Can OCD make you feel physically sick?

We all know that OCD can be very sneaky. It can latch onto any thought, feeling, or urge that pops into your brain unwanted. But did you also know that it can attach itself to bodily sensations as well? 

OCD can take the most mundane, normal feeling and make it feel like you’re experiencing a major crisis—and physical feelings are no exception. In fact, when OCD causes people’s fears and worries to spiral out of control, it’s not uncommon for them to actually feel as if they’re physically sick. Here’s how that works.

The mind-body connection

It has often been said that what affects the mind affects the body, and vice versa. People with OCD focused on health anxiety may report feeling unsafe in their own bodies, constantly staying vigilant, on the lookout for any abnormalities in their health so that they can prevent illness. They are in a constant state of anxiety about what the future of their health may hold. 

You might assume that the root is a fear of death and suffering. No one wants to suffer or get sick. But even deeper than these fears is the fear of uncertainty. How can anyone really know whether or not what they are experiencing isn’t indicative of something much more serious? How can we ever feel sure enough that what we’re dealing with is just a cold and not something more sinister? No amount of reassurance, even from doctors, is enough—OCD will always whisper but what if it’s something else? What if I gave them misleading information? What if I wasn’t clear enough? Did I really say that? Maybe I left out a key symptom.

Signs of health anxiety in OCD

People with these types of obsessions will often report spending large amounts of time scanning their bodies for any irregularities or checking for anything that feels unusual. They may even have other family members assist in this process, requesting or sometimes demanding reassurance about their worries. They may spend time looking in the mirror at any scar or bump, fearful that it might be the start of something much more serious. They may proceed to look at photos from others online, trying to find out if what they have is something dangerous. Countless hours may be lost to online research about symptoms. 

As with so many subtypes of OCD, reassurance from online research isn’t enough. Worries and anxieties surrounding one’s health often lead them to call their doctor, sometimes even scheduling multiple appointments within weeks. Even after being reassured by their doctor that they have nothing to worry about, they doubt the reliability of the diagnosis. No doctor is perfect, right? So their worry and doubt only continues to grow. They might seek out second or even third opinions from multiple providers, and even visit urgent care rooms. The financial cost can be daunting, and living in a constant state of stress about being ill can make one truly feel as if they are physically ill.

I am reminded of the “pink elephant” thought experiment. If I ask you not to think about a pink elephant, what will you think about? A pink elephant, of course. It can be the same with bodily sensations: the more I draw attention to them and check for even the slightest sign of them, the more I will feel them. If I am constantly worrying about having a heart attack I will likely notice anything that happens surrounding my heart rate or the mildest sensations in my chest. In turn, feelings that I interpret as signs of a health issue grow stronger as my anxiety continues to mount.

Health anxiety fears can attack any area of a person’s health, and it’s common to see people develop obsessions about mental illnesses, as well. OCD can fill people with all sorts of doubts about their mental health: Did I really hear that just now? What if I have schizophrenia? I usually have more of an appetite for that kind of food. Do I have an eating disorder? 

Doubts like these can cause people to be hyper-aware of their state of mind. For example, someone who’s afraid that they may have schizophrenia may then ruminate about all their intrusive thoughts—was that a thought or an actual voice? They may also ask others around them whether something they saw was real. Someone who’s afraid of having an eating disorder may pay extremely close attention to their hunger cycles: Am I really hungry? What if I really don’t want to eat? Does this mean I have an eating disorder? 

It’s important to remember that no matter what an intrusive thought is about, the real problem is the belief that you cannot tolerate the uncertainty surrounding it, that you can’t handle the distress that it may cause. This is the most powerful lie that OCD tells. In reality, you can tolerate discomfort, doubt, and uncertainty—even about your own health. And if you have OCD, there’s a specific form of treatment that can help you develop those skills.

ERP can help with health anxiety 

If you’re struggling with OCD that focuses on your physical sensations and doubts about illness, it’s important that you learn to sit with the anxiety that those feelings bring. With the right guidance and practice, you can learn to accept that these sensations may seem louder to you than they do for others, and that’s okay. Even when you become aware of your doubts or worries, you can still control how you respond to them, and that’s how you can loosen OCD’s hold on your life.

Learning to manage OCD by gaining control over the way you respond to distress and uncertainty is how exposure and response prevention (ERP) therapy works. ERP is considered the gold standard for OCD treatment and has been found effective for 80% of people with OCD. The majority of patients experience results within 12-25 sessions. When you’re doing ERP with a trained OCD specialist, you work with your therapist to confront your fear, doubt, and uncertainty head-on, without resorting to compulsions like online research, body checking, or calling your doctor. Instead, you intentionally sit with the anxiety and uncertainty you feel, and you begin to rely less and less on the short-term relief and reassurance that comes from compulsions.