This post is the second in a series of posts discussing body-focused obsessions and compulsions (aka, sensorimotor, somatosensory, or somatic obsessions and compulsions) in obsessive-compulsive disorder (OCD). This series was inspired by an original article written by Dr. David Keuler for OCDchicago.org. You can access Dr. Keuler’s excellent article here.
People with body-focused, sensorimotor OCD often worry about the underlying causes of their symptoms and how long their symptoms will last.
OCD Core Fears Related to Body-Focused Obsessions (also called Sensorimotor or Somatic Obsessions)
In Part 1 of this series of posts, I discussed the basic characteristics of body-focused (also termed sensorimotor [Keuler, 2011], somatosensory, or somatic) OCD. This type of OCD is extremely distressing and is associated with hyperawareness of particular bodily processes, urges, or sensations. Obsessions and compulsions often focus on breathing, swallowing, tongue movements, blinking, or other bodily phenomena (Keuler, 2011).
In clinical terminology, obsessive-compulsive disorder is a heterogeneous disorder. This means that different people have different combinations of OCD symptoms. Despite this variability, many individuals with body-focused, sensorimotor OCD share common fears related to their symptoms.
OCD worry about having the symptoms last forever (Keuler, 2011).
- What if my symptoms never go away, and I have to live the rest of my life like this?
- What if life is never satisfying again?
- What if I can never engage in [insert specific activity] without thinking about this? (Common examples include sleeping, eating, speaking, reading, or writing.)
- What if I lose my job (or fail out of school) because of this?
- What if I can never focus again?
- What if I can never sleep again?
- What if my mind is never “at peace” again?
OCD worry about the underlying cause of the symptoms.
- Why am I having these symptoms? There must be something seriously wrong with me.
- What if I have a brain tumor that is causing these symptoms?
- What if I have schizophrenia or another type of severe mental illness?
- What if I have brain damage in the parts of my brain that control these processes (e.g., the medulla oblongata or cerebellum)?
OCD worry about specific feared outcomes.
- What if I choke and die because I didn’t chew my food enough?
- What if my heart stops beating?
- What if my heart is beating at the wrong rate?
- What if there’s something wrong with my heart?
- What if I stop breathing?
- What if I’m breathing at the wrong rate?
- What if there’s something wrong with my lungs?
- What if I’m damaging my eye muscles because I’m blinking too quickly (or slowly)?
- What if toxic levels of carbon dioxide are accumulating in my lungs because I’m not exhaling enough CO2?
- What if I embarrass myself because I’m so stuck in my head that I miss what other people are saying to me?
- What if I can’t enunciate properly or trip over my words because I’m paying too much attention to my tongue?
- I wouldn’t be paying attention to this if there wasn’t something to worry about.
- If other people find out I’m thinking about this, they’ll think I’m crazy.
Interestingly, although common to sensorimotor OCD, this last cluster of fears can sometimes be used to differentiate body-focused OCD from more classic OCD presentations and other anxiety disorders. Sensorimotor OCD tends to be primarily associated with perceiving bodily processes, sensations, and urges, rather than specific feared outcomes. To take swallowing as an example, some individuals may fear choking and/or potential death. Others may fear the potential embarrassment of needing to be rescued by the Heimlich maneuver. Still others worry their attention will be permanently stuck on perceiving the urge to swallow. These last individuals are highly attuned to how their mouths and throats feel physically and often obsess about how often or how completely they have swallowed. They may also spit frequently and avoid wearing clothing that touches or constricts the neck (e.g., jewelry, turtlenecks, dress shirts).
Although all of the preceding examples may be consistent with OCD, the last example (i.e., hyperawareness of the urge to swallow) most clearly represents a body-focused, sensorimotor obsession. Fear of choking and/or fear of needing the Heimlich maneuver involve bodily processes, but the primary fear is death and/or embarrassment rather than being stuck with what feels like an inescapable urge. Although this distinction is fairly subtle, it is critical when selecting an appropriate treatment. Exposure with response prevention (ERP) therapy should always target a specific core OCD fear. In addition to OCD, other potential rule-out diagnoses for the first two fears might include phagophobia or social anxiety (social phobia), respectively. As will be discussed in a subsequent post, medical causes for these symptoms (e.g., neurological conditions) must also be assessed and ruled out before attributing these symptoms to OCD.
In the next installment of this series, I will discuss treatment strategies for body-focused sensorimotor obsessions and compulsions. Sadly, many individuals live with these symptoms for a long time before finding effective treatment. Due to the intolerable nature of these symptoms, it is not uncommon for people with sensorimotor obsessions and compulsions to feel frustrated and hopeless to the extent that they contemplate suicide as the only possible way of freeing themselves from their symptoms. Fortunately, effective treatment for this type of OCD is available. As I’ll discuss next time, therapy will be most effective if it’s based on the principles of exposure and response prevention (ERP), an evidence-based treatment for OCD.
Continue reading Part 3.
Questions? Comments? Experience with any of the core fears above? Share below.
Treatment for Body-Focused Obsessions & Compulsions in OCD (e.g., Swallowing, Breathing, Blinking)
Sensorimotor OCD Body-Focused Obsessions & Compulsions (Swallowing, Breathing)
Sensorimotor OCD & Social Anxiety Differential Diagnosis: “Obsessive Swallowing”