Somatic compulsions in Obsessive-Compulsive Disorder (OCD) involve repetitive behaviours or mental rituals related to concerns about bodily sensations, health, or physical well-being. Individuals with somatic checking compulsions may be preoccupied with the fear of having a medical condition or experiencing harm to their body, or distressed by relentless attention on ordinarily bodily sensations such as breathing or swallowing, fearing these bodily functions have become wilful rather than automatic, or that they may stop breathing if they do not manually make the effort to do so. Here are key aspects of somatic obsessions & compulsions:

 

1. Somatic Obsessions:
 

a. Health Concerns:​ Individuals with somatic checking compulsions often experience intrusive thoughts or fears about their health. These thoughts may involve worries about having a serious illness, experiencing physical harm, or developing symptoms.
 

b. Catastrophic Thinking: Obsessions may include catastrophic thinking about the potential consequences of a perceived health issue, or that they will stop breathing or swallowing if they do not monitor and manually attempt to breath or swallow. They may also catastrophise that every moment will be ruined by their symptom or awareness of it, and ruminate about the fact that they cannot lose awareness of their bodily sensations, creating a self-fulfilling loop of attention where the thoughts cannot leave on their own. Some individuals with sensorimotor OCD may fear losing control over their bodily functions or movements, leading to heightened anxiety and efforts to prevent any perceived loss of control.
 

c. Hyperawareness of Bodily Functions:​ Hypervigilance refers to excessive attention to bodily sensations or changes, with heightened sensitivity to any perceived abnormalities. Individuals may be hyperaware of minor discomforts or fluctuations in physical sensations. Individuals with sensorimotor OCD experience intrusive and distressing obsessions related to bodily sensations. These may include a heightened awareness of bodily functions, discomfort, or abnormal sensations.

 

Obsessions may involve concerns about the appropriateness or "rightness" of bodily movements. For example, individuals may fear that their walking, blinking, or other movements are not normal or may be observed critically by others. Individuals may obsessively focus on the "correctness" of their movements and engage in repetitive rituals to ensure that their actions are performed in a specific way.​

 

Sensory Hyperawareness: There is often an increased sensitivity or hyperawareness of normal bodily functions, such as breathing, swallowing, or heartbeat. This heightened awareness can lead to increased distress and preoccupation.Individuals may experience hyperawareness of bodily sensations, such as the feeling of clothing on the skin or the sensation of internal organs, leading to compulsive behaviours to alleviate discomfort.

 

Fear of Choking: Individuals may obsessively fear choking on food or liquids, leading to avoidance of certain foods or rituals such as excessive chewing.​

 

Breathing Concerns: Obsessions may revolve around the fear of not breathing properly or being overly aware of one's breath, leading to rituals like deep breathing exercises or constant monitoring of breathing patterns.

 

Swallowing Anxiety: Fear of swallowing difficulties or choking may result in rituals like repeated swallowing or avoidance of certain foods or textures.
 

2. Somatic & Sensorimotor Compulsive Behaviours:
 

a. Mental Compulsions: The predominant compulsions in this form of OCD are often engaging in mental rumination about their symptoms, attempts to block out thoughts related to their awareness of their symptoms, scanning their bodies for sensations, ruminating over the fact that they cannot stop being aware of their bodily sensations, trying to distract from their awareness of the symptoms, thought suppression attempts leading to a paradoxical rebound of their awareness of the symptoms.

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b. Frequent Medical Checks:​ Engaging in frequent medical check-ups, doctor visits, or health-related appointments to seek reassurance or confirmation of one's physical well-being.
 

c. Self-Examination: Excessive self-examination or monitoring of the body, such as checking for lumps, bumps, or changes in appearance. This behaviour is driven by the need to confirm the absence of a perceived health issue.
 

d. Online Health Research: Compulsive searching for health information online to validate or invalidate concerns. Individuals may spend significant time seeking reassurance through medical websites, forums, or articles.
 

e. Temperature and Pulse Checks:​ Frequent checks of body temperature, heart rate, blood sugar levels, or other physiological measures to ensure they fall within a perceived normal range. Individuals may monitor these parameters excessively to alleviate anxiety.
 

f. Avoidance of Triggers: Avoidance of situations or activities perceived as potential health risks. Individuals may modify their behaviour to reduce the likelihood of experiencing physical harm or triggering health-related anxiety. Individuals may avoid situations that trigger distressing sensations, or mental avoidance of their thoughts in attempt to block their interoceptive awareness.
 

3. Impact on Daily Life:
 

a. Interference with Daily Activities: Somatic checking compulsions can interfere with daily activities, work, or social engagements as individuals dedicate significant time and energy to checking behaviours. It may create distress, and impair the individuals ability to engage with previously enjoyable activities due to the obsessive focus on their unwanted bodily sensations or unwanted awareness of ordinary bodily functions. 
 

b. Anxiety and Distress: The constant need for reassurance and checking behaviours can lead to heightened anxiety and distress. Individuals may struggle with persistent worries about their health despite repeated reassurance. Somatic checking compulsions contribute to health anxiety, where individuals are preoccupied with fears of having a serious illness or experiencing physical harm.