Sensorimotor OCD: Symptoms, Examples & Treatment

What Is Sensorimotor OCD?

Sensorimotor OCD describes a particular form of obsessive-compulsive disorder. It is called sensorimotor OCD, sensory ocd, or somatic OCD because individuals suffering from it have a preoccupation with sensory/bodily perception. They have intrusive and unwanted obsessions that center around bodily sensations such as heart rate, breathing, swallowing, and blinking. In this form of OCD, an individual’s obsessional thinking is tied to constantly being worried about these bodily perceptions.

Obsessive compulsive disorder is diagnosed based upon the presence of obsessions or compulsions:

• Obsessions: Obsessions are persistent, distressing thoughts, urges, or mental images that intrude into a person’s mind, causing significant anxiety or discomfort, often referred to as intrusive thoughts.
• Compulsions: Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to their obsessions or to reduce distress, aiming to prevent or neutralize perceived threats or anxieties.

Sensorimotor OCD & Illness Anxiety Disorder

Sensorimotor OCD involves obsessive thoughts about bodily sensations or movements, leading to excessive attention and worry about normal bodily functions. This hyperawareness might overlap with illness anxiety disorder (formerly known as hypochondriasis), where individuals intensely fear having or developing a serious illness, despite reassurance and medical evaluations indicating otherwise. Both conditions involve heightened bodily focus and distress, albeit with different focal points: bodily sensations in sensorimotor OCD and the fear of illness in illness anxiety disorder.

Symptoms of Sensorimotor OCD

Sensorimotor OCD is not its own diagnosis within the Diagnostic and Statistical Manual (DSM-V). Rather it is a recognized subset of obsessive compulsive disorder. Sensorimotor OCD is a subset in which a person’s obsessions and compulsions are focused on bodily perceptions.

As a diagnosis, OCD affects 2-3% of the population in the United States.¹ Sensorimotor OCD has not been researched directly enough to provide statistics on its prevalence. Some people prefer to designate this form of OCD as “Pure O” (purely obsessional OCD). However, this is misleading because an individual who has sensorimotor OCD in fact does engage in compulsions. These compulsions just take place within their mind. For example, they may obsessively hyperfocus on their breathing rate or level of arousal and mentally engage in the same “checking” compulsions. They might constantly be checking to see if their heart rate is “too high” or be concerned with why they can feel their heartbeat so noticeably. To better understand these symptoms, it is important to understand the cycle of anxiety present in OCD, no matter the form.

Common obsessions in sensorimotor OCD include:

• Breathing: This might involve an intense focus on the act of breathing, feeling like one cannot breathe properly, or fear of losing control over breathing patterns.
• Blinking: A person may have a constant awareness of blinking, fear of blinking too much or too little, or concerns about blinking improperly, leading to repetitive checking or monitoring of blinking.
• Swallowing: Obsessions here could include a fear of choking while eating or drinking, feeling like swallowing is difficult or not being able to swallow properly, leading to heightened attention to the swallowing process.
• Movement of mouth or tongue: Obsessions may involve an intense focus on tongue or mouth positioning, concerns about speaking or moving the tongue correctly, or worries about accidentally biting the tongue or lips.
• Pulse and/or heartbeat: Pulse and/or heartbeat obsessions might entail hyperawareness of the heartbeat, fear of irregular heartbeats or heart problems, or the perception of a heightened or abnormal pulse rate, resulting in monitoring or checking the heartbeat frequently.
• Eye contact: Eye contact obsessions may involve discomfort or anxiety related to making or maintaining eye contact, feeling like eye contact is awkward or inappropriate, leading to avoidance or repetitive monitoring of eye contact during conversations.
• Floaters: Floaters obsession involves excessive attention or distress about seeing small specks or spots in vision, fearing they may signify a serious eye condition or cause visual impairment, leading to constant monitoring or concern about these floaters.

 Common compulsions in sensorimotor OCD include:

• Repeatedly checking a smartwatch to monitor heartbeat
• Counting breaths or monitoring breathing patterns
• Frequently checking a mirror to observe blinking or eye movements
• Engaging in swallowing rituals, such as excessive sips of water or repeating swallowing actions
• Constantly adjusting mouth or tongue positions to ensure they feel ‘right’
• Regularly measuring pulse rate using various devices
• Repetitive touching or feeling one’s own pulse to confirm its regularity
• Using eye drops excessively to address perceived vision issues or floaters
• Repeatedly asking others for reassurance about bodily sensations or movements

These compulsions often serve as temporary relief but can reinforce obsessions and contribute to heightened anxiety in the long run.

What Triggers Sensorimotor OCD Symptoms?

As with all OCD symptoms, the underlying mechanism is anxiety. Anxiety is our body’s reaction to a threatening internal stimulus (a feeling, a memory, or past experience). Anxiety is triggered by feelings and is our natural human response to internal feeling states that we have, in previous relationships, learned are not safe to express. In future instances when this same emotional state is triggered, our unconscious threat detection system triggers anxiety even before our conscious mind can realize what is occurring.² Someone with OCD uses obsessions and compulsions as a way to manage their anxiety.

