Your Guide to Sensorimotor OCD

This article will take you through all you need to know about what sensorimotor obsessive compulsive disorder (OCD) is and how it can be treated.

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What is sensorimotor OCD?

Let’s get started with the basics: sensorimotor OCD is a type of OCD categorized by obsessions which focus on bodily sensations. The word sensorimotor is defined as, “of, relating to, or functioning in both sensory and motor aspects of bodily activity.” You might also hear this type of OCD referred to as somatic OCD, as the word somatic simply means referring to the body. We’ll use the two terms interchangeably: they both mean the same thing.

The International OCD Foundation explains that, “Sensorimotor obsessions as defined here involve either a focus on automatic bodily processes or discrete physical sensations.” Essentially this type of OCD causes you to focus on bodily processes which would normally be unconscious. If you struggle with this type of OCD, you will find it nearly impossible to draw your attention away from these bodily functions. This might include things like breathing, swallowing, and your heartbeat: we’ll go into more detail on types of sensorimotor obsessions later.

Once you are so focused on one of these bodily processes, it consumes your attention and can become extremely distressing. You may begin to fear that something is wrong with your body or that your body isn’t functioning normally. For example, if you’re focusing on your breathing, you might worry you’re breathing too fast or too slow, and that this indicates something seriously wrong with your body.

As well as fears that something is wrong, you might find yourself fearing that you are never going to be able to stop noticing this bodily process (breathing in our example). This article aptly explains: “Fears center mainly on the concern that automatic bodily processes or physical sensations will fail to return to their previous unconscious state, thus forever ‘driving the sufferer crazy.’”

Just as with other forms of OCD, obsessions lead to heightened emotions and anxiety which are very distressing for the individual. Likewise, you will then feel compelled to do something to ‘cope’ with these fears and lessen your anxiety. This is when compulsions come into play.

Compulsions in sensorimotor OCD can focus on trying to take your attention away from your obsessions, or trying to ‘prevent’ something bad happening as a result of them. Unfortunately, compulsions only alleviate anxiety for a short time. It will come back, and is often stronger when it does. This leads you to carry out more compulsions to try to cope. This is the vicious cycle of OCD.

It’s common for sensorimotor obsessions to be related to other types of obsessions, in particular health related obsessions or sexual obsessions. Those with health related obsessions often fear becoming unwell or something being wrong with their body. Since they are so focused on these intrusive thoughts and fears, they may start to scan their body for signs that their health obsessions are true, or for reassurance that they are not true. It’s common for them to become hyper aware of everything their body is doing, which only fuels their health obsessions and leads to sensorimotor obsessions.

Someone with sexual obsessions may find themselves scanning their body for signs of sexual arousal when they are in situations which trigger their obsessions. For example, someone with pedophilia obsessions who is visiting their family who have children, may find themselves checking for any physical signs that they are attracted to the children (such as a groinal response). It’s important to remember that these obsessions do not reflect their true feelings or indicate risk: they are intrusive thoughts like any other in OCD.

Someone who struggles with obsessions centered around perfectionism and order may also develop somatic obsessions as their hypervigilance and need for everything to be perfect in their environment takes over. It’s important to note that although sensorimotor obsessions can occur as a result of (or alongside) other types of obsessions, they can also occur on their own. Either way, they can be very distressing.

How does sensorimotor OCD affect an individual?

As we’ve mentioned, being constantly aware of a bodily process can be very uncomfortable and upsetting. It can evoke fears and anxiety that this is never going to stop. It can feel impossible to fully focus on anything else, whether it’s work, a conversation with a loved one, or even doing something you enjoy like watching TV or exercising. This can lead to problems with daily functioning, problems at work, issues with keeping up with self-care, and even tense relationships with others.

When others aren’t able to see what you are going through, they may struggle to understand why you are not engaging socially or paying attention to what they’re saying. This can lead to the individual with OCD withdrawing socially to avoid upsetting others. Unfortunately, social isolation can cause low mood and worsen anxiety.

Some people may struggle to even try to direct their attention elsewhere. They may feel driven to give their full and complete attention to their obsession, so anything that tries to take their attention away from this should be avoided. They might fear what will happen if they don’t pay enough attention to their obsession.

