Sensorimotor, somatic or body focused OCD is where an individual is excessively aware of an involuntary bodily processes or sensations or movement such as:

• a movement of your body such as blinking or breathing (for example, whether you are breathing correctly at the right depth or rate), or
• are excessively aware of the sensation of breathing or swallowing or a floater in your eye, or whether your gaze is on someone’s genitalia.

If you have sensorimotor OCD, you may be plagued by doubts – for example “Am I breathing correctly?”, “Am I staring at the person’s breasts/genitals?” The motivation might be to avoid harm, in the sense that you are fearful that the sensations will never stop. You might fear losing control or going mad if you do not focus your attention on the sensation. For others they just cannot do anything until the sensation or movement feels “just right”.

Sensorimotor OCD is sometimes associated with being on the Autistic Spectrum, where an individual may be more sensitive to internal bodily cues and sensations (for example sights, sounds or smells). This website is a helpful description of the sensory issues in autism. I have also noticed in some of my patients an association between sensorimotor obsessions and Ehlers-Danlos syndrome – a connective tissue disorder that might present with joint hypermobility or vascular symptoms. They suggest that if there are impairments from sensory receptors in your body for sending feedback to the brain, you might have to do more guess work for example in your breathing. This then creates the foundation for your doubts.

Whatever the context, such obsessions can be significantly interfering in one’s life. Intellectually you probably “know” that these sensations or movements have no relevance to you. However, you probably fear that they will go on forever.

A key process that drives the problem is “selective attention”. This magnifies and increases your awareness of the threat (or sensation). This is important to have when there are predators like lions in the environment and you need to monitor where they might be. However, your bodily sensations like breathing or floaters do not require monitoring as these are activities that are automatic. They are things that you have been doing since birth and do not require your conscious help. Any bodily process or sensation can form the foundation of a sensorimotor obsession. For example, if you focus your attention on your breathing, it magnifies the sensation and you fear not being able to stop thinking about it. You try to stop thinking about it, but this just increases thinking about it, makes you more anxious and increases your attention on the sensation in a vicious circle.

Overcoming sensorimotor OCD is the same as for any other type of OCD but it can be tricky, partly because people find it hard to imagine that the problem will ever stop. However, once you no longer fear the sensation, you are not anxious, and you no longer monitor it, then it will go away.

Try to try to identify the meaning of having to focus on your sensation e.g. what your greatest fear would be if you could not monitor your breathing/ blinking/ swallowing/ staring? A therapist would then help you find an alternative explanation (known as Theory B) for the motivation for focusing on your bodily activity. An example is that you are focusing on the sensation because you are extremely fearful of it going on forever and find it difficult to tolerate “not knowing” whether it will continue.

Sometimes, it may be that focusing on the activity or sensations is a way of avoiding other issues, for example being abused as a child or difficult relationship problems.

The principle will be to invite in the sensation, to welcome it, without judgement and without trying to escape or to control the sensation or activity. Trying not to think about the sensation is part of the problem. The key is to notice and acknowledge the intrusive sensation (a bit like smiling at a stranger that you walk past in the street) – but not to engage with it or to monitor what it’s doing. That is, you do not start talking to the stranger or look at it closely. There is no need to question it or repeat a phrase (which are compulsions). Sometimes it can be helpful to conduct a “body scan” to demonstrate that you can focus your attention and awareness on various bodily sensation and then leave them. As you move through your body, just observe any bodily sensations with curiosity and interest.

This is tough, difficult to do and requires a lot of practice. It’s even harder if you are on the Autistic Spectrum or have long-standing problems in sensory issues. SSRIs may also help like other types of OCD.

It’s also important that you do the things in life which you are avoiding or are important to you despite the intrusive sensations and movements and are not waiting for them to go away. As you become more willing to experience the sensation, without trying to avoid, monitor or control it, it will fall into the background and will no longer be intrusive.