Body Vigilance: When Hypersensitivity to Bodily Sensations

Drive You Crazy! Treating Sensorimotor Obsessions

Mary Kathleen Norris, LPC

2700 Tibbets Drive Office 817-237-9889Suite 500 Appointments 940-242-0501Bedford, TX 76022 Fax 817-545-8417 www.dfwocd.com

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Goals of Presentation Explain typical sensorimotor obsessions found in OCD sufferers

Describe how these sensations develop a “life of their own”

Analyze the common fears associated with sensorimotor obsessions

Learn various techniques to successfully treat sensorimotor obsessions

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What is a Sensorimotor Obsession?

A preoccupation or focused awareness on an automatic bodily process or discrete physical sensation

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Confused and May Be Misdiagnosed

Sufferers are concerned and don’t know where to turn for help.

Medical professionals may struggle pinpointing the core issues.

The connection between the sensorimotor awareness and OCD or other anxiety disorders may be missed.

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Categories of Sensorimotor Obsessions

Those concerning:• Automatic bodily functions• Awareness of symptoms of

chronic physical disorders

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Examples of Automatic Bodily Functions that May Become

Obsessional• Breathing• Blinking• Eye contact (not as in

social anxiety)• Eye movements or

flickering• Eye twitching• Eye floaters• Visual awareness of body

parts (not BDD)• Swallowing

• Amount of saliva• Mouth or tongue

movements• Sound of swallowing• Lump in the throat• Pulse or heartbeat• Sound of heartbeat• Tingling in head

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Awareness of Symptoms of Chronic Physical Conditions

• Dizziness• Non reality feeling• Dryness of eyes or

mouth• Coughing • Discharge in nose• Nausea• Heartburn• Distention or gas• Urge to burp

• Sensations in stomach• Sensations in

intestines or bowel• Bladder fullness• Ringing in the ears• Ache in a muscle or

body part• Muscle tremor• The presence of gray

hair

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What Causes these Sensations to “Come to

Life”?• Experience sensory awareness• “Couple” that with reactive

anxiety• Once it is linked to anxiety, the

conscious mind will keep it present

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A Function of Survival?• Anxiety mechanisms are part of

the alarm system of the brain.• Survival skills have been honed

over millions of years to protect us.• Anything that scares us, we need

to remember – not forget.• Our brain will override attempts to

not think about it.• It will remind us over and over.

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The Glue that Makes the Awareness Stick

Interpretation of fear

• What if this never stops?

• What if I have a brain tumor?

Awareness of a

sensation

Strong feeling

of anxiety

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Now the two are stuck!!

Sensation Anxiety

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Impact on Daily Functioning

• Frustrating to totally debilitating• May result in taking a leave of

absence or quitting work• Avoidance of social activities• Marked increase in depressive

symptoms

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Treatment is KeyFirst Step:• Thorough evaluation by a medical

doctor to rule out medical problems causing symptoms

• These workups may require a specialist

• Once ruled out, find a trained mental health professional to diagnose and provide proper treatment

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Treatment is KeyAn evidence based treatment will provide the following components:• Psychoeducation• Identification of the Obsessions• Identification of the Neutralizations• Exposure and Response Prevention• Mindfulness Strategies• Relapse Prevention

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Treatment is KeyPsychoeducational Components to Include:• How the body reacts to anxiety• How selective attention develops• How reactive anxiety glues the awareness to

the mind• How ERP works to habituate to the sensations

by increasing tolerance for anxiety• That the condition is not dangerous• Reassurance that once the anxiety dissipates,

the sensory awareness will shift• The treatment will seem paradoxical

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Treatment is KeyIdentify the Obsession Awareness of the sensation Situations that may trigger awareness

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Treatment is KeyWhat fears show up when you experience the sensation?• Worry the symptoms will never go

away• Worry about the underlying cause• Worry about specific feared

outcomes

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Treatment is KeyWorry my symptoms will never go away• What if I have to live this way forever?• What if the awareness ruins the satisfaction

I could have in my life?• What if everything I do takes a back seat to

this and I can’t focus?• Examples of feared loss include sleeping,

eating, speaking, reading, writing, working, parenting, worshipping.