As well as causing issues functioning, it can be extremely difficult for someone with these obsessions to fall asleep at night. At night when things are quiet and there are far fewer distractions in our environment, it’s natural for our thoughts and our problems to seem ‘louder’ and harder to ignore. The same applies to these somatic obsessions: they can become even more present and harder to ignore. When you’re in this tense, anxious state, it can be extremely difficult to relax enough to sleep.

Sensorimotor obsessions

We’ll cover some of the more common sensorimotor obsessions and how they can be experienced by an individual. However, it’s important to remember that there are many potential sensorimotor obsessions and since we’re all individual, our experiences can vary greatly.

As we’ve mentioned, a great deal of fear and anxiety surrounds these obsessions. You might have intrusive thoughts that if everything was ‘normal’ and there was nothing to worry about with this bodily process, then you wouldn’t be so aware of it. These feelings and fears are a pivotal part of all of each of these obsessions.

Breathing

Excessive attention to breathing is a very common somatic obsession. An individual with this type of obsession may be hyper aware of the sensation of their breathing, for example how it feels when they breathe in and out. They may take notice of how their body reacts, such as their chest rising and falling as they breathe.

If you struggle with focusing on breathing, you may notice how frequently you breathe in and out. You may have a specific idea of how you should be breathing, for example aiming for a specific number of breaths per minute. You might notice how deep your breaths are, or conversely if your breathing seems or feels shallow. You might have fears running through your head, such as ‘what happens if I’m not breathing regularly enough?’, ‘what if I’m not getting enough oxygen?’, or ‘what if I just stop breathing?’.

Blinking

If you are hyper focused on blinking, you may take note of how often you blink. You may be aware of how fast or slow you are blinking. You may take notice of how blinking feels, for example the feeling of your eyelashes on your skin as your eyes close and then open. You may even be so tuned in to this experience that you are noticing any sound which is made when you’re blinking. You might have intrusive thoughts which make you fear whether you’re blinking ‘correctly’, or whether you’re going to hurt your eyes by blinking too fast or too slow.

Swallowing

If you’re focused on swallowing, you may be paying attention to how it feels when you swallow, whether it’s swallowing food or drink, or just swallowing in general. You may notice how it feels when food slides down your throat, and even notice any noises or patterns in your swallowing which occur.

You might pay attention to how regularly you swallow when you’re eating. You may also take notice of how often you swallow during the day, even when you aren’t eating or drinking. You might fear what will happen if you don’t chew your food well enough before you swallow, for example fearing choking. You may pay attention to how much saliva is in your mouth, along with when it increases. You might fear that there is too much saliva, or not enough, and that this will cause harm.

Pulse and heartbeat

You might be excessively aware of your pulse and heartbeat, for example noticing how fast or slow your heart rate is. You might feel the urge to constantly check and count your heart rate. You may pay attention to how your heartbeat speeds up or slows down in specific situations, such as in reaction to stress, when you’re exercising, or in reaction to other obsessions.

You might notice how your heartbeat feels or even sounds. You may have fears such as your heart stopping beating, or what would happen if it beats too fast or slow. You may be focused on whether your heart is beating ‘in the right place’, or whether it skips a beat. These fears tend to be amplified at night when there are no other distractions.

Movement of mouth and tongue

It’s common to pay excessive attention to the movement of your mouth and tongue. This might be when you’re talking or eating: you might be constantly aware of the position of your tongue within your mouth and how it feels when it moves. You might worry about the position of your mouth and how it appears to others. You may fear that you will choke when eating if your tongue is not moving in the right way. You might worry that you are not pronouncing words properly, or that you are not in full control of your mouth and tongue while talking.

You might also be constantly aware of the position of your mouth and tongue when you aren’t talking or eating. You might be aware of how your tongue feels in your mouth, where it sits, how big it is, and whether it moves when you are going about other daily activities.

Eye contact

This is a separate concern than a social anxiety based on eye contact. Instead it’s an awareness of the act of eye contact itself. It may be awareness of how long eye contact is held with another person, or how frequently eye contact is made. It may be an awareness of which eye you are making more eye contact with, along with how the eye contact feels physically.

Specific body parts

This can be awareness of any body part at all and can vary greatly depending on the individual. It might be awareness of your limbs, such as how they move and how they feel. It could be awareness of your nose, seeing it in your line of vision everywhere you look. It may be awareness of your hands, such as how they move and how they feel when they touch different surfaces. The list goes on.

You may also be aware of a specific body part in relation to another obsession. Going back to the sexual obsessions we mentioned earlier, you may be very aware of any groinal response in triggering situations.

