Sensorimotor OCD – When OCD attacks your sense of self…

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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)

With sensorimotor OCD you develop a heightened sense of awareness of automatic body functions such as the heartbeat. This can become distressing becuase the sufferer is often unable to think about anything else.

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.

To break the vicious circle of OCD you need to know what compulsions you are performing and to try and stop doing them. But with sensorimotor OCD this can be quite hard as the compulsions are often difficult to spot.

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.

The Practice of ACT and mindfulness meditation can bring a greater level of calmness to your mind, making you more aware of your thoughts and actions. In turn, this make it easier for you to spot compulsions and to not perform 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.

Conclusion

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.

#ocd #sensorimotorocd #anxiety #breathingocd #mouthocd #swallowingocd #mouthocd

18 Comments

  1. George June 28, 2020 at 7:45 am

    Hi,
    For the past few months I have been going through what I could only describe as conscious breathing. I cant let my breathing happen naturally. I have tried to unlink this compulsion from its anxiety by sitting still and just letting myself consciously breath but no matter how long I sit and observe that nothing bad is happening I cannot get rid of this constant urge.

    Was wondering if you had any advice for a breathing compulsion specifically. It feel its a little different from most as you have to breath constantly so it is quite difficult to remove the anxiety.

    Thanks so much

    Reply
    1. Robert James September 30, 2020 at 8:14 am

      Hi George, this kind of thing can be very frustrating. I dealt with this for a few years and have clients now who have the same issue. The trick is to learn to purposefully tune into the breath in a mindful way. This sounds counter intuitive, but what´s happened is that you have become afraid of the breath. To overcome that, you need to show your brain that you are not afraid of it and to do that you need to start focusing in on your breath and learning about it. It´s not easy but you can overcome this. I´m happy to talk to you about it in more detail if you like.

      Reply
  2. Caroline June 30, 2020 at 1:52 pm

    I’m dealing with blinking awareness and it’s very hard ! I try to accept it, it can work for a moment even for a day but I always come back to the starting point where I’m completely stuck and scared by it.

    Reply
    1. Robert James September 30, 2020 at 8:09 am

      Hi Caroline, yes this is a very common problem with sensorimotor. It can feel like you will never be able to think about something else again, but this simply isn´t true. With time and practice, you can use things like ACT to help you to overcome this. If you would like to know more, then feel free to send me a messaqge 🙂

      Reply
  3. Mohammed Ismail October 1, 2020 at 5:32 am

    I am suffering from breathing OCD .
    Its like i am dying .
    I dont know what to do
    Please help.

    Reply
    1. Robert James October 7, 2020 at 7:46 am

      Hi Mohamed, i´m sorry to hear that you are struggling with this. You need to practice breathing more slowly. Have you been to see you doctor? I highly reccomend that you do this. If you can practice some slow breathing techniques, then that will also help. If you have more questions, then please let me know.

      Reply
  4. Marine October 6, 2020 at 9:20 pm

    Hello, I’m suffering from various obsessions and the ones I have at the moment are about my breathing and face area (especially lower jaw and chin). I know that the second one may sound a little strange, but the thing is that, when I control my breathing, I tend to “constrict” the passage of air (in my nose and throat areas). Consequently, when I breathe, it almost feels like i’m breathing “with my face” (I hope you understand what I mean by that!).
    For example, because I’m controlling my breathing through my nose and throat (I don’t let the air go through freely, in other words), my face gets really tense everytime I exhale. And for this reason I sometimes have trembling feeling on my chin because it gets so tense. I even have neck spasms when I finish exhaling (right before I automatically inhale) and very strange head tension because of that control I make.
    The problem is that I don’t even feel anxiety or panic regarding the breathing obsession. I’m so used to it (been going on (on and off) for three years) that it doesn’t scare me anymore. But it makes me sad and deeply angry. And because it has real physical consequences (face tension), I don’t know how I can make it stop. I mean, I feel like i’ve habituated my brain and my body to these sensations. What should I do ? I don’t feel like ERP can do anything since I don’t feel panic or tremendous fear when I’m aware of my breathing. I just feel extremelly helpless and upset.
    Thank you !

