I’m not one to generally give content warnings however…
This article is about my experience overcoming sensorimotor/somatic OCD.
The few people who I’ve told my story to found it helpful to learn about my experience and how I got over it.
However, some find reading about this type of OCD to be triggering as it deals with obsessive awareness of bodily sensations and functions which may bring on the awareness; usually briefly but not always.
Do what’s best for you.
You may be wondering how I could say I overcame sensorimotor/somatic/hyperfocus OCD (hereafter sensorimotor), a disorder which, not uncommonly, resurfaces.
Fair point. But to you I would reply that the fact that I am writing this demonstrates to me that I am in a different place with regard to this intermittent psychic torture.
Allow me to explain…
People with sensorimotor OCD experience an aversive, intrusive, maddening awareness of various bodily sensations or processes. Imagine every time you breathe, swallow, or blink you noticed it. A constant bodily function that’s supposed to be on autopilot suddenly grabs your attention every time like the ring of a text message.
Or maybe you feel your feet and it feels a little uneven. You breathe in and wonder if your breath was full enough. Or whether your trachea is open or closed. Or if there is a lump in your throat or a bubble under your tongue.
If it happens a few times, who cares. But when it happens a few times a minutes, for hours, for days straight it feels like torture. You fear that you’ll never go back to normal. You long for those amazing days before you noticed that first swallow.
Unlike other forms of OCD, for example contamination, there is at least a clear compulsion you could do to get very temporary relief or you could avoid your triggers by, for e.g. not using a public toilet. With sensorimotor OCD, you can’t avoid swallowing nor noticing it. I couldn’t identify the compulsion I could do or stop doing. What’s the exposure to help reduce your symptoms?
Unfortunately there is not a ton of research on sensorimotor OCD. Thousands of people have it in various forms, but It’s not super common. There’s prevailing clinical wisdom clunkily applying the exposure and response prevention model to it. But I wasn’t an exposure therapist then, just a lowly 23 year old with a BA in psychology.
My sensorimotor also included some earworms. Either particular words or thoughts that would keep popping in my mind and would become a theme. Words like “toast” for some reason, or the thought of death being infinitely alone in the dark with your thoughts. Not super pleasant.
It first happened shortly after graduating college. This gets a little personal, but you and I go way back. Basically, I noticed that when kissing my girlfriend at the time saliva would build up in the back of my throat. I would try to swallow it and wondered if she was noticing my swallowing…
And then I started noticing it.
Then a few times.
Then, I tried to not notice it… which you could imagine was not very successful.
Then I wondered how long I would notice it.
Then I wished it away.
Then it didn’t go away and I started to freak out.
Then the cycle repeats.
Between times spent with her, I continued to notice swallowing throughout the day. Sometimes for over an hour straight, sometimes a few minutes. But even when I didn’t have the thought, I would worry about getting the thought. I felt a barrage of anxiety punches to the gut that made me feel physically and emotionally ill.
I made the mistake of reading message boards about people who have suffered with this condition for years with no relief. Some were suicidal, other were desperate for help. Some were sold random unhelpful supplements or had courses of failed therapy. I feared I would share their fate.
What ultimately broke that particular spell came to me in a flash of divine epiphany. I said Fuck it. Let my girlfriend notice the swallowing. Let me notice the swallowing forever, I don’t give a shit. And I meant it and then it started to get better. I still noticed it here and there but knowing that it could subside gave me hope that It wouldn’t be a forever thing.
I was still afraid to various extents that the savage beast would wake up. That my acceptance may no longer be effective. It would pop up here and there, but looking back I would say I no longer met clinical criteria.
As luck would have it, I decided to become a psychologist – probably one of the best decisions of my life because being a shrink is awesome. As luck would also have it, after externing at an OCD specialty practice, I decided to become an OCD specialist.
And then one day, I worked with a patient who had the same sensorimotor swallowing symptoms I had. I thought the beast had died, but in working with this individual it came back ferociously. Worse yet, this time the acceptance trick wasn’t working. Ironic, since I had since been trained in Acceptance and Commitment Therapy.
I regretted taking on the case, but was committed to providing the best care I could. It was helpful for that person, but I was left back to square one, maybe even worse. What was most frustrating was the confusion that I was unable to fix myself with all my fancy therapy techniques that was helpful for others.
Since the re-emmergence of symptoms in 2020 until two months prior to this articles publication in 2023 I would sometimes go for a few weeks straight without symptoms. But during this whole time, when I wasn’t in a loop, I would actively try to avoid things that reminded me of it so as not to awaken the beast. I did not really tell anyone about it. How I wanted to be open about it to my colleagues, but I did not want to risk getting attention over it and in doing so causing a symptom spike. And I certainly was not going to write about it as I am doing now. I was hesitant to take on or supervise sensorimotor cases, but did so now and then, just because I felt uniquely qualified to help, understanding the condition academically and personally.
During this period of time when experiencing the symptoms as a psychologist, when I started to get into a sensorimotor loop, like noticing a string of swallows, I tried to ‘accept’ it. However, this is true for many acceptance strategies. You can’t ‘accept’ for the sake of the symptoms going away. As such, the acceptance is not actually acceptance, it’s another compulsive strategy disguised as a therapeutic technique. Additionally, you cannot ‘accept’ what you don’t actually accept. You cannot trick yourself into believing that you are accepting something when you don’t. I did not find it acceptable to have my conscious experience constantly interrupted. I did not find the waves of anxiety to be tolerable. I did not actually accept a future living in fear of the beast awakening and the symptoms returning in waves indefinitely.