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Treatment is KeyWorry about the underlying causeI wouldn’t have these symptoms if they didn’t signal something serious. These symptoms may signal:

• Brain tumor or brain damage• MS• ALS• Schizophrenia• Some rare degenerative disease

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Treatment is KeyWorry about specific feared outcomes• What if I just stop breathing, levels of CO2 and O2

are off, or I damage my lungs?• What if I damage my eyes because of over

blinking, staring, or twitching?• What if I swallow so much I hurt my throat,

swallow air, feel distended and burp constantly?• What if I seem so out of it because of paying

attention to this and miss important moments, or embarrass myself?

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Treatment is KeyWhat are the Neutralizations or Compulsions?• Checking• Reassurance Seeking• Avoidance

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Examples of Neutralizations or

CompulsionsChecking• Mental checking for status of symptoms• Mental review of how it started, what it

could be, what should I do?• Mental review of the impact on quality

of life• Mood checking

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Examples of Neutralizations or

CompulsionsReassurance Seeking• Treatment providers• Friends and family− Asking if it is serious or when it will go awayAvoidance• Situations which might trigger awareness

− Being alone− Quiet environments− Times of inactivity or low distraction

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Exposure and Response Prevention

Invivo ExposuresWays to trigger awareness or invite in the sensation• Sticky dots or notes remind us to cue the

sensation or thought• Paradoxical worry – sit and focus at planned time• Have coaches mention or cue focus• Recite poems or songs• Create interoceptive exposures to trigger the

unwanted sensation

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Exposure and Response Prevention

Imaginal ExposuresWays to trigger the anxiety to the “what if” thoughts• Write an imaginal script to include the

feared outcomes• Use descriptive details to trigger anxiety• When recording, use emotional tones for

more effect

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Treatment is KeyRemember to expose and not neutralize• Allow the sensations, invite them

in with a dispassionate view• Resist the urge to lower the

anxiety by checking, seeking reassurance or avoidance

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Mindfulness StrategiesBody Scan Exercises• Involves learning to shift focus to various

bodily processes one at a time. Learn to move gently without emotion, without the “glue” of anxiety – allowing all sensations.

Mindfulness Exercises• Provide ways to be “in” an experience in

the absence of criticism, judgement, or defensiveness, just as it is.

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Putting it All TogetherUsing all of the components of the therapy, patients begin to experience fading of these sensory experiences, or more tolerance for them. Their anxiety diminishes as their acceptance and willingness to experience these sensations grows.

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The Case of Kim48-year-old femaleHistory of minor OCD symptomsHappily married, three grown childrenCareer classroom teacherComplaint: Awareness of swallowingReferred by local MD psychiatristNumber of medications triedResigned teaching position

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The Case of Rachel33-year-old femaleHistory of past OCD symptomsHappily married, three school-aged childrenStay at home MomComplaint: Ringing in the earsReferred by local MD psychiatristNumerous meds triedSuicidal ideations

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The Case of Chris40-year-old maleHistory of past OCD symptomsMarriage issues/near divorceEngineer, entrepreneurComplaint: Dry mouth and eyesReferred by psychologistResistant to medsStrong suicidal ideations

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ReferencesHershfield, J. and Corboy, T. (2013) The Mindfulness Workbook for OCD. California: New HarbingerKeuler, David J. (2011) paper When Automatic Bodily Processes Become Conscious: How to Disengage from “Sensorimotor Obsessions.”Ramachandran, V. S. (2012) Encyclopedia of Human Behavior. New York: Academic PressSeay, Steven J. (2011) paper/post Sensorimotor OCD Body-Focused Obsessions and Compulsions, Part One. OCD Core Fears Related to Body-Focused Obsessions and Compulsions, Part Two. Treatment for Body-Focused Obsessions and Compulsions, Part Three.Williams, M., and Penman D. (2012) Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World. New York: Rodale