Sensorimotor OCD & Social Anxiety Differential Diagnosis: “Obsessive Swallowing”

Posted by in ERP, Obsessive-compulsive disorder (OCD), Social Anxiety Reader Question: For the past year, I have been dealing with OCD-related sensorimotor obsessions focused on swallowing. My symptoms started during a class discussion in which I noticed myself swallow. Since then, whenever I am in a lecture or quiet place surrounded by people, I become deeply focused on my own swallowing and worry that others will notice my swallowing and then judge me. I am practicing meditation and daily exposures in which I sit down in a quiet room and intentionally invite the swallowing in. I also purposefully invite the swallowing in throughout the day, even when I am in the presence of friends. I try to be mindful of my swallowing without doing anything to avoid it or mask it. Even though my awareness of swallowing has not entirely gone away, the anxiety associated with it has decreased significantly. However, I find myself feeling impatient and worried on the random days when my OCD-related anxiety flares up. For me, the most difficult situations continue to be one-on-one conversations, especially when I notice other people swallowing after I do. This makes me worry that I am spreading the condition, even though I know rationally that this is not possible. Do you have any recommendations for how to deal with OCD-related swallowing obsessions when they are triggered by interactions with friends? Should I seek professional help to address my sensorimotor obsessions and compulsions? I have always felt like a very confident and outgoing person, but this frustrating obsession has kept me from being my normal self. Your general approach of allowing yourself to focus on the swallowing is sound as long as you are not doing anything to intentionally change the behavior (i.e., trying to swallow with less force or with less sound) or “perfect” the behavior. However… Based on your description, it is likely that you are experiencing significant symptoms of social anxiety in addition to OCD-related symptoms. It is also possible that your symptoms might be primarily social in nature, rather than being OCD-based. This important differential diagnosis issue should guide treatment selection. Social Anxiety vs. Sensorimotor OCD Obsessions/Compulsions: Treatment Implications Unfortunately, meditation and imaginal exposure will not address the social aspects you’ve described. You must specifically target these social situations directly in order to habituate to your fear. Your in vivo exposures should address the mistaken belief that swallowing loudly will lead to a negative outcome...
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Treatment for Body-Focused Obsessions & Compulsions in OCD (e.g., Swallowing, Breathing, Blinking)

Posted by in ERP, Obsessive-compulsive disorder (OCD) This post is the last in a series of posts discussing body-focused obsessions and compulsions (aka, sensorimotor, somatosensory, or somatic obsessions and compulsions) in obsessive-compulsive disorder (OCD). This series was inspired by an original article written by Dr. David Keuler for OCDchicago.org. You can access Dr. Keuler’s excellent article here. Ruling out Medical Causes for Body-Focused Obsessions & Compulsions in OCD (sometimes called Sensorimotor or Somatic Obsessions) Before we begin discussing cognitive behavioral treatment for body-focused obsessions and compulsions, it is important to note that there are many non-psychological causes of physiological symptoms. Consequently, it is essential to be evaluated thoroughly by a medical doctor in order to rule out any possible physiological causes for your symptoms. If a medical disease is responsible for your issues with swallowing, breathing, blinking, or moving, the techniques I will be discussing below are inappropriate and may prevent you from getting the medical help you need. There are a variety of serious neurological conditions that can cause these types of symptoms, and it’s important that you rule these out prior to seeking a psychotherapy-based solution. In some cases, specialty medical providers might also be consulted to rule out health-related problems. For example, in the case of swallowing issues, it might be useful to consult with a physician who specializes in ENT (ear, nose, and throat) issues, a gastroenterologist, or a neurologist. Confirming an OCD Diagnosis Assuming that your healthcare providers have ruled out medical causes for your symptoms, you should establish a relationship with a psychologist to make sure that your symptoms fit the diagnostic profile for OCD. A trained anxiety specialist can help you differentiate between specific phobias, panic, obsessive-compulsive disorder (OCD), and other anxiety-related conditions. In comparison to some of these other conditions, OCD is more likely to be associated with generalized and pervasive fears, fears that span multiple domains, fears that jump from domain to domain over time, and (in the case of body-focused OCD) the specific fear of being unable to redirect your attention away from physiological processes. Moreover, in almost all cases, OCD will be associated with both obsessions (e.g., intrusive thoughts, impulses, or images) and compulsions (attempts to reduce the anxiety associated with your obsessions). A simple way to distinguish an obsession from a compulsion is by asking yourself the following two questions: What increases my anxiety? (These are your obsessions.) What do I do to try...
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OCD Core Fears Related to Body-Focused Obsessions & Compulsions (e.g., Swallowing, Breathing, Blinking)