In OCD, anxiety functions in a cyclical pattern. Imagine you are afraid of the dark. Each time you have the opportunity to face your fear, you instead turn on the light. Now, this helps ease your fears in the moment, but as time goes on, you learn to rely on the light to deal with your fears. Two things are likely to occur as this pattern continues: you will both become more afraid of the dark and your reliance on the light to manage that fear will increase. This is similar in anxiety and OCD. The dark is the unprocessed feelings and the lights are the strategies of defending ourselves against the anxiety caused by those feelings (compulsions). The more we use our strategies (the lights) in order to deal with our anxiety (caused by our underlying feelings) in the short term, the more our reliance on the strategies grows, and the more our fear of our unprocessed feelings (anxiety) grows too. These strategies were once really helpful, but now come to hurt the individual.

Common triggers for sensorimotor OCD include:

• Watching a horror movie where the sound of the character’s heartbeat is amplified
• Reading or hearing about medical conditions related to breathing difficulties or heart irregularities
• Having a potentially dangerous medical condition or being at risk of a potentially dangerous medical condition
• Experiencing physical sensations such as a minor muscle twitch or unusual heartbeat
• Observing someone else experiencing discomfort or showing signs of an illness
• Experiencing stress or anxiety, which can heighten bodily awareness and sensations
• Engaging in activities that require intense focus on bodily movements or sensations, such as yoga or meditation
• Being in environments where there are repetitive or constant noises, like ticking clocks or dripping faucets
• Watching or listening to media content that emphasizes bodily functions or sensations, such as documentaries about breathing techniques or heartbeat sounds

Possible Causes of Sensorimotor OCD

In terms of sensorimotor OCD, the anxiety is focused around the bodily perceptions. An individual is hyper aware of certain sensations and usually fears something bad occurring as a result of these sensations. Understanding the cause of OCD is a topic of debate, and depends upon one’s therapeutic perspective. However, based upon the fact that the supposed “gold standard” treatment methods for OCD have recently been shown to be only effective for ⅕ of those treated, understanding the cause of OCD seems more important than ever.³

In light of this, some possible causes of sensorimotor OCD include:

• Genetics: Some argue that OCD is hereditary/genetic.⁴ However, this is complicated. Just because one shares genetic material that might predispose them to OCD, doesn’t mean they will develop it. The gene must be triggered by something in the environment (usually watching someone else in the family with OCD and developing similar habits for managing anxiety). It is more nurture than nature.
• Environmental factors: Recent investigations have sought to understand the cause of obsessional symptoms based upon childhood trauma and maltreatment.^{5, 6} Implications of these analyses have also suggested a potential link between OCD and PTSD symptoms. Possible links to traumatic symptoms are supported by the fact that in both PTSD and OCD, there is a hypervigilance and hyper awareness that can be observed with regard to the individual and their bodily sensations.
• Brain activity: More biological medical-based models suggest OCD symptoms result on the basis of faulty basal ganglia functioning,⁷ afflicted serotonin levels,⁸ or various other abnormalities in brain structures seen on MRI machines.⁹
• Attachment ruptures: Recent investigations have also looked at the role of attachment complications and OCD symptom formation.¹⁰ Some attachment styles feature increased anxiety and obsessive mechanisms may be more likely to be used to modulate these anxieties that occur in relationships.

Impacts of Sensorimotor OCD

Living with OCD of any form is debilitating. Not only does a person suffer from high levels of anxiety that motivate the symptoms, there is also a high level of stigmatization involved. OCD tends to be a fairly invisible disorder for many. The individual can often appear to be doing fine to the public, but internally suffers agonizing bouts of anxiety, insecurity, uncertainty, and the like. This misperception can lead the one suffering to feel even more isolated.

Sensorimotor OCD, as a form of OCD that primarily affects the perceptions of the individual’s awareness of their body, is a special form of the above scenario. Often, one can feel like they are ‘going crazy’, that their body is ‘shutting down’ or that one of these sensations is going to seriously harm them. They may feel this despite evidence to the contrary. And, it is not uncommon for people who do not know how this disorder feels to simply urge the sufferer to just ‘move on’ or ‘get over it’. This results in further feelings of isolation. In extreme cases, the person with sensorimotor OCD may be so preoccupied with their bodily sensations that they are afraid to engage in day to day activities, keeping them within a vicious cycle of anxiety and isolation from others.

How Is Sensorimotor OCD Diagnosed?

An OCD diagnosis is made by a trained clinician such as a psychiatrist or psychologist. A skilled clinician would not only be sure one meets criteria labeled within the DSM-V under obsessive compulsive disorder, but conduct an evaluation of your relevant history. As the DSM-V itself notes, in diagnosing any mental disorder, considerations beyond specific criteria must be evaluated thoroughly as social, emotional, and behavioral considerations dramatically influence what symptoms appear.¹¹

As stated, sensorimotor OCD is not a specific diagnosis, but a subset of OCD. Likely, the clinician will investigate whether one meets the criteria for OCD and discuss the specifics of the disorder with the patient, including its presenting form. This may entail education regarding how sensorimotor OCD is a specific form of OCD where the anxiety is focused on bodily arousal, but with the same underlying structure of OCD proper.

