Hyperawareness and Sensorimotor OCD are subtypes of Obsessive Compulsive Disorder that focuses on sights, sounds, and physical sensations.
“I wonder how I’ll start this article. How did I start all my other articles? It’s supposed to be about Sensorimotor and Hyperawarness OCD, but where do I start? I’m kinda congested today, so breathing makes a scratching, scraping noise, which is distracting and annoying. I wonder if other people think about that. Is that normal? Alright, I need to get back to work, but the echo-y internal sound of breathing in my ears won’t go away. Is it always there? How do I get it to stop? If it doesn’t stop, I’ll be too distracted to write my article. Darn. Now that I’ve been thinking about my thoughts and writing them down I can’t stop thinking about my thoughts. Stop thinking. STOP THINKING.”
A side effect of having a human brain is that we can think about anything! We can think about things have haven’t happened yet, or things that could never happen. If we wanted to, we can put all of our attention on a bodily sensation or function and think about what that feels and sounds like. We can even think about our own thinking.
While this may be a fun feature of our brain’s ability for many, it is experienced as an impairment and burden to some. In fact, people can experience these thoughts as constant, intrusive, and nagging obsessions that drain their energy and can leave them feeling hopeless that they will ever go away.
What is Hyperawareness and Sensorimotor OCD?
Hyperawareness and Sensorimotor OCD are two subtypes of Obsessive Compulsive Disorder (OCD) that pertain to an undesired and excessive amount of mental and emotional energy toward thoughts, sounds, physical sensations, bodily functions, visual anomalies, or energy level. This overattention to thoughts and sensory experiences falls in line with the OCD experience. Sufferers find that they are unable to shake off these thoughts despite a great deal of effort and they believe that if they cannot get rid of these thoughts that they will have a catastrophic impact on their future, their functioning, and ultimate happiness.
Hyperawareness Obsessive Compulsive Disorder
Hyperawareness OCD often refers to the excessive attention paid to external stimuli. Someone who experiences Hyperawareness OCD feels as if whatever their brain has fixated on is significantly louder, brighter, closer, persistent, occurring in greater frequency, and more distracting to them than to the average person. While not wanting to pay attention to these things, their brain has latched onto these very specific stimuli with a Kung-Fu grip that feels impossible to release.
Common objects of focus in Hyperawareness OCD can include highway noise, TVs in other apartments, people talking, screeching breaks, other’s keyboard typing, florescent lights, broken TV pixels, oscillating fans, etc.
Some obsessions within Hyperawareness OCD have even earned their own name. For example, Misophonia is the excessive awareness of sounds. This differs from Phobophobia, which is a fear of a particular sound. With Misophonia, people become too focused on a specific yet benign sound that has no objective offensive character or quality. Despite this, the sound somehow makes someone feel, well, miserable. For example, sitting too close to someone eating carrots, or another crunchy food, can feel physically grading, like there is no end to the sound, and seem like a concentration black hole sucking in all thought other than the CRUNCH CRUNCH sound. (This may also be from my personal experience)
In addition to external stimuli, Hyperawareness also refers to being overly aware of one’s thought process. The internal monologue of our thoughts is how we think, make decisions, and evaluate between choices. Someone suffering with Hyperawareness OCD will feel completely distracted by the internal thinking, thinking about the thinking, and the assumption that they shouldn’t be thinking about their thinking.
Sensorimotor Obsessive Compulsive Disorder
Sensorimotor OCD can be considered a more specific subtype of Hyperawareness OCD. Many people will simply categorize the Sensorimotor symptoms as Hyperawareness, and they wouldn’t be wrong. In fact, other writers may not even make a distinction between Sensorimotor and Hyperawareness. Think of Sensorimotor as the hyperawareness of bodily sensations and/ or functions.
Common Sensorimotor OCD symptom include excessive attention of one’s:
- Breathing (sensations, depth, quality, fullness)
- Blinking (frequency, intensity, sound, feeling)
- Eye floaters
- Heart beat (sound, consistency, situational context, sensation)
- Feeling of clothing on skin (weight, texture, fit, tags, seams)
- Joints popping or creaking
- Position of arms and legs
- Swallowing (amount, frequency, quality, pattern)
What Makes Hyperawareness and Sensorimotor OCD So Bad?
