Hyperawareness OCD: Revealed
Introduction
For numerous individuals grappling with obsessive-compulsive disorder (OCD), their experiences seldom align with the conventional depictions found in popular literature. Their struggles revolve around an oft-neglected subgroup of OCD manifestations termed “sensorimotor obsessions” or “hyperawareness OCD.” This perplexing condition centres on an excessive preoccupation with bodily processes or sensations that typically occur automatically and without conscious attention. Join us as we delve into the intricate realm of sensorimotor OCD, unravelling its distinguishing characteristics, underlying mechanisms, and effective treatment approaches.
The Essence of Sensorimotor OCD
Sensorimotor OCD, also known as hyperawareness OCD, is characterised by an intense fixation on automatic bodily functions or discrete physical sensations. This obsessive focus arises from an individual’s selective attention to these processes, which ordinarily occur without conscious effort. The root cause lies in the fear that this heightened awareness will become permanent, rendering the individual unable to disengage from these thoughts and sensations.
Common Manifestations of Sensorimotor Obsessions
Sensorimotor obsessions can manifest in various forms, each centred on a specific bodily process or sensation. Some of the most prevalent manifestations include:
- Breathing: An excessive focus on the depth, rhythm, or sensations associated with breathing.
- Blinking: Preoccupation with the frequency or physical necessity of blinking.
- Swallowing/Salivation: Fixation on the act of swallowing, the amount of saliva produced, or the sensation of swallowing itself.
- Speech: Heightened awareness of the mouth and tongue movement during speech.
- Pulse/Heartbeat: Excessive attention to one’s pulse or heartbeat, particularly during attempts to fall asleep.
- Eye Contact: Intense focus on making eye contact or the specific eye being looked at during social interactions.
- Visual Distractions: Fixation on floaters, particulate matter within the eye, or subtle eye movements.
- Body Part Awareness: Hyper-awareness of specific body parts, such as the nose, feet, or fingers.
Distinguishing Characteristics of Sensorimotor OCD
Unlike other forms of OCD, sensorimotor obsessions rarely involve elaborate fears of harm to oneself or others. Instead, the primary concern revolves around the fear that these automatic bodily processes or physical sensations will fail to return to their unconscious state, thereby “driving the sufferer crazy.” This fear is often accompanied by the broader concern that the obsession will be unending, a phenomenon termed “obsessing about obsessing.”
Perfectionistic attitudes or beliefs infrequently accompany sensorimotor obsessions, although they may occasionally play a role. Individuals with this condition report significant levels of distress, mainly due to impairments in concentration at work, during social interactions, or when attempting to fall asleep. Compulsions in response to sensorimotor obsessions are typically limited to repeated attempts to use distraction to interrupt the fixation on sensory phenomena.
The Relationship with Obsessive-Compulsive Spectrum Conditions
Anecdotal evidence suggests that individuals diagnosed with sensorimotor OCD are more likely to have current or past difficulties with other forms of OCD, generalised anxiety disorder, or panic disorder. This reflects the fact that problems with sensory hyper-awareness are not confined to a particular diagnostic entity but cut across various obsessive-compulsive spectrum conditions.
For example, individuals with bowel or bladder preoccupations, health anxiety (hypochondriasis), and panic disorder may experience sensory hyper-awareness coupled with specific, catastrophic fears (such as humiliating bowel accidents, serious illness, or having a heart attack). Future research will determine whether sensorimotor preoccupations occurring within various clinical diagnostic categories reflect the same or unrelated neurobiological processes.
Treating Sensorimotor Obsessions: A Comprehensive Approach
Sensorimotor obsessions can be effectively treated by decoupling sensory awareness from reactive anxiety. The goal is for individuals to experience their sensory hyperawareness without any resulting anxiety, as anxiety serves as the “glue” that binds particular thoughts to conscious awareness.
Psychoeducation: Laying the Foundation
The first stage of treatment focuses on educating patients that selective attention to previously automatic or unconscious bodily processes or sensations is not inherently dangerous. Patients are reassured that their sensory awareness will shift once their anxiety dissipates. This reassurance often sets the stage for “inviting in” the sensations as a means of reducing anxiety.
Exposure and Response Prevention (ERP): Confronting the Fear
Sensorimotor obsessions can be effectively addressed through exposure and response prevention (ERP). Patients are instructed to voluntarily pay attention to the relevant bodily process or sensation (exposure) and resist the urge to engage in distraction or avoidance behaviours (response prevention). Repeated voluntary exposure to the sensations leads to diminished anxiety as patients grow accustomed to embracing the awareness without attempting to avoid or escape it.
Imaginal exposure to particular feared outcomes (e.g., “My life will be ruined,” “I’ll never have peace of mind,” “I’ll never be able to get rid of this problem,” or “this obsession will never go away”) may be employed to enhance exposure. Additionally, patients may be asked to invite in the sensations and accompanying fears throughout the day, facilitated by reminders such as Post-It notes or stickers placed in various locations.
Body Scan and Mindfulness: Embracing Awareness
Patients are often unaware of the changes in perception when selectively attending to their bodies. Participation in a body scan can help patients fluidly move in and out of their awareness of these sensations without resorting to forced attempts to shift attention.
A body scan involves shifting attention to various bodily processes or sensations for prescribed periods, allowing patients to acquire full sensory awareness before moving to the next area. This practice teaches patients to move gently from one sensation to another without getting “stuck” by focusing and refocusing in the absence of anxiety or active attempts to force a shift in awareness.
Mindfulness, the practice of paying close attention to an experience without criticism, judgment, or defensiveness, can also play a crucial role. Patients are instructed to allow their particular sensory preoccupation to become their meditative focus, accepting all sensations with curiosity and interest. Over time, patients begin to experience a fading of sensory awareness or greater tolerance of it as their anxiety diminishes and their willingness to invite in the sensations grows.
Embracing Uncertainty: The Path to Recovery
Sensorimotor obsessions likely affect countless individuals yearly, yet systematic research is necessary to determine the prevalence and optimal treatment approaches. Until then, anecdotal evidence suggests that a cognitive-behavioural framework incorporating psychoeducation, cognitive reframing, reassurance, exposure and response prevention, and mindfulness and acceptance techniques can play vital roles in diminishing the frustration and distress associated with this perplexing and often incapacitating experience.
By embracing uncertainty and learning to disengage from the compulsive attempts to control their thoughts and sensations, individuals with sensorimotor OCD can embark on a journey towards recovery, reclaiming their lives from the grip of this enigmatic condition.
