difference!!

My OCD makes me believe that I’m going to have a heart attack. I have panic attacks and they make my heart rate increase greatly sometimes and then I begin to obsess on the fact that I am potentially having a heart attack. Even once my heart rate slows down, as it always does, I will still obsessed for days afterwards and worry that I am going to have a heart attack. I will feel pressure and pain in my chest and become convinced that I’m gonna have a heart attack. It is so intrusive in my life and it sets me on the path of depression. Is there anyway that I can stop these obsessive thoughts about having a heart attack? I’ve worn a halter monitor for two days and was told that my heart is fine. But I still can’t help But to obsess on it. It is truly ruining my life.

Hello, I am new here! I experience near constant intrusive thoughts and sensations about vertigo and balance. About once or twice a year I have horrible vertigo which means I have to lie very still for around a day or 2 but I fear this symptom constantly and when particularly stressed or anxious I have a chronic mild balance and vertigo problem. Could this be an OCD and if so what would be the best form of therapy?

Hi Patricia and everyone else, does anyone else suffer with groinal response to almost everything? Even myself? I have struggled with POCD, HOCD, TOCD, GAD and Suicidal OCD, and only just realising I’ve been getting false arousal to the same sex for a long time, this started from when I was little I would constantly type in girls on the internet and I can’t remember if I enjoyed it or not, but now every single girl I see, even myself I get the fake arousal too, which triggered my TOCD. I also kissed girls as a child and can’t remember if I felt anything, this is hell! Everytime my friends talk about their boyfriend I get intrusive thoughts of being their boyfriend and having sex with them and it gives me the groin response:(! Does anyone else relate? I’ve only just come to this realisation that overtime I may have been checking girls subconsciously and getting these responses and all this time I’ve thought I’m actually gay, when actually I just accustomed to checking and it became sort of daily life that every girl I would get aroused by?