8 Signs of Hyperawareness Anxiety: The Silent Struggle

Hyperawareness, also known as sensorimotor obsessive-compulsive disorder (OCD), is a mental health condition characterized by an excessive preoccupation with normal bodily functions and processes. Individuals with hyperawareness OCD experience obsessive thoughts and anxieties about automatic processes that would typically go unnoticed, such as blinking, breathing, or swallowing.

In this article, we will delve into the complexities of hyperawareness OCD, exploring its causes, common obsessions, and associated fears. We’ll also examine the compulsions that often arise in an attempt to alleviate the distress, as well as effective treatment approaches for overcoming this debilitating condition.

Understanding Hyperawareness and Sensorimotor OCD

Hyperawareness and Sensorimotor OCD are two closely related subtypes of Obsessive-Compulsive Disorder (OCD) that involve an excessive and undesired focus on normal bodily processes, physical sensations, and autonomic functions. These conditions are characterized by an intense preoccupation with thoughts, sounds, visual anomalies, or energy levels related to the body.

Hyperawareness OCD

Hyperawareness OCD often refers to the excessive attention paid to external stimuli or bodily sensations. Individuals with this condition feel that whatever their brain has fixated on, whether it’s a sound, physical sensation, or visual distraction, is significantly louder, brighter, closer, more persistent, occurring with greater frequency, and more distracting to them than it would be for the average person.

Sensorimotor OCD

Sensorimotor OCD can be considered a more specific subtype of Hyperawareness OCD, focusing primarily on the hyperawareness of bodily sensations and functions. Many experts categorize Sensorimotor symptoms under the broader umbrella of Hyperawareness, as the two conditions share a common core of excessive attention to bodily processes.

Common Sensorimotor OCD symptoms include an excessive focus on:

1. Breathing (sensations, depth, quality, fullness)
2. Blinking (frequency, intensity, sound, feeling)
3. Eye floaters
4. Heartbeat (sound, consistency, situational context, sensation)
5. Feeling of clothing on skin (weight, texture, fit, tags, seams)
6. Joint popping or creaking
7. Posture
8. Position of arms and legs
9. Swallowing (amount, frequency, quality, pattern)

While these bodily functions and sensations typically occur without conscious awareness for most individuals, those with Sensorimotor OCD become fixated on them, unable to divert their attention away from these automatic processes.

Relationship Between Hyperawareness and Sensorimotor OCD

Although some experts may not make a clear distinction between Hyperawareness and Sensorimotor OCD, the latter can be viewed as a more specific manifestation of the former. Sensorimotor OCD involves a hyper-focus on bodily sensations and functions, while Hyperawareness OCD encompasses a broader range of external stimuli and physical sensations.

Regardless of the terminology used, both conditions share a common thread: an excessive and distressing preoccupation with thoughts, sensations, or bodily processes that would typically go unnoticed by most individuals.

Common Obsessions in Hyperawareness OCD

Hyperawareness or sensorimotor obsessions are characterized by an excessive concern that one’s attention to some otherwise forgettable or involuntary bodily process will become totally and permanently conscious. In other words, individuals with this condition fixate on bodily functions that typically occur without conscious awareness for most people, leading to significant discomfort.

Common Experiences in Hyperawareness Obsessions

Individuals with hyperawareness obsessions often struggle with an excessive focus on the following bodily processes and sensations:

1. Blinking
2. Swallowing
3. Breathing
4. Heartbeat
5. Hunger levels
6. Bladder or bowel pressure
7. Itches or minor pains
8. Hair touching forehead, ears, or neck
9. Positioning of body parts (e.g., where the arms are in relation to the rest of the body, where the tongue rests in the mouth)
10. Items in the field of vision (e.g., the nose, eye floaters)
11. White noise (e.g., the hum of a refrigerator)
12. The very presence of thinking itself

While these bodily functions and sensations typically occur without conscious awareness for most individuals, those with hyperawareness OCD become fixated on them, unable to divert their attention away from these automatic processes.

Cross-over with Other Obsessions

Like any obsession, hyperawareness obsessions can overlap with other types of obsessions. For example:

• Hyperawareness of the position or sensations in the groin area is a common issue for those with obsessive fears related to sexual issues.
• Hyperawareness of sensations in the hands can be triggers for obsessive fears of harming oneself or others.

However, the primary focus of hyperawareness OCD is the obsessive concern with the awareness itself, rather than the specific bodily function or sensation.

Hyperawareness of External Stimuli

In addition to bodily processes, individuals with hyperawareness OCD may also experience an excessive focus on external stimuli. They may feel that whatever their brain has fixated on, such as highway noise, TVs in other apartments, people talking, screeching brakes, others’ keyboard typing, fluorescent lights, broken TV pixels, or oscillating fans, is significantly louder, brighter, closer, more persistent, occurring with greater frequency, and more distracting to them than it would be for the average person.

Misophonia: Excessive Awareness of Sounds

Some obsessions within hyperawareness OCD have even earned their own names. For example, misophonia is the excessive awareness of sounds. This differs from phobophobia, which is a fear of a particular sound. With misophonia, individuals become too focused on a specific yet benign sound that has no objectively offensive character or quality. Despite this, the sound somehow makes them feel miserable. For instance, sitting too close to someone eating carrots or another crunchy food can feel physically grating, as if there is no end to the sound, and it seems like a concentration black hole, sucking in all thought other than the CRUNCH CRUNCH sound.

