Somatic (Body-Focused) Compulsions

What are somatic compulsions?

The word somatic means “relating to the body, especially as distinct from the mind.” So, somatic compulsions are rituals focused on the body and how it feels.

• Somatic, or body-focused, compulsions are common in OCD
• Somatic compulsions are often connected to worries about health conditions
• Sexual obsessions can cause monitoring of physical cues of sexual arousal
• People can even compulsively hyper-focus on their heartbeat
• Visiting the doctor repeatedly is part of the compulsive cycle of OCD

People with OCD do compulsions repeatedly in an attempt to gain relief from worrisome thoughts, or obsessions. Some compulsions are very apparent (like handwashing), but somatic compulsions are covert. In these cases the person with OCD is mentally checking how their body feels at any given moment. Somatic compulsions are commonly seen among people who have obsessions with themes around health or sexual worries, although people with any type of OCD may engage in them.

Health Anxieties

People with OCD may have obsessive fears they are coming down with a dreaded disease, called health anxiety or illness anxiety. In such cases they may repeatedly scan their body for signs of illness. They may focus on their heart rate or other bodily functions to ensure they are functioning properly.

Sometime people are worried that they have a disease, for example cancer. In a case like this, the person with OCD may wonder if his body is starting to show signs of illness. Perhaps on a given day he notices some fatigue or weakness and even becomes hyper aware of the energy he’s expending. He might notice going upstairs seemed easier before and then carefully pays attention to how going up the stairs feels the next time he does it. Is he breathing harder? Are his legs more tired than last time? Is his heard beating faster or stronger?

Another example might be a person with obsessive worries that they are having cognitive decline due to an imagined brain tumor, exposure to hazardous mold, or fears of having contracted a brain-eating amoeba. To that end, a related compulsion could be to constantly check that the person’s thinking is clear and attend to any possibility of problems with perception or memory.

Sexual Worries

Sometimes people with OCD fear that they may be sexually attracted to a person that they think they should not be attracted to. This would typically involve concerns about having feelings for someone that is incongruent with the OCD sufferer's sexual history, desire, and values. For example, the person would fear they could be attracted to a child, relative, or someone of a sex that does not match their orientation. This could even be someone they do find attractive, but just feel they are not “supposed” to be attracted to, like a subordinate at work, a married friend, or a person who is in some other way “off limits.”

As a result they scan their body for signs of sexual arousal, and feel relief if no signs can be found but distress if they cannot be absolutely sure. People with these fears may hyperanalyze every little body sign, trying to deduce some meaning and certainty from it.

Here is an example of someone with such a fear:

The person in this example is not a pedophile, but rather has an excessive fear induced by OCD. In response to these fears the OCD sufferer will pay careful attention to their body signs and may even test themselves for reassurance. Note the focus on how the person felt in response to a brush against the arm and the hyper focus on feelings in the groin. The paradox of this is that more one focuses on these feelings, the harder it is to achieve any certainty at all. Bodily sensations are fleeting and are greatly subject to influence based on our mental state.

Compulsions about Heart Beating Worries

OCD can make people worry about normal body functions, leading to other types of somatic compulsions. For example, a person might be quietly resting and notice an unusual sensation in their chest one daye that makes them hyperfocus on their heartbeat. Although the person's heart may be beating at a normal speed and not be abnormal in any way, by continuing to pay extra attention to the heart beating (a compulsion), it begins to feel as if it is pounding so hard that it can't be ignored. A person in this situation might complain to their doctor and have several EKGs to rule out a problem (and these unneeded doctor visits are also compulsions). By continuing to focus attention on the person's heart, they become overly aware of the pounding heart throughout the day, and may even lie awake at night unable to focus on anything else.

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