Visual ‘floaters’ or disturbances

Visual ‘floaters’ can be defined as, “the particulate matter that is drifting within the eye that is most visible when staring at a blank wall”. They can appear as spots, specs, colours, or even strings which are present in your field of vision. Once the individual with OCD is aware of them, as with the other obsessions, it can be impossible to draw their attention away from them.

Some people may also become aware of very small, subtle eye movements known as saccadic eye movements. These movements tend to be jerky and abrupt. They can vary from small eye movements such as when you’re reading a book, or larger eye movements such as your eyes scanning a room. You may worry about what these eye floaters or movements mean. You might take notice of how often they occur and how they change, and fear that they could indicate something wrong with your vision.

Posture and positioning of limbs

You may be very aware of your posture, for example how you sit or how you hold yourself when you walk. You may worry that a hunched posture indicates something is wrong. You may be concerned about what your posture suggests about you and your physical and mental health. It’s possible that you will feel the constant urge to adjust your posture to a more pleasing position.

Some people also become very focused on how their body parts are positioned along with this, such as where your legs and arms are placed when you’re sitting down. You might also pay very close attention to how your limbs move when you’re walking or carrying out another daily activity. It’s possible you will even notice sounds that your limbs make as you move, such as creaking of joints. This can increase fears about whether something is wrong.

Feeling of clothing on skin

Some people with somatic obsessions become very focused on the feeling of clothing on their skin. They may be conscious of how their clothing moves and feels every time they move. They may be aware of every seam and button. They might be very conscious of how their clothes fit. They may even notice sounds their clothes make when they’re moving.

Bladder and bowel

You might be very aware of the pressure in your bladder and bowel, and how they feel at any point in the day. You might be constantly looking for signs that you need to go to the toilet. You might pay close attention to your toilet habits and be aware of any changes. You may also keep track of any patterns in your toilet habits.

You may worry that any pain you feel or any toilet habits which are different than your normal, indicate something is wrong. You may fear not making it to the bathroom when you need to go. You may worry about what every twinge or feeling means.

Hunger

Some people with somatic obsessions may focus on feelings of hunger. They may feel the urge to constantly check how much they’ve eaten and when, to see if how hungry they feel ‘lines up’. If you struggle with this, you may be constantly evaluating your level of hunger and looking for signs that you are hungry or full. You may be very conscious of how your food feels inside your body once you’ve eaten it, and how quickly you feel full afterwards.

Itches and minor pain/injuries

Some people may become very aware of every itch or twinge within their body. Even normal aches and pains may evoke a feeling of fear and panic. A normal injury, such as a papercut or stubbed toe, could feel like a significant event. You might be concerned that these smaller events indicate something more serious being wrong.

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Sensorimotor compulsions

Now we’ve taken a look at the obsessions which often come with sensorimotor OCD, it’s time to take a look at the compulsions. Many of these compulsions focus on distraction or finding evidence that you will not always have this hyper awareness of their bodily functions. This article from the California OCD and Anxiety Treatment Center explains that: “Compulsions are an attempt to regain the confidence that everything will be ok, that the attention to these thoughts and sensations won’t ruin their life, and that these thoughts will eventually go away permanently.”

Many people, including the individual with sensorimotor OCD as well as others from an outside perspective, can make the mistake of thinking that compulsions aren’t carried out with this form of OCD. This is because many of the compulsions are done mentally, meaning within the individual’s head. You might also hear this referred to as covert compulsions. They aren’t able to be observed from an external perspective. However, all forms of OCD involve both obsessions and compulsions. Mental compulsions are just as debilitating as physical (or overt) compulsions.

Just as with the obsessions, compulsions can vary greatly. Each compulsion may be experienced differently by each individual. Compulsions tend to take up a great deal of time and can interfere with daily functioning. All compulsions are valid, so don’t worry if you don’t see your compulsion here.

Distraction

Trying to distract from somatic obsessions is possibly the most common compulsion with this type of OCD. The type of distraction used can be literally anything. It could be doing intense exercise to keep your mind busy and worn out. It could be throwing yourself into work so you don’t have time to think about anything else. It might be trying to drown out the thoughts with loud music. It could be focusing on another problem in your life to stop your mind from wandering back to your obsession. The list is endless.

