When people think of OCD, some very specific ideas come to mind about what it looks like, such as obsessive handwashing or compulsive organizing or cleaning. But this disorder can make its presence known in many different ways. One of the lesser-known groups of symptoms includes ritualized touching, tapping, and movement.
People with OCD often perform rituals to help alleviate distress or anxiety caused by obsessive thoughts. For some, their rituals are driven by obsessive thoughts, while others are motivated by distinct urges, sometimes described as tension or pressure throughout the body. In OCD, a ritual is a behavior or activity driven by a compulsive urge.
Here are some common rituals associated with touching and movement:
- Looking, turning, stepping, or walking in specific ways.
- Performing certain activities, such as opening or closing cabinets, walking down the sidewalk, or getting dressed in the morning in symmetrical or specific ways.
- Repeating behaviors such as sitting down, getting up, blinking, swallowing, or passing through doorways a special number of times or until they feel just right.
- Touching or moving objects in a particular way or specific number of times, according to special numbers or until it feels just right.
Driven by Obsessive Thoughts
Some people who perform touching and movement rituals are motivated to reduce distress triggered by “magical thoughts.” Such magical thinking is the belief that one event happens as a result of another without there being a logical or rational connection between the two. For example, “If I don’t walk in a perfectly straight line, something terrible will happen to my family.” The old phrase “Step on a crack, break your mother’s back” comes to mind when describing a magical thought. Many people say, “I know this sounds bizarre, stupid, crazy or irrational,” when describing the thoughts that drive this type of ritual. They know their behavior is not logical, but the feelings of intense doubt and anxiety persist until they perform the behavior. Rituals are often repeated until a person is assured it’s been done “perfectly” or a specific number of times.
Many of us perform regular rituals, referring to them as superstitions; knocking on wood to avoid bad luck is a common one. But for someone with OCD, their rituals can be numerous and provide only short-term relief from very distressing obsessive thoughts. Because the relief is so short-lived, rituals can build to a point where they interfere with daily activities. In severe cases, they may take up most of a person’s time, which compromises school and work performance and relationships.
For some with touching and movement compulsions, other common behaviors that can become ritualized include the way they touch random objects, walk or move, pick things up, or set them down. These rituals can interfere with shaving, showering, preparing a meal, getting dressed, and other daily activities.
Others who suffer from these compulsions can’t identify a trigger for their behavior, but they report feeling uneasy or distressed if they don’t perform their rituals. They may have had a distressing, obsessive thought that motivated them in the past, but they’ve fallen into a pattern of behavior so ingrained that they no longer remember what started it.
Driven by a Powerful Urge
Others with OCD move, touch, or tap compulsively for the sole purpose of alleviating a unique, persistent urge. For them, there are no feared negative consequences other than what they describe as a relentless internal sense of urgency to perform the ritual. Some describe their efforts to resist as similar to fighting the urge to scratch a poison ivy rash or trying to suppress a sneeze. This type of compulsion is comparable to the tics associated with Tourette syndrome; and in some cases, the rituals may be diagnosed as tics rather than movement or touching compulsions. There is an overlap in symptoms, as well as an apparent genetic link between the two disorders.
Antidepressant medications known as SSRIs (selective serotonin reuptake inhibitors) can provide some relief, alleviating some obsessive thoughts and compulsive behavior, as well as symptoms of depression that often accompany OCD. However, medication alone is not the answer. The most valuable component that medication adds is to increase the chance that those with OCD will be willing to participate in behavioral therapy and improve the likelihood that treatment will be effective and long-lasting.
We know that certain symptoms of touching and movement are akin to tics, so other medications may be prescribed for those who have these compulsions as their primary issue. These drugs block dopamine receptors in the brain. Other medications that show promise in helping to alleviate tics come from classes of drugs typically used to treat high blood pressure or seizures.
As with other symptoms of OCD, the good news about touching and movement rituals is that they respond well to a specific form of cognitive-behavioral therapy known as exposure and response Prevention (ERP). Research confirms that ERP is the most effective form of treatment.
Just as medication may vary for individuals, so does the behavioral intervention for those who move, touch, or tap compulsively. Habit reversal training is effective in treating those who move or touch almost reflexively.
Ultimately there is great hope and highly effective treatment to alleviate all forms of touching and movement compulsions. Those suffering improve significantly through a combination of appropriate therapeutic techniques and medication. The essential starting point for anyone seeking help is to find knowledgeable and skilled treatment providers who specialize in helping people ease the symptoms of OCD so they can live full and productive lives.
Nina Rifkind, LCSW, ACS
Anxiety, Phobia, and OCD Specialist
Updated September 2016