Sensorimotor Obsessions Hyperawareness of Body Sensations

I have felt an affinity to the Princess who can feel the pea under all the mattresses in her bed. When I read David J. Keuler's article, When Automatic Bodily Processes Become Conscious: How to Disengage from "Sensorimotor Obsessions", I recognized myself. Here is Keuler's list of examples of Sensorimotor Obsessions:

• breathing [whether breathing is shallow or deep, or the focus is on some other sensation of breathing]
• blinking [how often one blinks or the physical requirement to blink]
• swallowing/salivation [how frequently one swallows, the amount of salivation produced, or the sensation of swallowing itself]
• movement of the mouth and/or tongue during speech
• pulse/heartbeat [awareness of pulse or heartbeat, particularly at night while trying to fall asleep]
• eye contact [unlike social anxiety-based concerns, this form involves awareness of the eye contact itself or which eye one is looking at when staring into the eyes of another person]
• visual distractions [e.g. paying attention to “floaters”, the particulate matter that is drifting within the eye that is most visible when staring at a blank wall or awareness of subtle movements of the eyes, such as saccadic eye movements]
• awareness of specific body parts [e.g. perception of the side of one’s nose while trying to read or, as in the cases of a young boy and older man, a hyper-awareness of particular body parts such as their feet or fingers respectively]

My health anxiety is linked in part to assuming what I am aware of is dangerous. Floaters in my field of vision were particularly hard to deal with because I was afraid it was serious, and then when the doctor said it wasn't, I was worried I'd be aware of the bits of gray squiggles forever, and haunted by them, and I obsessed about obsessing. Bladder sensations took up a lot of my mental space from an early age.

Keuler proposes treatment consisting of:

• Helping the sufferer understand that awareness of automatic body processes is not dangerous
• Exposure to the sensation and prevention of responses such as distraction.
• Body Scan and Mindfulness, and learning to observe sensations without judgement(Jon Kabat-Zinn has detailed instructions for doing a body scan. I did them everyday for many years, and it helped expand my focus.)

He suggests post-it notes with reminds of the sensation in strategic locations, practicing inviting the sensation in rather than fleeing from it, which ultimately leads to less sensitivity to the sensations and/or greater tolerance of them. Before you panic at the thought of purposely evoking sensations you'd rather banish forever, remember that in actuality you can't perfectly set up the world to never remind you of your breathing, your tongue or your bladder.

I know that bliss when a sensation recedes and the agony of something reminding me of it, but it's the jolt of encountering the feeling reinforces the anxiety, making me wish I could ratchet down my life even more so that I never get surprised. It was liberating to discover that I could purposely face the sensation, and not have to tiptoe around my life.

Apt cartoon by xkcd, about tongue awareness.

Pure O How do I tell the difference between obsessions and compulsions

There's been discussions lately on the OCD support lists about how to tell the difference between an obsession and a compulsion, if it's all thoughts, as in "Pure O." My understanding is that the initial thought is the obsession, and the cascade of thoughts afterwards are the compulsion. For me it would be something like, "What if I said the wrong thing?" as the obsession, followed by trying to figure out if I did indeed say the wrong thing, including retracing my words, trying to account for all of them, which is the compulsion.

The irony is that the compulsion is supposed to be what reduces the anxiety produced by the obsessive thought, and yet, when I used to say "I wish I could stop obsessing about this" what I really meant was the whole flood of compulsions. I fly into compulsing so quickly that it seemed quite dubious that the initial thought was causing the anxiety--surely all the retracing, figuring out, analyzing, and research were the obsession right? How could they possibly be a way to lower my anxiety??

But what I learned during exposure therapy was that compulsions only provide short term relief, and in some cases, very very short term, and then they rebound with their own additional suffering, taking up mental space and energy, and that if I challenged myself to refrain from figuring out an obsessive thought, that my anxiety level immediately spiked, and that was a sign that the compulsion was serving its function of a short term hit of relief, even if I couldn't see it as it happened.

My husband had the flu this week, and he gave this analogy--the virus is the obsession, and the immune system response is the compulsion. When we are sick, what makes us feel lousy isn't the virus itself, but the attack of the immune system on the virus. In the case of our bodies, for the flu or other illnesses, we actually want the immune system to attack, but OCD is more like an allergy, where our immune system attacks something harmless like pollen, mistaking it for an invader. I know the things we obsess about don't seem harmless, and that they are often about things important to us, but our full blown compulsions cause us more misery in many cases than the initial obsession.

In the midst of my worst OCD flare ups, I had glimpses of how destructive the compulsions were, but I was so scared by the obsessive thought that I clung to my compulsions. I finally hit a low point with my health anxiety, that even though I was terrified of getting treatment, I knew I couldn't continue on the way I was going and have any kind of life. If you are like me, you probably also spend time trying to figure out if something is an obsession or a compulsion, and wanting to know for sure which it is. Another lovely complication of the OCD! Take your best guess.