While distracting yourself might seem like a good coping strategy, it’s only masking the problem rather than dealing with it. The anxiety and focus on your obsession will come back at some point, and it will often be stronger when it does. In fact, this distraction actually reinforces to the brain that these obsessions should be feared, actually strengthening the OCD cycle. This article explains: “Instead of treating the thought and sensation as neutral and harmless, sufferers reinforce the feared association by treating the thought as something worthy of fear.”

Avoidance

Avoiding obsessions is very common compulsion, even in other forms of OCD. With somatic obsessions, the individual will often go out of their way to avoid any situation or environment which might increase their awareness of their obsession. For example, if you are focused on eye contact, you might avoid social interaction.

Likewise if you struggle with swallowing obsessions, you might avoid eating as much as possible. If your obsessions focus on the feeling of clothes on your skin, you might avoid buying or wearing clothes which could aggravate this awareness. As with the distraction compulsions, avoidance actually feeds into the OCD cycle.

Counting

You may find that you are counting the amount of times a bodily process occurs. For example, you might count the amount of times you breathe in and out within a minute. If you are focused on blinking, you might count how many times you blink each minute, and so on. You might feel driven to count to ‘ensure’ everything is normal. You might feel that counting these occurrences prevents something bad from happening as a result of your obsessions.

Some people might find that they have ‘lucky’ numbers they favour. They may try to match these lucky numbers, for example swallowing or blinking a lucky number of times. Similarly, they may have ‘unlucky’ numbers they want to avoid. If while counting they notice their obsession matches an unlucky number (such as breathing in and out an unlucky number of times), they may fear that something awful is going to happen as a result.

Measuring and monitoring

As well as counting, you might focus on measuring and closely monitoring your bodily functions. For example, if you have obsessions around hunger, you might closely monitor when you’re hungry, how hungry you feel, and what this is in reaction to. You might meticulously keep track of what you eat. Alternatively if you have an obsession with bowel movements, you might keep track of whether they were normal, how regularly they occurred, and how they felt.

Some people may keep note of these details, or simply monitor them in their head. You may be driven to keep close track of these things to ‘ensure’ you notice if something is wrong, or to reassure yourself that everything is normal.

Rumination

Since an individual with this type of OCD is already so hyper aware as part of their obsessions, rumination is common. Rumination refers to excessively focusing on an intrusive thought along with the feelings, sensations, and memories revolving around it.

Seeking reassurance

You might find that you are seeking reassurance from others, whether it’s loved ones or medical professionals. You may ask for reassurance that this hyper awareness is normal, or that it will go away. You might also seek reassurance that nothing is wrong with your body, and that your bodily functions are normal. This article on the topic states: “Some sufferers will see a long line of doctors to figure out if there is actually anything wrong with their bodily functioning.”

Looking up symptoms

Some people might be driven to look up their symptoms or seek information about the bodily function they are focused on. They may spend a great deal of time seeking and gathering information, whether online, in books, or watching videos. If you struggle with this compulsion, you may be seeking reassurance that everything is normal.

Mental checking and reviewing

It’s common to repeatedly mentally check to see whether a sensation still feels the same. You might also mentally check whether a bodily function still sounds the same, or is still happening in the same way. You may check to see whether it ‘feels normal’. You might also mentally check to see whether this hyper awareness is still present and whether you still find it emotionally distressing.

You may review past memories to prove to yourself that nothing is wrong with your body. By looking to the past, you may be actively seeking evidence that the bodily process you’re focused on was normal previously, to reassure yourself that everything is ok now.

Physical checking

As well mentally checking, you may also physically check that a bodily function ‘feels ok’. You might do this by actively carrying out the function where possible, by feeling your body as the function is carried out, or by visually checking for signs that things are ok. For example, you might deliberately breathe in and out deeply to ensure that your breathing is as it should be. You might also put your hand on your chest so you can physically feel your chest expanding as you breathe. You may also raise your hands to your mouth to feel your breath on your skin.

Repeating

If you struggle with repeating compulsions, you might actively repeat a bodily process over and over again (such as deliberately blinking, swallowing, or breathing in and out). You may do this a specific number of times or in a specific, ritualized way. You might fear that if you don’t do this to the exact rules your OCD has set out, that something terrible might happen.

Thought neutralization

When an obsession comes to your mind or you begin to feel fearful, you might try to neutralize your negative thoughts and feelings. It’s common to try to actively think of something positive, to try to ‘cancel out’ the negative thought.

