What is Somatic OCD: Diagnosis and Treatment

What are Other Types of Body or Health-Focused Disorders That Can Overlap with Somatic OCD?

Somatic OCD shares similarities with other disorders like hypochondriasis, where there's excessive worry about having a serious illness, and Body Dysmorphic Disorder, which involves preoccupation with perceived physical flaws. Distinguishing Somatic OCD from these disorders is crucial for appropriate treatment.

Somatic OCD Symptoms

Somatic OCD is characterized by an intense and often overwhelming focus on internal bodily sensations or processes. This condition goes beyond normal body awareness, creating a state of hyper-vigilance that can be both mentally and physically exhausting. 

The individual may find themselves constantly distracted by these sensations, making it difficult to focus on tasks, engage in social activities, or even relax. This heightened state of alertness to bodily functions typically leads to significant anxiety and distress, as the individual may fear that ignoring these sensations could lead to harm or indicate a serious health issue.

Examples of Somatic Obsessions

• Breathing: An obsessive awareness of the rate, depth, or rhythm of breathing. Individuals may fear that if they stop thinking about breathing, they might stop breathing altogether.
• Heartbeat: A preoccupation with the sensation of the heartbeat, its speed, or regularity. There might be a fear that any variation in the heartbeat is indicative of a heart problem.
• Blinking and Swallowing: Intrusive thoughts about the frequency or the mechanics of blinking and swallowing. The individual might worry that these processes will not happen automatically.
• Digestive Processes: Obsessing over the sounds or sensations of digestion, leading to concerns about digestive health.
• Muscle Tension: Fixating on the feeling of muscle tension or relaxation in various parts of the body, such as the back, neck, or jaw.
• Skin Sensations: Becoming overly aware of sensations on the skin, like itching or temperature, leading to obsessive thoughts about skin health or diseases.
• Balance and Posture: Preoccupation with the sense of balance or the exact positioning of the body in space, causing anxiety and distress.

Examples of Somatic Compulsions

• Checking Breathing or Pulse: Repeatedly checking to make sure they are breathing correctly or that their heart rate is normal, often using medical devices like pulse oximeters.
• Seeking Medical Reassurance: Frequently visiting doctors or seeking medical tests to confirm that bodily functions are operating normally.
• Rituals Involving Bodily Functions: Engaging in specific breathing patterns, blinking a certain number of times, or swallowing in a particular way to ensure these functions continue normally.
• Mirror Checking: Frequently looking in the mirror to observe certain bodily functions or movements.
• Touching or Tapping: Using touch or tapping certain body parts as a ritual to ensure they are functioning or to ‘reset' a sensation.
• Counting or Timing Bodily Functions: Compulsively counting breaths, heartbeats, or the frequency of blinks or swallows.
• Avoidance Behaviors: Actively avoiding situations that might make their bodily awareness more acute, such as quiet rooms where internal sounds like heartbeat or breathing are more noticeable.

Understanding these specific symptoms and behaviors is crucial for parents and caregivers in recognizing Somatic OCD in their children. It helps in seeking appropriate professional help and providing the necessary support at home. 

Distinguishing Characteristics of Sensorimotor Obsessions

A key feature of Somatic OCD is sensorimotor obsessions, which involve a debilitating awareness of autonomic bodily functions. Unlike general awareness, these obsessions create a fixation on these functions, leading to significant distress and compulsive behaviors.

Somatic OCD Treatment

Treatment usually combines therapy with methods that calm the brain. Supplements for OCD, neurofeedback, PEMF, and nutrition and diet  can all work synergistically with Exposure and Response Prevention (ERP)  therapy.

ERP therapy combines Cognitive Behavioral Therapy (CBT) with exposures and is highly effective, helping individuals to alter their thought patterns and responses to obsessive thoughts.

Somatic ERP Therapy

Exposure and Response Prevention (ERP) therapy, a form of CBT, is particularly successful in treating Somatic OCD. It exposes individuals to their fears (like ignoring a bodily sensation) and prevents the usual compulsive response, thereby reducing the anxiety over time.

Examples of Somatic Exposures in ERP Therapy

Exposure and Response Prevention (ERP) therapy is a cornerstone in the treatment of Somatic OCD. It involves gradually exposing the individual to their feared thoughts or sensations and then helping them to resist the urge to engage in compulsive behaviors. Here are some expanded examples of how somatic exposures can be applied in therapy:

Deliberate Focus with Controlled Response:

• Breathing: A common exercise might involve focusing intentionally on the act of breathing, noticing each inhale and exhale, and then consciously refraining from altering the breathing pattern despite any rising anxiety.
• Heartbeat Awareness: The individual might be asked to sit quietly and concentrate on their heartbeat, learning to tolerate the discomfort and anxiety without engaging in checking behaviors like taking their pulse.