All OCD subtypes have their own feared outcomes that present the sufferer with possible consequences if they don’t avoid, check, get reassurance, or neutralize the fear. These “feared stories” are often in the form of an “If ___, then ____”, or “What if…” frame. Hyperawarness and Sensorimotor OCD generally focuses on the fear that the awareness of the thought or sensation will never go away, resulting in a lifetime of distraction, inability to be present for work or relationships, diminished quality of work and other endeavors, and an eventual life without happiness. All of this is feared unless they can get their obsessions to go away for good.
Compulsions for Hyperawareness OCD and Sensorimotor OCD
Compulsions are an attempt to regain the confidence that everything will be ok, that the attention to these thoughts and sensations won’t ruin their life, and that these thoughts will eventually go away permanently. Unfortunately, while compulsions may provide a temporary sense of relief, the ultimately solidify one’s attention on these obsessions, and eventually make the problem worse.
Since the subjects of the obsession are decidedly neutral (breathing, blinking, swallowing, etc.), the main compulsive effort is simply to get rid of the thought and overattention. The hope is that if the sufferer can get rid of the thought, even for a minute, that they can get back to their life. Some attempt to drown out distracting sounds with music. Others try to use meditation and mindfulness as a way of controlling their thoughts. Some become workaholics to constantly occupy their mind with occupational tasks. Others try to suppress their thoughts by effortfully shoving their thoughts out of their mind. Some suffers will change their whole wardrobe to avoid specific sensations. Some sufferers will see a long line of doctors to figure out if there is actually anything wrong with their bodily functioning.
These attempts, while hopeful, inevitably feed the obsession and make it worse. Instead of treating the thought and sensation as neutral and harmless, sufferers reinforce the feared association by treating the thought as something worthy of fear. Furthermore, attempts to suppress the thought by forcefully pushing the thought out of mind makes it more present in our attention.
Treatment for Sensorimotor OCD and Hyperawareness OCD
Sensorimotor OCD and Hyperawareness OCD can be treated using the combined approaches of Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness based approaches, such as Acceptance and Commitment Therapy (ACT).
CBT is often used as the overall framework of therapy as it helps someone reconsider the interpretation of their thoughts, leading them to a more rational understanding. Through cognitive restructuring, therapist and client work together to use reason to develop a grounded understanding of their thoughts that typically undermine the OCD’s anxious-based feared story. Using logic will not, however, reduce the level of discomfort with the feared story. Instead, it helps to build the client’s rational confidence as treatment progresses into mindfulness and ERP exercises.
Treating this subtype differs from other OCD manifestations. Typically, OCD subtypes are treated through exposure to the triggering item, situation, or action. Through continued exposure to these stimuli, the experienced anxiety slowly reduces through a processed called “habituation.” In Hyperawareness and Sensorimotor OCD, our focus is not on the specific sensations or thoughts themselves. Instead, the focus will be on the feared outcome of the sensations and thoughts. In other words, Exposure and Response Prevention exercises will focus on tolerating the fear that the awareness of sensation will in fact ruin one’s life. For example, accepting that the inability to avoid noticing eye floaters may have a negative impact on one’s career and personal life. The reality of these feared stories is of course illogical, without evidence, and often absurd. Nevertheless, it is the anxiety associated with the stories that must be inoculated.
Finally, Acceptance and Commitment Therapy (ACT) is used to help clients develop a more tolerant and accommodating perspective of their thought and physical sensations. Instead of viewing one’s thoughts and feelings as antithetical to happiness, success, and connection, ACT helps by providing some space between the thought and the client. This process helps the client see that the thought and sensation are just that, thoughts and sensations; not the enemy. When the awareness of triggering sounds, sights, or sensations are accepted as simply the result of the brain and nervous system perceiving the world, then they can be disconnected from their feared story (i.e. if I keep focusing on my breathing then I’ll never be focused on my life and will never feel happy again, etc.). Finally, the client then works to take this previously feared thought with them into their life and attempts to pursue their values and goals despite the periodic presence of the thought.
FearCast Podcast episodes relevant to Hyperawareness and Sensorimotor OCD:
The California OCD and Anxiety Treatment Center offers specialized therapy for Hyperawareness OCD Sensoritmotor OCD in its Fullerton offices. In addition to serving North Orange County, Los Angeles, and the Inland Empire, CalOCD offers online therapy, group therapy, and Intensive Out-Patient treatment.