Introduction

Sensorimotor OCD is a lesser-known subtype of Obsessive-Compulsive Disorder (OCD) characterized by hyper-awareness and excessive focus on automatic bodily processes. Unlike traditional OCD, which often revolves around external compulsions and rituals, sensorimotor OCD involves a preoccupation with internal bodily sensations such as breathing, blinking, or swallowing.

Signs and Symptoms of Sensorimotor OCD

Individuals with sensorimotor OCD experience persistent intrusive thoughts and heightened awareness regarding involuntary bodily functions. These obsessions can manifest in various ways, depending on the specific bodily process the individual fixates on. Common symptoms include:

• Excessive monitoring of breathing patterns, leading to fears of suffocation if not consciously controlled.
• Obsessive focus on the frequency and pattern of blinking, with a fear of potential eye damage or social embarrassment.
• Persistent awareness and discomfort with the process of swallowing, often leading to eating difficulties.
• An irrational belief that if these processes are not constantly monitored, catastrophic consequences may occur.

Compulsions and Avoidance Behaviours

To alleviate the distress caused by these obsessions, individuals with sensorimotor OCD may engage in compulsive behaviours. These might include:

• Repeatedly checking and controlling breathing patterns.
• Blinking in a specific pattern or frequency to reduce anxiety.
• Avoiding certain foods or eating situations due to swallowing concerns.
• Seeking reassurance about the normalcy of their bodily sensations.

Treatment Approaches

Cognitive Behavioral Therapy (CBT) with a focus on Exposure and Response Prevention (ERP) is the cornerstone of treatment for sensorimotor OCD. The therapy involves:

• Exposure to the feared bodily sensation in a controlled environment.
• Prevention of the compulsive response, thereby allowing the individual to experience the sensation without engaging in ritualistic behavior.
• Cognitive restructuring to challenge and change maladaptive beliefs about bodily sensations.
• Developing coping strategies to manage anxiety and reduce reliance on compulsive behaviours.

Sensorimotor OCD Success Story

Consider the case of “Emma,” who developed an obsessive focus on her blinking. Emma began to excessively monitor her blinking after noticing an increase in frequency during a period of high stress. She became preoccupied with the fear that if she didn’t consciously control her blinking, it would become abnormal or noticeable, leading to social embarrassment or permanent alteration of her blinking pattern. This obsession was accompanied by the catastrophic thought, “I’ll get stuck with this forever,” which significantly heightened her anxiety.

Emma’s treatment involved Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP). Through CBT, Emma learned to challenge her irrational beliefs, understanding that blinking is a natural, automatic process that does not require conscious control. ERP sessions exposed her to situations that triggered her blinking obsession, encouraging her to resist the urge to monitor or control it. Gradually, Emma learned to tolerate the discomfort and uncertainty associated with her blinking, reducing her anxiety and the compulsive need to control it. This approach helped Emma break the cycle of obsession and compulsion, leading to a significant improvement in her quality of life.

Alternatives to CBT and ERP for Sensorimotor OCD

Although CBT with ERP is highly effective in terms of treating sensorimotor OCD, there are other ways of treating it.  One such way is a third wave form of CBT called “Acceptance and Commitment Therapy” or “ACT”.

ACT focuses on developing psychological flexibility through six core processes: acceptance, cognitive defusion, being present, self-as-context, values, and committed action. For someone like Emma, struggling with a blinking obsession, ACT would help in the following ways:

• Acceptance: Learning to accept blinking as a natural bodily function without attempting to control or avoid it.
• Cognitive Defusion: Techniques to distance and reduce the impact of negative thoughts about blinking, such as “I’ll get stuck with this forever.”
• Being Present: Encouraging mindfulness and present-moment awareness, helping Emma focus on her current activities instead of obsessing over her blinking.
• Self-as-Context: Understanding that she is more than her OCD symptoms, which helps in reducing self-stigma.
• Values: Identifying what truly matters to her, beyond managing her OCD, and using these values to guide her actions.
• Committed Action: Setting goals based on her values and taking steps towards them despite the presence of OCD symptoms.

In the case example of Emma above would work by helping Emma to accept her blinking as a part of her experience, without letting it define or control her life. This approach aims to increase psychological flexibility, allowing her to live a fuller, more value-driven life despite the presence of OCD symptoms.