As I write about the many subtypes of obsessive-compulsive disorder (OCD) and how they impact people’s lives, I’m reminded of the period of time where I became hyperfocused on the feeling of my tongue in my mouth, and the mechanics of speaking. My tongue felt too big, and I would think about it as I spoke, trying not to trip over my words. It’d start to feel tingly, and I’d start to feel panicky. I couldn’t imagine how I could go back to not noticing it.
Despite having experienced it and learned about OCD for years, I had to double-check the answer to the question: is sensorimotor OCD the same as somatic OCD? Clinical terminology gets confusing. Some conditions are referred to by multiple names, and it’s hard to keep them straight.
All this is to say: yes, sensorimotor OCD and somatic OCD are the same thing. The terms are used interchangeably to describe a subtype, also known as a theme, of OCD that focuses on autonomic bodily processes/functions.
I asked Dr. Patrick McGrath, Chief Clinical Officer at NOCD, if one is more apt than the other, and he says they’re equal in accuracy. Now that that’s out of the way, let’s get into all things sensorimotor/somatic OCD: what it is, what the symptoms are, and how you can get help for it. I will use the term somatic for simplicity.
What is sensorimotor/somatic OCD?
Somatic OCD is a subtype of OCD that fixates on autonomic bodily processes and functions, such as breathing, blinking, swallowing, heartbeat/heart rate, eye contact, chewing, the movement/feeling of one’s tongue, bladder or bowel pressure, itching, or even the internal mechanism of thinking, among others.
Dr. McGrath says the core fear for someone with this theme tends to be, “What if my body is not doing something the right way?” The sufferer feels the need to take control of the function they’re fixated on. This hyperattentiveness and need for control can cause a problem where there isn’t one, as the more we focus on something, the more likely we are to find something “wrong” with it.
For example, my focus on my tongue and the mechanics of speaking sometimes did cause me to trip over my words, as I so vividly imagined my tongue taking up too much space in my mouth. Then, when I tripped over my words, it seemed to prove my fears. This represents the insidious, vicious cycle of OCD.
People with somatic OCD experience intrusive thoughts—which can manifest as thoughts, sensations, images, or urges—surrounding one or more bodily functions. Because autonomic processes are, by definition, happening all the time, people suffering from this theme of OCD likely find themselves constantly triggered. In order to relieve themselves of the distress that intrusive thoughts cause, they perform compulsions, which can happen externally (an action) or internally (an image or thought pattern).
Signs & symptoms of sensorimotor/somatic OCD
The symptoms of sensorimotor OCD will vary from person to person, but in any case, they will involve obsessions, which can include intrusive thoughts, sensations, images, and urges; and compulsions, which can be mental or physical, or both. People with OCD often experience high levels of distress, guilt, shame, or embarrassment.
The presence of compulsions is what differentiates OCD from anxiety disorders. One can feel anxious over bodily functions, but if they don’t engage in compulsions for a sense of relief or safety, they’re probably not experiencing OCD. Here are some examples of what intrusive thoughts might sound like for someone with sensorimotor OCD:
- “What if I never stop noticing my swallowing?”
- “What if my breathing is not normal?”
- “I have to make myself blink, so I can ‘check’ that it’s normal.”
- “I can’t stop noticing every time I move my head.”
- “My tongue feels so weird in my mouth. Is it sitting in the right place?”
- “Does my eye contact look normal?”
- “Is my bladder working normally? I can always notice its pressure.”
- “I notice every tingle or itch on my body and worry that they happen too often.”
- “What if I forget how to chew?”
- “Is my heartbeat normal? I have to pay attention to it to check.”
- “What are my eyes doing when I’m talking to someone?”
- “What if I can never yawn?”
- “Will I keep noticing my breathing forever?”
Compulsions will vary as well, of course, depending on each individual and which process or function their intrusive thoughts latch onto, but some examples include:
- Doing excessive research online to find similarities between your experience and others’, attempting to “get to the bottom” of whether your function is “normal” or find out how you can stop paying attention the function
- Seeking reassurance from yourself or others. You might repeat to yourself, “My breathing is totally normal, and I’m not paying attention to it,” or ask a loved one, “Do you think my breathing sounds normal?”
- Avoiding places or activities where your intrusive thoughts are especially triggered. For example, if your intrusive thoughts focus on chewing, you might avoid going out to dinner with friends because you won’t be able to be present.
- Mentally reviewing past experiences when you didn’t feel hyperaware and trying to figure out how you can get back to that state
- You might try to distract yourself with books, movies, or other activities.
- You might induce the function (i.e. make yourself swallow) so that you can “check” its normalcy.
Sensorimotor/somatic OCD is sometimes confused with health anxiety. Health anxiety, also known as illness anxiety disorder, occurs when someone is hyperfocused on every sensation and occurrence in their bodies out of the fear that they have a serious illness. While they share similarities, the fear behind health anxiety is that the sufferer has an underlying medical condition. With sensoritmotor/somatic OCD, the primary fear is that one won’t be able to stop paying attention to the function and/or that they’re not doing it “correctly.”
How is sensorimotor/somatic OCD treated?
There is hope for anyone struggling with somatic OCD. With evidence-based treatment administered by a mental health professional, OCD is a highly treatable disorder. Every subtype of OCD is treated the same: with exposure and response prevention therapy (ERP). ERP consists of gradually exposing someone to their triggers, then giving them the tools to resist engaging in compulsions before, during, or after the exposure exercise. In the case of sensorimotor/somatic OCD, examples of exposures include:
- Intentionally blinking, breathing, or swallowing “wrong”
- Going to dinner with friends, where it will be difficult to engage in compulsions surrounding your chewing
- Write down “I might be blinking too much” or “my breathing might not be ‘complete’” and read it back to yourself
- Read a case study about someone who couldn’t perform an autonomic process/function correctly
Dr. McGrath says that the goal of these exposures is for people to learn that they can handle the distress that’s brought on by their obsessions. “Eventually,” he says, “the process will go back to being automatic.” It might sound overwhelming, but that’s kind of the point—through facing your triggers, they will become less and less overwhelming over time. It’s important to know that you will not be forced into anything you’re not ready for. Remember, you and your therapist will work together to come up with a plan for your exposures.
From one OCD sufferer to another, I wish you well in your treatment and recovery. Even if that sounds impossible right now, I can assure you it’s not. If you’re interested in starting your recovery journey with ERP therapy, please schedule a free 15-minute call with the NOCD Care team. Every therapist in the NOCD network has received rigorous training in treating all subtypes of OCD with ERP therapy.