Prayers and mantras

Someone who engages in this compulsion will repeat prayers or mantras, either out loud of within their mind. This might be to try and distract themselves, to ease fear and anxiety, or to ‘prevent’ something bad happening.

Wishing

Someone people might compulsively wish that their fears and this hyper awareness would go away. This becomes so repetitive that it reinforces the importance of the obsessions, and therefore feeds into the OCD cycle.

Treatment for sensorimotor OCD

While sensorimotor OCD is very difficult to live with, it’s important to remember that there are effective treatments which can help you to get your life back. If you’re struggling with sensorimotor symptoms, it’s vital you reach out for help. You can access treatment through your doctor or mental health professional, privately, or through online OCD therapy.

There are a wide range of treatments which can be effective for sensorimotor OCD. We’ll take a look at some of the most common, primarily recommended treatment options.

Psychoeducation

The aim of treatment for this type of OCD is to break the association between awareness of bodily processes and high anxiety. This article from the International OCD Foundation explains: “Sensory obsessions can be treated quite successfully by decoupling any sensory awareness with reactive anxiety.” This means that you must experience hyper awareness without it evoking anxiety.

This takes a lot of work, but is possible and very successful. The first step towards this goal is psychoeducation. This teaches patients that the awareness in itself is not going to harm them. During this stage you’ll learn that it’s the anxiety that causes the distress, rather than the awareness. You’ll be taught that once you’re able to ease that anxiety, the awareness will fade away. This provides a good basis for the next stages of therapy.

Exposure and Response Prevention (ERP)

ERP is a form of cognitive behavioural therapy (CBT). It’s the primary line of treatment for all forms of OCD. Through ERP you learn to face your obsessions without reacting with compulsions, therefore breaking the cycle of OCD. This is done in a gradual, manageable way under guidance.

In the case of sensorimotor obsessions, patients are asked to actively allow themselves to focus on their awareness of bodily functions, without trying to distract from it or avoid it. You’ll be guided through allowing this awareness to come to the forefront of your mind, and just experiencing it without reacting with a compulsion. Over time, the anxiety in reaction to the hyper awareness will fade, as will the awareness itself.

Acceptance and Commitment Therapy (ACT)

ACT is sometimes used alongside ERP to treat sensorimotor OCD because it’s methods teach patients that thoughts are just thoughts: they don’t have to lead to actions or ‘mean’ anything. Through ACT you can learn to accept your awareness as it is, and understand on a deeper level that it’s not going to hurt you.

You can learn to let this awareness and your intrusive thoughts pass you by, without attaching meaning to them. Over time, this will decrease awareness and the accompanying anxiety. This article states: “When the awareness of triggering sounds, sights, or sensations are accepted as simply the result of the brain and nervous system perceiving the world, then they can be disconnected from their feared story.” ACT then helps you to commit to more positive coping strategies for your anxiety going forward.

Mindfulness

Mindfulness is about being present in the moment, encouraging a state of relaxation. Mindfulness can also be defined as, “the art of paying close attention to an experience in the absence of criticism, judgment, or defensiveness”. This state of calm and non-judgement can be very useful when treating sensory obsessions. It can be used in conjunction with ERP to encourage patients to experience their awareness without attaching any feeling or emotions to it.

Mindfulness can also ease stress and anxiety in general, and help patients to sleep more restfully. Mindfulness practices might involve guided meditations, guided visualization, breathing exercises, or mindful movement for example. Once you learn the skills of mindfulness, you can also practice in your own time to continue managing your anxiety and gaining the benefits of relaxation in the long term.

One of the primary ways mindfulness can be used to treat sensory obsessions is through a mindfulness process called a body scan. This involves being guided into a calm state, either sitting or lying down in a comfortable position. Once you’re relaxed, you’ll be guided through actively focusing on each area of your body and deliberately focusing sensory awareness on each area. As you move through different areas of your body, you’ll learn that you can actively control your awareness and shift it, rather than allowing it to control you. This article summarizes the aim of this practice aptly: “Patients learn that they can move gently from one sensation to another without getting “stuck” by focusing and refocusing in the absence of anxiety, apprehension, or active attempts to force a shifting in awareness.”

References

David J. Keuler, PhD, (2011), “When Automatic Bodily Processes Become Conscious: How to Disengage from “Sensorimotor Obsessions”” International OCD Foundation.

The California OCD and Anxiety Treatment Center, (2020), “Hyperawareness and Sensorimotor OCD”.

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