Most people have experienced transient problems of sensory hyperawareness at some point in their lives. Stuffy noses, irritated eyes, rashes, coughing, and similar symptoms represent normal sensory annoyances that can preoccupy individuals for short durations. For some individuals, chronic allergies, pain syndromes, and other medical problems can cause sustained hyperawareness. However, for a minority of people, their awareness of sensori-motor phenomena is associated with anxiety and preoccupation severe enough to warrant a diagnosis of obsessive-compulsive disorder (OCD). This is called “sensori-motor OCD” (or somatic-focused OCD). It is a less common obsession that occurs when a person experiences heightened awareness of an involuntary bodily sensation or activity. (We refer to a sensation for short as these are the most common, but it can also be an activity like breathing).

Typically, the preoccupation and focus are on the following:

  • breathing (doubts about whether you are breathing correctly or at the right depth or rate or whether it feels right)
  • swallowing (being unusually aware of the sensation of swallowing)
  • blinking (doubts about how you blink, or how often)
  • the movement of your mouth or tongue when speaking
  • the sensation of clicking in your joints
  • eye contact (for example the fear of staring into the eyes or at the breasts or genitalia of another person)
  • the temperature of your body and, e.g., feeling excessively cold
  • visual fields (e.g. paying attention to floaters or something in your peripheral vision).
  • awareness of the side of your nose when reading
  • the sensation of clothes on your body
  • the sensation of one’s anus
  • intrusive sounds or songs that keep playing in your head.

Sensorimotor obsessions and doubts usually centre on the concern that

  • you will be unable to stop focusing your attention on the physical sensations and will persist forever
  • you will not be able to “feel right”
  • it will make you go mad
  • you will stop breathing or lose some function related to the sensation

Intellectually, you ​may “know” that the sensation or movement is irrelevant, but it still feels important, and you have doubts. OCD is often called the doubting disease, and the greatest distress is often the “not knowing” what will happen and not being in control of your bodily sensations. These are the things anu therapy will help you give up​.

People with sensori-motor OCD are constantly trying to avoid being aware of the sensations; they may distract themselves (a form of avoidance). Unfortunately, this makes it worse in the long term. Compulsions are usually limited to repeated attempts to feel “right” or to check if the sensation is still there.

Sensori-motor obsessions are less common than other forms of OCD but are just as distressing and disabling to the sufferer.

A key process is called “selective attention.” This means focusing on specific stimuli while ignoring others. In anxiety, this means focusing on possible threats and filtering distractions. This tends to magnify and increase the awareness of possible threats. This is an important skill for humans to have when there are predators or someone who could harm them. The problem is that in sensorimotor OCD, it is focused internally, and there is no threat. Any bodily process or sensation to which one selectively attends can be the basis of this obsession. In a typical scenario, individuals begin to selectively attend to their swallowing and become anxious that they will be unable to stop thinking about it. Attempts to distract themselves fail, leading to increased anxiety levels. This anxiety perpetuates the focus on swallowing, leaving them frustrated by unsuccessful attempts to shift their attention elsewhere. These sensations do not of course require monitoring because these activities are automatic.  They are things that you have been doing since birth and do not require your attention.

Treating sensori-motor OCD

This is the same treatment as for other types of OCD, although there has been no research that has recruited people with sensori-motor OCD into a trial as it is too uncommon. Therefore, SSRI medication ​may help alleviate anxiety and improve the problem. Cognitive behaviour therapy can also improve your symptoms but is also challenging and requires persistence. We discuss some of the principles below.

A therapist would help identify ​the meaning of focusing on your sensations, for example, what your greatest fear would be if you could not monitor your breathing, blinking, swallowing, or staring. They would then help you find an alternative explanation for the motivation for focusing on your bodily activity (for example, that you are fearful of the sensation lasting forever and that you are trying too hard to prevent it). This explanation (commonly referred to as Theory B) is then tested in therapy. It will be important to fully accept and not respond to your doubts (e.g., “my life will be ruined,” “I’ll never have peace of mind,” “I’ll never be able to get rid of this problem,” or “It will never go away”). These relate to intolerance of uncertainty. The future is not your business and is not in your control. The more you try to work out what will happen or control the sensation, the worse it will get.

Distracting yourself by focusing on activities may sometimes be a way of avoiding other difficult issues or emotionally linked to memories that may be troubling. These may need to be processed emotionally, such as imagery rescripting.

The principle to follow in therapy is to simply notice the sensation without judgment and without trying to escape or control the sensation or the activity. We know that trying not to think about one’s sensations is part of the problem. The key is to notice and acknowledge the intrusive sensation (a bit like smiling at a stranger that you walk past on the street) but not to engage with it. That is, you do not start talking to the stranger or look at them closely. It is not helpful to answer your doubts, reassure yourself, or rationalise your fear. It is important not to distract yourself in response to the sensations (but distraction might be helpful to stop ruminating about the sensation). It is also important to do the things in life which you are avoiding or that are important to you, despite the intrusive sensations and movements.

Sensory obsessions can be outsmarted by voluntarily paying attention to the relevant bodily processes or sensations. The trick is to allow the sensation to be present and invite any awareness (exposure) with a casual and dispassionate focus. By purposely focusing on the sensations (exposure), you will stop relying on distraction or trying to feel right as a tool for reducing anxiety. The aim here is to feel “not right” or “wrong”.  Repeated voluntary exposure to sensations leads to diminished anxiety as you become accustomed to embracing awareness without attempts to avoid or escape it. Additionally, you may be asked to recall the sensations and accompanying fears throughout the day.

In summary, you can overcome sensori-motor OCD, but it is tough work that requires a lot of persistence and courage.

David Veale 14.11.2026 www.veale.co.uk