Questions to ask your doctor about sensorimotor OCD include:

• Where can I find specialized sensorimotor OCD treatment?
• What does a typical treatment plan look like?
• How does this treatment deal with my underlying anxiety and not exacerbate it?

Treatment for Sensorimotor OCD

Many therapists struggle to effectively treat OCD. This is because they misunderstand the root of the disorder which is not ‘maladaptive cognitions’, but underlying emotional difficulties. Studies reveal that more than half of individuals seeking therapy for specific symptoms end up returning within just 6-12 months for the same issues.¹² Moreover, some treatment methods considered the ‘gold standard’ have faced criticism for not being very effective in the long run.³

OCD is a highly complex and often misunderstood condition that can coexist with other diagnoses. Therefore, it’s crucial for those affected to understand that effective treatment doesn’t just aim to manage symptoms but targets the root causes to eliminate them. Collaborating with a therapist specialized in OCD treatment typically yields the most favorable outcomes. This being said, there are some specific treatments that tend to have more effective outcomes.

Treatment options for OCD include:

• Exposure response therapy (ERP):  Exposure therapy for OCD interrupts the OCD cycle and often is a first step in granting the sufferer some agency in being able to impact the course of their symptoms. There is an educational component that helps understand the cycle of anxiety involved in OCD.
• Medications: Medications for OCD are sometimes helpful. But it is extremely important to understand that medications have variable effectiveness and do not work as the sole treatment method for many. Typical OCD medications used are antidepressants and SSRIs.
• Cognitive behavioral therapy (CBT): CBT for OCD is sometimes effective. But, it is important to understand that CBT was developed by Aaron Beck for depression. Some aspects of teaching an individual to break automatic bonds between thoughts and rituals are effective.
• Eye movement desensitization reprocessing therapy (EMDR): EMDR for OCD can target the distressing emotions, thoughts, and memories associated with specific obsessions and compulsions with the goal of decreasing their intensity.
• Specific forms of psychodynamic therapy: Tailored psychodynamic therapies specifically address the emotional issues that drive obsessive and compulsive behaviors. Unlike other  therapies, these forms can result in lasting improvements that extend beyond the therapy period.

6 Tips for Coping With Sensorimotor OCD

When we are suffering, we utilize coping methods. These methods are often initially developed as the best possible solution to an issue. However, what happens when our coping mechanisms actually come to be the thing that is hurting us most? Rituals and compulsions are initially means of coping with underlying anxiety. Over time, these rituals are overly relied upon and become the only thing a person uses, instead of dealing with the underlying anxiety. Effective therapy does not just help a person cope, it helps them see the ways their coping mechanism hurt them, and instead deals with the underlying issues that necessitated a coping mechanism in the first place.

Effective coping mechanisms can be determined based upon their effects on the person’s overall functioning. A healthy coping mechanism will increase connection to self and others, rather than increase isolation and perpetuate symptoms.

Some helpful coping mechanisms that may be beneficial for sensorimotor OCD include:

1. Breathwork: Focusing on the breath is an important part of learning to regulate anxiety. When we are anxious, we all work out our own ways of holding our breaths and attempting to suppress anxiety.¹³ Learning to tune into yourself and your emotional state is a helpful coping mechanism.
2. Mindfulness and relaxation techniques: Practices like deep breathing, meditation, or progressive muscle relaxation can help reduce anxiety and stress, making it easier to manage OCD symptoms.
3. Emotional awareness exercises: Along with mindfulness, learning to understand what emotional triggers feel like in our bodies is important for regulating our nervous systems. Our emotions are there to inform us. When we avoid them or neglect them, we often feel lost. Learning to engage with our emotional worlds by understanding what an emotion (such as anger) feels like for us,  how it makes us want to act, and perhaps more importantly, how we often avoid certain emotions, can help one identify their relational triggers and better advocate for themselves.
4. Exercise: Exercise can help anxiety. Engaging in regular physical activity has been shown to alleviate symptoms of anxiety and stress, which can be beneficial for managing OCD.
5. Healthy lifestyle: Maintaining a balanced diet, getting enough sleep, and avoiding substances like caffeine and alcohol can positively impact mood and overall well-being, potentially reducing OCD symptoms.
6. Developing trusting relationships: Relationships are a coping mechanism that can be extremely effective and often overlooked. Learning how to trust and engage with peers, family and other support systems is instrumental in gaining a sense of security and feeling supported in our struggles.

When to Seek Professional Support

If you’re experiencing any of the above symptoms and they are impacting your daily life, seeking professional help is recommended. Online therapist directories or online OCD resources can connect you with licensed mental health professionals specializing in OCD treatment.

It’s crucial to ensure the therapist is experienced in treating OCD complexities. Sometimes, therapy alone might not be enough, and medication could be beneficial. Consulting a psychiatrist is wise for medication considerations. While an in-person consultation provides valuable data, online appointments with reputable psychiatrists can be beneficial when in-person visits aren’t possible.The key is to understand that help is available and you can receive support for the effects of OCD.