Sensorimotor OCD

What is sensorimotor OCD?

In sensorimotor OCD, attention becomes fixed on automatic bodily processes or sensory experiences. English terms include sensorimotor OCD, sensorimotor obsessions and hyperawareness OCD.

The focus may be on breathing, swallowing, blinking, heartbeat or tongue movements. It may also centre on the field of vision, the sound of one’s own voice or the small movements involved in speaking and walking.

It is common to briefly notice something that normally takes care of itself. If someone reads the word swallowing, they may immediately register their next swallow. In sensorimotor OCD, the observation is followed by fear that the awareness will never disappear again. The person therefore begins monitoring whether the process still feels automatic.

Research into interoception examines how we register and interpret signals from inside the body. Sensorimotor OCD may also concern external sensory experiences and movements, such as the field of vision, voice and gait. Both bodily sensations and automatic movements may become the subject of persistent monitoring.

When attention becomes what must be controlled

It may begin at bedtime, during a conversation or in the middle of a meal. The person notices their breathing, tongue movements or blinking. At first, the observation may be neutral. Concern arises with the question: What if I keep noticing it?

The person may then begin checking whether the awareness has gone. That very check requires the process to be brought back into focus. It is like examining whether one has forgotten a particular thought: to perform the test, one must remember what one is trying to forget.

Attention itself is not under voluntary control. The compulsive pattern lies in the repeated attempts to determine whether the awareness is still present, make the process feel natural or ensure that it will not interfere later. Every check makes the process more noticeable and prompts the next.

Which bodily processes may become prominent?

Sensorimotor OCD may focus on many sensory and movement processes. Some people have one stable focus, while others move between several.

Breathing. The person registers every breath and begins to doubt whether the body is still breathing automatically. It may feel necessary to control the depth and pace, making breathing more effortful.

Swallowing, saliva and sensations in the mouth. Attention centres on the need to swallow, the amount of saliva or the position of the tongue. The person may try to time swallowing, avoid swallowing in front of others or check whether the mouth feels normal. Meals and conversations may become difficult because they make the processes more noticeable.

Blinking and eye movements. Every blink is registered, and the person may examine whether it happens voluntarily or automatically. During eye contact, attention may shift between the conversation and monitoring how the eyes move. Some become preoccupied with whether they look natural to others.

Heartbeat and pulse. The heartbeat is felt in the chest, throat, fingers or against the mattress. The person becomes preoccupied with whether it can ever recede into the background again. For some, this overlaps with worry about illness.

Speech, voice and tongue movements. The person notices how words are formed, how the tongue touches the teeth or how the voice sounds. What was previously a fluid activity is broken down into many small movements that are now consciously experienced. This may create fear of losing the ability to speak spontaneously.

Walking, body parts and touch. Attention may focus on every step, the swing of an arm, clothing against the skin or the position of hands and feet. The person may compare the right and left sides or look for a position in which the body does not draw attention to itself.

Field of vision and background impressions. The nose, eyelashes, visual phenomena or blurring may become difficult to filter out. The person tests whether the impression is still visible or tries to position their gaze so that it disappears.

Typical obsessions and feared consequences

Doubt often concerns how long the awareness will last and what it will cause. Typical thoughts include:

• What if I always notice every breath?
• Have I damaged the automatic process by becoming aware of it?
• What if I forget how to swallow or speak naturally?
• Can I sleep at all if I keep feeling my heartbeat?
• What if I can never concentrate on a conversation again?
• Does the persistent awareness mean that something is wrong with my brain?
• What if I begin noticing even more bodily processes?
• Can thinking about the process make it permanently conscious?

The awareness may also have social consequences. The person may fear looking tense or losing the thread of a conversation because blinking or tongue movements take up so much attention. Others fear the exhaustion of having to register the process for the rest of their life.

Eventually, doubt may also concern why this particular process acquired such significance and whether the fear will ever disappear. The preoccupation itself then becomes another subject for analysis.

Typical compulsions and safety strategies

The compulsions often take place covertly and may resemble attempts to concentrate or find a sense of calm.

Monitoring. The person follows the process closely to detect changes and check whether it is still prominent. Attention may move between rhythm, intensity, symmetry and the sense of automaticity.

Deliberate control. Breathing, blinking, swallowing or walking is actively controlled. The person tries to find the normal rhythm or ensure that the process is performed correctly. The more it is controlled, the more unfamiliar it may feel.

Testing awareness. The person asks themselves whether the process had slipped from awareness during the previous few minutes or seeks out a quiet situation to see whether it becomes noticeable again. A period without awareness may later be scrutinised: Was I truly free of it, or did I just notice it less?

Distraction. Sound, screens, conversations or constant activity are used to drown out the bodily experience. If the person needs constant diversion to feel able to be still, distraction has become a safety behaviour.

Comparison. The person compares the sensation with how it felt earlier in the day, with other body parts or with the time before the problem began. The aim is to determine whether the experience has become more normal.

Information and reassurance seeking. The person searches for explanations of whether automatic processes can break down or asks others whether they also notice their breathing. The answer may provide brief relief, but is often followed by doubt about whether their own experience is the same.

Avoidance. The person avoids bedtime, silence, exercise, meals, eye contact or conversations because particular processes become noticeable. Others avoid words and articles that could draw attention to a new bodily function.

Three examples of sensorimotor OCD

The difference between sensorimotor OCD and illness OCD

In illness OCD, the person examines a bodily sensation to determine whether it is a sign of illness or harm. Heart palpitations may, for example, lead to repeated investigations of whether something is wrong with the heart.

In sensorimotor OCD, the person may know that their heart is healthy but still feel trapped by every beat. The fear is that the sensation will never recede into the background again.

Both forms of doubt may be present at the same time. The question the person is trying to answer indicates whether the checking mainly concerns illness or persistent awareness.

New or changed bodily symptoms require appropriate medical assessment. Once a specific concern has been examined, repeated checks without new information may become part of the OCD pattern.

The difference from panic and Just-Right OCD

In panic, a bodily signal may prompt an acute fear of fainting, dying, losing control or having an attack. The fear is linked to an immediate perceived catastrophe. In sensorimotor OCD, the fear mainly concerns continuing to be aware of the process. The two patterns may occur together.

In Just-Right OCD, an action is often repeated until it creates a bodily sense of completion, balance or wholeness. A movement may need to be performed again because one side did not feel like the other. In sensorimotor OCD, the problem is typically that the person registers the movement or sensation and fears that they will keep noticing it.

A person may first become stuck on a blink and then repeat it until it feels right. Here, both sensorimotor monitoring and the need for the right feeling are present.