The literature of OCD is littered with information about the more famous classical types of this disorder, with repeated descriptions of washing, checking, repeating or worries of doing harm to oneself or others. Sensorimotor obsessions however are based on a preoccupation with normal bodily processes such as breathing, blinking and swallowing. Sufferers become so obsessed with these processes, that they can barely think about anything else. This creates an enormous amount of anxiety as they worry that their selective attention will always be focused on these obsessions. But perhaps there is a way out of this subtle, but infuriating type of OCD. Here I share my story and how I learnt to live with sensorimotor OCD.
What is Sensorimotor OCD?
Sensorimotor obsessions are related to the day to day workings of your body. It could be your breathing, blinking, swallowing or a million other variations. In an article taken from beyond OCD, David J Keuler PHD states that “Sensorimotor obsessions as defined here involve either a focus on automatic bodily processes or discrete physical sensations. Whether technically sensory or sensorimotor in nature, such obsessions share one common precursor: selective attention.” It seems that this selective attention and an unwillingness to experience it is what creates the problem.
A person becomes anxious that they will never be able to stop thinking about the obsession and this leads to a lot of anxiety. What often seems to happen is that the person ends up making matters worse by constantly trying to push the obsession away, which tends to only make the problem worse. Keuler goes on to say that “In a typical scenario, individuals begin to selectively attend to their swallowing, for example, and become anxious that they will become unable to stop thinking about their swallowing. Attempts to distract themselves fail, leading to higher levels of anxiety. This anxiety perpetuates the focus on swallowing, leaving them preoccupied and frustrated.
Common Sensorimotor Obsessions
– Breathing (how your breathing feelings, whether your breathing deeply or shallowly)
– Blinking (awareness of blinking, counting how often you blink)
– Swallowing/Salivation (the regularity of swallowing and how much saliva you might have in your mouth
– Movement of the mouth and/or tongue during speech
– Pulse/Heartbeat (a heightened sense of awareness of the pulse)eye contact (anxiety about how to look into peoples eyes, whether to look at one eye or both)
– Awareness of Specific Body Parts (for example being hyper aware of the mouth, or the sensations of how your fingers touch your other fingers)
How did it affect me?
From my own personal experience of fighting with sensorimotor OCD for many years, it is one of the most infuriating and potentially debilitating subtypes of OCD. I am well aware of what feels like the ´impossible to get away from´ scenarios that it creates. Perhaps the hardest thing about this type of OCD is that you can´t ever get away from it. Your bodily sensations are there with you all the time and if you don´t know how to deal with them effectively, they can bother you ALL THE TIME. OCD is a dirty trickster, hanging out in the dark corners of your mind, waiting for an opportunity to latch on to your thought process
Probably the hardest sensorimotor obsession i´ve dealt with has been hyper awareness of the mouth. I´m not entirely sure why, but from time to time my attention gets fixated on my mouth.
I become obsessed about how my teeth rest against my cheeks, how my tongue touches the palate or about whether my teeth look normal when I smile. I would get so stuck on these thoughts that I would struggle to pay attention to anything else. Social settings would become a nightmare, where I would have to perform a tricky balance between paying attention to the sensations whilst trying to listen to a conversation and smile like I was actually paying attention. More often than not, I would just get drunk and this would often temporarily resolve the issue, only for the anxiety to come back twice as bad the next day. “Hey sucker, i´m here and don´t you forget it”. Nobody had any idea that this circus performance was going on in the inside. I guess people found me to be distant, dreamy or perhaps just drunk.
What makes sensorimotor OCD so tricky?
The major difference between this type of OCD and classical OCD is that it can be really hard to detect the compulsions that you are performing. With hand washing OCD it is pretty damn blatant if you are performing the compulsion or not, but with sensorimotor, the compulsions are in disguise, hence you keep getting stuck in them again and again, even if you are determined not to perform the compulsions. If you don´t know what the compulsions are, then how can you stop yourself from performing them? Janet singer from Psych comments that “those with OCD who suffer from sensorimotor obsessions often find their lives greatly affected. They have trouble concentrating on anything other than their obsessions and might have difficulties socializing and sleeping as well.” So what can be done to help people with this difficult type of OCD.
Treatment for Sensorimotor OCD
Sensoritmotor OCD can be treated quite successfully by breaking the connection between sensory awareness and reactive anxiety. The first thing you would need to do is to seek the support of a professional and tell them about your concerns. Unfortunately, as this type of OCD is rarer, you may come across some therapists who are unaware of it, so you might need to be ready for this. A therapist should work with you so that you can experience the sensory obessions, but without the accompanying anxiety. This is because once a thought is linked with anxiety, the conscious mind will persistently keep it present. This is very much related to an experiment from the late 80´s called ´The White Bear Syndrome´. In the experiment, people are told they are allowed to think about anything other than a white bear and of course they end up thinking about nothing but white bears (Wegner 1989), they have white bears coming out of their ears.
The most common compulsion that is used to reduce the anxiety is to try and forcibly distract your attention onto something else. Unfortunately this doesn´t work and you will end up with even more anxiety enducing white bears coming into your head. A powerful tool in learning to recognize the compulsions and breaking the thought and anxiety link is developing awareness through mindful meditation. It is important to teach people that if they can sit and observe their anxiety without doing anything to reduce it, the anxiety will go down on itself and the sensory obsession will likely pass. Keuler from the previously mentioned article states that “The first stage of treatment focuses on teaching patients that selective attention to previously automatic or unconscious bodily processes or sensations is not dangerous in and of itself. Patients are reassured that once their anxiety dissipates, the sensory awareness will shift.” In addition to this, you could also decide to learn about acceptance and commitmenth therapy, a powerful combination of CBT and mindfulness that helps people to become more aware of their negative habits and to chage them.
This then links directly into the Exposure and Response Prevention (ERP). Dr Steven Seay, a specialist in the treatment of OCD, breaks ERP down into two components: 1) exposure, and 2) ritual. He states that “Exposure involves intentionally confronting situations that you know are likely to increase your fear and anxiety. Ritual prevention involves choosing to sit with your anxiety (without resisting it) and letting go of the unhelpful strategies (rituals) that are maintaining the cycle.” When you first do this, you are likely to feel a lot of fear, but with time and practice the fear will decrease along with the obsessions of bodily sensations.
You may try thought experiments where you purposely try to invite the obsessions in. For example for my mouth obsession I would sit comfortably in my room (always make sure you are somewhere safe if you try this and definitely do not try it when driving) and would then purposely bring all my attention to my mouth, the sensations of the teeth, how my tongue felt, how much saliva I had until I started to feel the anxiety. If you keep doing this, over time you are tricking your brain into thinking that it is ok to feel this anxiety, because you are the one who is intentionally inviting it in. You are no longer trying to run from it. This subtle difference IS the difference and you will begin to notice how by just sitting with the anxiety it will go down on it´s own.
Personally, I was amazed at the difference these techniques made to my life. I felt like sensorimotor OCD was ruining my life and at times I felt pretty desperate. Within a few weeks of applying mindfulness and ERP I noticed a huge reduction in the obsessions. I had been fighting with them years, but suddenly through acceptance and trust in these techniques I started going for days without being bothered by them at all. Please feel free to ask questions and If you would like to discuss this further then drop me a message.