Incremental Increase in Exposure Duration:

• Gradual Extension of Non-Checking: Start with brief periods of not checking bodily functions and gradually increase the duration. For example, if the person compulsively checks their swallowing, they might begin by delaying this check for one minute, gradually increasing to longer periods.
• Scheduled Attention Shifts: Setting specific times to focus on a bodily function, then deliberately shifting attention away for increasingly longer periods, helps in gradually reducing the anxiety associated with non-attention.

Mindful Exposure to Sensations:

• Mindful Walking: Paying attention to the sensation of feet touching the ground, then purposefully redirecting focus to the external environment, practicing staying present without obsessing over the sensation.
• Texture Exposure: Touching different textures and focusing on the sensation against the skin, then practicing letting go of the focus and moving attention to another activity.

Resisting Reassurance-Seeking:

• Refraining from Medical Consultations: For those who seek constant medical reassurance, an exposure exercise might involve resisting the urge to call or visit a doctor for a non-critical concern, slowly extending the time between these reassurance behaviors.

Sensory Overload Exposures:

• Intense Physical Activity: Engaging in rigorous exercise, focusing on the heightened awareness of bodily sensations like sweating or muscle fatigue, then practicing non-response to these sensations.
• Cold and Hot Exposures: Alternating between hot and cold temperatures in showers or baths, concentrating on the body's reaction to these extremes, then working on non-reactive behavior.

Visualization and Imaginal Exposures:

• Visualization of Worst-Case Scenarios: Imagining scenarios where the individual loses control over a bodily function, then mentally working through the anxiety without engaging in physical compulsions

Technological Aids:

• Using Apps or Recordings: Listening to guided meditations or apps that prompt focus on certain body parts or functions, then practicing shifting attention away after a set period.

These somatic exposure techniques are tailored to confront the specific fears and compulsions of the individual with Somatic OCD. By practicing these exposures under the guidance of a trained therapist, individuals learn to tolerate the anxiety associated with their obsessions, gradually reducing their impact and frequency over time.

How Parents Can Help a Child With Somatic OCD

As parents, witnessing your child struggle with Somatic OCD can be both heart-wrenching and challenging. This subtype of Obsessive-Compulsive Disorder, marked by an intense preoccupation with bodily functions, can significantly impact your child's daily life and overall well-being. 

Understanding how to effectively support and guide your child through this journey is crucial. In this section, we will explore various strategies and approaches that you, as a parent, can adopt to help your child manage and cope with Somatic OCD. From fostering a supportive home environment to collaborating with healthcare professionals, we'll delve into practical steps you can take to empower your child and facilitate their path towards recovery and resilience.

• Understand the Disorder: Comprehending the nuances of Somatic OCD is crucial for providing appropriate support.
• Foster Open Communication: Ensure your child feels comfortable discussing their fears and experiences without judgment.
• Pursue Professional Assistance: Engage with therapists skilled in treating OCD, particularly those experienced in ERP therapy.
• Be Patient and Empathetic: Recognize the challenge of overcoming Somatic OCD and appreciate each step forward, no matter how small without accommodating the behaviors.
• Encourage Stress-Reducing Activities: Activities like cooking together and regular exercise can be beneficial in managing anxiety.
• Lead by Example: Demonstrate positive coping mechanisms and non-reactive responses to symptoms.

Additional Considerations in Somatic OCD Treatment

Mindfulness and Relaxation Techniques and Somatic OCD

While mindfulness and relaxation techniques can be particularly effective in managing anxiety and even some forms of OCD, care should be taken in use of these techniques with Somatic OCD. Practices like yoga, deep breathing exercises, and mindfulness meditation can inadvertently reinforce the somatic OCD or my too anxiety producing of an exposure. 

The Importance of a Supportive Environment

Creating a supportive and understanding home environment is crucial. Parents should educate themselves and other family members about Somatic OCD to foster empathy and reduce potential stressors in the home.

Involving the Child in Treatment Decisions

Involving children and teens in their treatment planning can empower them and increase their engagement in the therapeutic process. Psychoeducation about OCD is key in this process. This collaborative approach can make the process of confronting OCD easier.

Citations

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Puranen J. P. (2022). Bodily obsessions: intrusiveness of organs in somatic obsessive-compulsive disorder. Medicine, health care, and philosophy, 25(3), 439–448. https://doi.org/10.1007/s11019-022-10090-3

Stein, D. J., Costa, D. L. C., Lochner, C., Miguel, E. C., Reddy, Y. C. J., Shavitt, R. G., van den Heuvel, O. A., & Simpson, H. B. (2019). Obsessive-compulsive disorder. Nature reviews. Disease primers, 5(1), 52. https://doi.org/10.1038/s41572-019-0102-3

Van Noppen, B., Sassano-Higgins, S., Appasani, R., & Sapp, F. (2021). Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update. Focus (American Psychiatric Publishing), 19(4), 430–443. https://doi.org/10.1176/appi.focus.20210015