This continued until about 2 months ago when I believe I got over it. I imagine you’re wondering how I could make such a bold declaration, after all there has been periods of time when it has not been a problem. Be that as it may, I will say now, for the first time, it finally feels different. I believe I have come to genuine acceptance, which indeed eliminated the symptoms, both in the present and my fear of their returning between symptom spikes. This is categorically new for me. The fact that I could write this piece, knowing that it could awaken the beast and honestly not care if the beast is awake makes me believe this is different. I don’t have a crystal ball so I cannot know for a fact if this will last forever, but I commit to providing an update if anything changes.
Here’s how I think I got over it.
I realized I wasn’t actually accepting the experience and the situation. I was telling myself to accept it so I wont be in emotional/physical pain anymore. Even the exposures I was doing, purposefully reminding myself to focus on my swallowing, was done for the sake of not noticing it or not feeling distressed about it anymore.
While I was well trained in ACT, I was misapplying the values portion as a more general concept vs. its specific life mission value set (see the tombstone or the retirement speech exercises). At a certain juncture in my flailing attempts, I somehow recalled the OG, Logotherapy creator, Victor Frankl. To save time I asked Chat GPT to explain Logotherapy and as usual it did a superb job:
Logotherapy is a form of psychotherapy developed by psychiatrist and Holocaust survivor Viktor Frankl. Central to this therapy is the belief that human nature is motivated by the search for a life purpose. Frankl argued that the ability to find meaning and purpose in life is a primary motivational force for humans. Unlike traditional psychotherapy that focuses on past experiences, Logotherapy emphasizes the future, particularly the meanings to be fulfilled by the patient in the future. It posits that even in the face of suffering and tragedy, individuals can discover significance and value in life, which can lead to psychological healing and growth.
I read Frankl’s seminal work Man’s Search for Meaning as an undergrad, but it was not taught in my graduate psychology work beyond a passing honorable mention. As the son of a Holocaust survivor, I found it very powerful and the ideas were always swirling around somewhere in the recesses of my clinical psychology mind.
While I would say I had been living life according to my general values – being a family man, doing meaningful work, etc. – I was less focused on my personal purpose /mission/ meaning in life. I can’t quite identify why I started asking myself these lofty, even cliche’ questions – maybe early mid-life crisis, who knows or Maybe life has a way of providing you with the discomfort necessary to start asking the hard questions.
Asking myself these questions and starting to formulate a working answer to this existential problem was helpful for the sensorimotor OCD and associated low mood and anxiety.
What, you may be wondering, is my personal mission?
None of your business!! It’s personal.
I don’t think revealing what I have found to be my working personal purpose will be helpful for you.I also think it’s something that will evolve as I evolve. In fact, it may confuse you into believing that there is something about the particular content of my discovered purpose which was convalescent in itself, but I believe the process of getting there, and being true to it behaviorally is way more important and helpful for you.
This is what was helpful for me in my personal exploration. Here are some questions you may want to ask yourself to get started:
What is unique about you?
What are things you can do that other people can’t?
What are unique experiences which shape how you see the world?
What is unique about your environment (local and beyond)?
What is unique about the time in which you are living?
What are you fascinated, even obsessed with?
What would you do if you had no fear of consequences?
What problems occupy your mind?
What keeps you up at night?
If you were omnipotent and can make one change, what would it be?
What excites you on a deep level?
What brings you a deep sense of joy?
What angers you?
What do you like being thanked for?
What do you want to be remembered for?
Why were you born?
Why are you living?*
You want your purpose to be both general and have specific implications for your behavior, both short term and long. You may want to think about it in written form as it could be elusive at first. It could also help you concretize the ideas for future reference should it feel unclear.
This was my personal process, and its not always clear, there is a right or wrong answer, though it felt right when I came to it. I also don’t know if it will change, but it works for me for now and I’ll continue searching as it evolves. Don’t be afraid to make a mistake. You’ll know if what you came to is wrong if you are bored by it and you still lay awake at night fixated about something else.
The searching process and finding my personal purpose helped me honestly accept sensorimotor OCD experiences for the first time. Because I can honestly say, as long as I am physically able to live my personal mission I don’t care if I notice my swallowing, blinking, breathing, the sounds of the refrigerator, the lump in my throat or the air bubble under my tongue, the word “toast,” the unevenness of my right foot, and there will be more. They just don’t stick. I even find them a little humorous (swallowing is kinda a weird thing, no?). I hope my own healing is permanent, I just don’t care whether or not it is because I know seeking and living my purpose will always be there.
I believe discovering one’s purpose can be helpful for many with sensorimotor OCD as well as any other form of OCD. Though, I am not naive to believe it will have the same effect on everybody.
If you or a loved one are suffering with this or any type of OCD, I hope you get the help you need to get over it. I hope this article was helpful in even the smallest of ways. (Writing it felt like one of the mini missions). Unfortunately, its a presentation even OCD specialists struggle to treat so make sure whoever you work with has successfully treated a bunch of sensorimotor/somatic OCD cases. Go to iocdf.org to find a good specialist.
*This is meant in the existential sense. If you are experiencing feelings of suicide please call 911 or go to your nearest emergency room.