Posted by in Obsessive-compulsive disorder (OCD) This post is the second in a series of posts discussing body-focused obsessions and compulsions (aka, sensorimotor, somatosensory, or somatic obsessions and compulsions) in obsessive-compulsive disorder (OCD). This series was inspired by an original article written by Dr. David Keuler for OCDchicago.org. You can access Dr. Keuler’s excellent article here. OCD Core Fears Related to Body-Focused Obsessions (also called Sensorimotor or Somatic Obsessions) In Part 1 of this series of posts, I discussed the basic characteristics of body-focused (also termed sensorimotor [Keuler, 2011], somatosensory, or somatic) OCD. This type of OCD is extremely distressing and is associated with hyperawareness of particular bodily processes, urges, or sensations. Obsessions and compulsions often focus on breathing, swallowing, tongue movements, blinking, or other bodily phenomena (Keuler, 2011). In clinical terminology, obsessive-compulsive disorder is a heterogeneous disorder. This means that different people have different combinations of OCD symptoms. Despite this variability, many individuals with body-focused, sensorimotor OCD share common fears related to their symptoms. OCD worry about having the symptoms last forever (Keuler, 2011). What if my symptoms never go away, and I have to live the rest of my life like this? What if life is never satisfying again? What if I can never engage in [insert specific activity] without thinking about this? (Common examples include sleeping, eating, speaking, reading, or writing.) What if I lose my job (or fail out of school) because of this? What if I can never focus again? What if I can never sleep again? What if my mind is never “at peace” again? OCD worry about the underlying cause of the symptoms. Why am I having these symptoms? There must be something seriously wrong with me. What if I have a brain tumor that is causing these symptoms? What if I have schizophrenia or another type of severe mental illness? What if I have brain damage in the parts of my brain that control these processes (e.g., the medulla oblongata or cerebellum)? OCD worry about specific feared outcomes. What if I choke and die because I didn’t chew my food enough? What if my heart stops beating? What if my heart is beating at the wrong rate? What if there’s something wrong with my heart? What if I stop breathing? What if I’m breathing at the wrong rate? What if there’s something wrong with my lungs? What if I’m damaging my eye muscles because I’m blinking too...
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Body-Focused Sensorimotor Obsessions & Compulsions in OCD (Swallowing, Breathing)

Posted by in Obsessive-compulsive disorder (OCD) This post is the first in a series of posts discussing body-focused obsessions and compulsions (i.e., sensorimotor obsessions and compulsions) in obsessive-compulsive disorder (OCD). This series was inspired by an original article written by Dr. David Keuler for OCDchicago.org. You can access Dr. Keuler’s excellent article here. Body-Focused Obsessions and Compulsions in OCD (sometimes called Sensorimotor, Somatosensory, or Somatic Obsessions/Compulsions) As I have mentioned previously, one particularly distressing symptom of obsessive-compulsive disorder (OCD) can be hyperawareness of particular bodily sensations. Body-focused obsessions (also called sensorimotor obsessions (Keuler, 2011) or somatosensory obsessions) often feel intolerable and typically involve getting your attention “stuck” on thinking about or analyzing particular autonomic processes. Thoughts may become fixated on one’s breathing rate, heart rate, swallowing, blinking, eye “floaters”, or flickering of the visual field (Keuler, 2011). Sufferers frequently label the problem as conscious breathing/conscious swallowing/conscious blinking, obsessive breathing/obsessive swallowing/obsessive blinking, or compulsive breathing/compulsive swallowing/compulsive blinking. Although for most individuals these processes occur automatically below conscious awareness, individuals with this form of OCD find themselves acutely and frustratingly aware of their own bodily sensations. People with these obsessive-compulsive symptoms attend to how often and how “completely” these processes have occurred. For example, individuals with respiration/breathing-related symptoms often try to consciously control their breathing rates, as well as how “fully” each breath is inhaled and exhaled. Obsessions and compulsions involving breathing, swallowing, and blinking are quite common in this form of OCD. However, other individuals may over-attend to fullness and other sensations in the bladder, stomach, or digestive system. Still others find their attention gets overly focused on the urge to burp or belch. Another different, distressing symptom involves analyzing the amount and frequency of eye contact with other people (Keuler, 2011). Doubt and uncertainty about how often and how intensely to make eye contact can lead to avoidance of other people, which may disrupt performance in work, school, and social settings. Additional examples of body-focused obsessions and compulsions include paying excess attention to how your tongue moves when eating or speaking, the timing of your speech, the amount of saliva in your mouth, the sound you hear when swallowing or chewing, how your teeth feel when your mouth is closed, or how your skin feels as it brushes against your clothing. Although compulsions associated with these symptoms often involve consciously controlling these processes, mental rituals occur as well. These include repeating certain words or phrases...
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