    Reply
    1. Robert James October 7, 2020 at 7:42 am

      Hello Marine, yes i can imagine this must be very difficult. With this, i think it´s important to remember that fear can take on disguises. For example, anger is ultimately a form of fear. So although you may not be experiencing this as fear, deep down there is probably some feqr involved. What you need to do in my opinion is learn some proper breathing techniques and practice them for 5-10 mintues each day. You need to slowly retrain yourself to breathe in a more relaxed way. I think you would also benefit from working on the mindset and the anger that you have built up around this. You can definitely do this, it just takes time and practice. If you like, I offer a free phone call, so i´d be happy to talk to you about this in more detail.

      Reply
  5. Michael October 13, 2020 at 6:51 pm

    Hi Robert,

    I have OCD that feels like itching on the skin of my throat.
    How would ERP for this subtype of OCD look like, according to you?

    Thank you!

    Reply
    1. Robert James October 15, 2020 at 6:40 pm

      Hi Michael,

      You need to do your best to avoid scratching or itching it, that in itself will be an exposure. You could also try imaginary exposures.

      Reply
  6. Neca Rosales November 1, 2020 at 5:51 am

    Hello I’ve had breathing OCD since 2016 but I was able to forget about it at times because I got distracted with school and social life. Now, I’ve started to think about it every minute again. I’ve been looking at a lot of articles and started trying ERP by myself. I would just like to ask some advice on how I should do it? Most self-help books don’t really tackle sensorimotor OCD.

    Reply
    1. Neca Rosales November 1, 2020 at 9:39 am

      When I think of breathing I manually breathe sometimes I think I will never stop thinking of breathing again and will manually breathe forever. Sometimes I also think that If I don’t breathe manually I will die from not breathing. So what should my approach be in exposure? Do I hold my breath?

      Reply
      1. Robert James November 1, 2020 at 12:44 pm

        Hey, I just replied to your previous message.

        Reply
        1. Neca Rosales November 5, 2020 at 7:04 am

          thank you for replying. I have read in forums that acceptance is key and I think this relates closely to what you are saying.

          Reply
    2. Robert James November 1, 2020 at 12:43 pm

      Hello Neca, you need to learn to be comfortable with both concious and unconcious breathing again. To do that you need to purpsodefully tune into the breath. You can do this through meditattion, deep breathing practices, the Wim Hof method etc. In addition to this, you can purpsoefully keep bringing your breath to your attention throughout the day. Like this you are no longer running from this fear and facing it head on. When you keep doing this, you giving your brain the message that ypu don´t care about concious breathing and the problem with it will hopefully start to fade.

      Reply
  7. Tessa Juliet November 2, 2020 at 3:39 pm

    Hello, i have been suffering from breathing OCD for the past year now and my anxiety with it got so bad that I couldn’t drive even for 5 minutes because I thought I couldn’t breathe in such small space as a car. In the summer it got much better but now in the second lockdown it’s getting bad again and I don’t want to fall in to the intense anxious period like i did last winter again. I am very afraid that this sensation won’t ever go away and i feel like i will never be able to travel (because i would have panic attacks on a plane), which was my biggest passion in life 2 years ago. I try to think about breathing without anxiety and sometimes i am successful but mostly not. What should i do? I would be extremely happy if you could help me, I cannot live like this anymore it’s ruining the quality of my life!

    Reply
    1. Robert James November 4, 2020 at 8:11 pm

      Hi Tessa,

      Thanks for reaching out. It often feels with sensorimotor like the sensations are never going to go away, this is just what the OCD does. If you can learn to move towards these obsessions and explore them, they may start to become less severe. If you like, i´m happy to chat to you about this over skype?

      Reply
  8. Lee Hedges November 20, 2020 at 8:27 am

    Hi Richard

    In the last 2 months I’ve had the swallowing, which turned to breathing and now blinking!! I’ve been through a highly anxious traumatic time due to death of a loved one. Which I believe has triggered this. I’m currently receiving help from a hypnotherapist/psychotherapist and taking and SSRI which has helped with my anxiety greatly. I would love to have a Skype session or a reply from you recommending how I stop this conscious blinking. ERP or ACT?? Thank you in advance and to fellow sufferers you aren’t alone 🙂

    Reply

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