Common Obsessions in Sensorimotor OCD

Sensorimotor OCD, formerly known as Somatically-Focused OCD, occurs when individuals become hyper-aware of their bodily sensations, body functions, and the internal sounds of thinking itself. This results in an excessive focus on these sensations, leading to repeated checking, monitoring, and analyzing of the sensations. This obsession with bodily sensations creates an increased amount of worry and uncertainty.

Common Sensorimotor Obsessions

Sensorimotor obsessions often involve an excessive preoccupation with one or more of the following bodily processes and sensations:

1. Breathing
   • Whether breathing is shallow or deep
   • Focusing on specific sensations associated with breathing
2. Blinking
   • Excessive awareness of how often one blinks
   • Preoccupation with the physical requirement to blink
3. Swallowing/Salivation
   • Hyperawareness of how frequently one swallows
   • Obsession with the amount of salivation produced
   • Fixation on the sensation of swallowing itself
4. Movement of the Mouth and/or Tongue During Speech
   • Excessive focus on the movements of the mouth and tongue while speaking
5. Pulse/Heartbeat
   • Heightened awareness of one’s pulse or heartbeat
   • Particularly noticeable at night while trying to fall asleep
6. Eye Contact
   • Unlike social anxiety-based concerns, this form involves an obsessive awareness of the eye contact itself
   • Fixation on which eye one is looking at when staring into the eyes of another person
7. Visual Distractions
   • Paying excessive attention to eye floaters (particulate matter drifting within the eye)
   • Hyperawareness of subtle eye movements, such as saccadic eye movements
8. Awareness of Specific Body Parts
   • Obsessive focus on the perception of certain body parts (e.g., the side of one’s nose while trying to read)
   • Hyper-awareness of particular body parts, such as feet or fingers

These obsessions often lead individuals to engage in compulsive behaviors, such as repeatedly checking or monitoring the sensations, attempting to distract themselves, or avoiding situations that might trigger the obsessive thoughts.

Suggestion for read: Understanding Psychological Disorders

The Fear and Anxiety in Hyperawareness/Sensorimotor OCD

At the core of hyperawareness and sensorimotor OCD lies a profound fear and anxiety surrounding the inability to disengage from intrusive thoughts and sensations related to automatic bodily processes. This excessive preoccupation with otherwise innocuous bodily functions stems from a deep-seated concern that the awareness itself will become permanent, leading to a lifetime of distraction, impaired functioning, and an overall diminished quality of life.

The Feared Outcome

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. Hyperawareness 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.

The Vicious Cycle of Anxiety

Anxiety, as is the case in other forms of obsessive-compulsive disorder, serves as the glue that binds particular thoughts to conscious awareness. Once a thought is linked with anxiety, the conscious mind keeps it ever present. This occurs because anxiety is part of the brain’s alarm system for danger.

The mind clearly does not want us to forget about any danger that may be lurking around. If a particular idea scares us, we tend to think about it over and over.

In sensorimotor obsessions, sufferers repeatedly attempt to shift their attention for fear that their sensory focus will become “stuck,” and they will not be able to concentrate fully on the task at hand. Here, the thought that “I’m never going to stop thinking about this” leads to immediate fears of impaired functioning. As a result of the pairing between this thought and a feared outcome, the mind holds on tightly to the very awareness that the sufferer is attempting to rid.

The Paradox of Hyperawareness

The paradoxical nature of hyperawareness and sensorimotor OCD lies in the fact that the more individuals try to disengage from the intrusive thoughts and sensations, the more entrenched these obsessions become. In a typical scenario, individuals begin to selectively attend to their swallowing, for example, and become anxious that they will become unable to stop thinking about their swallowing. Attempts to distract themselves fail, leading to higher levels of anxiety. This anxiety perpetuates the focus on swallowing, leaving them preoccupied and frustrated by their unsuccessful attempts to shift attention elsewhere.

The Underlying Fears

While hyperawareness obsessions may appear to be innocuous at first glance, they often mask deeper, more profound fears. Some related obsessive thoughts include:

• I will be permanently distracted by these thoughts
• I will never feel what it felt like to experience this automatically, without conscious attention
• I will be depressed forever because this thought will dominate my attention during meaningful experiences (e.g., my wedding and memories thereof will be ruined by my focusing on my blinking)
• I will embarrass myself socially because I can’t pay attention to anything but these thoughts
• I will have a mental breakdown, a panic attack, or become psychotic because of constantly thinking about this

These underlying fears fuel the anxiety and perpetuate the vicious cycle of hyperawareness and sensorimotor OCD, making it a debilitating and distressing condition for those who suffer from it.

Compulsions in Hyperawareness/Sensorimotor OCD

People with hyperawareness and sensorimotor obsessions often assume that they are not engaging in compulsions because the experience is primarily one of lamenting the intrusive thoughts and sensations. However, many compulsions drive these types of obsessions, and being able to identify and resist or interfere with them is key to overcoming this issue.

Common Compulsions

Some common compulsions associated with hyperawareness and sensorimotor OCD include:

1. Mental Checking
   • Repeatedly checking to see if the awareness or sensation is still present
   • Mentally or physically checking to see if the sensation feels “normal”
2. Ritualistic Repetition
   • Repeating activities like blinking, swallowing, or checking a specific number of times or in a ritualistic way to give oneself permission to stop thinking about it
3. Distraction
   • Relying heavily on distraction techniques to avoid having the intrusive thoughts or sensations
4. Reassurance Seeking
   • Seeking reassurance from others that the awareness will go away or that it’s normal to experience such sensations
5. Mental Rituals
   • Engaging in mental rituals, such as chants, affirmations, neutralizing statements, or other mental exercises to neutralize the fear of being permanently aware
6. Avoidance
   • Avoiding environments or circumstances where the awareness or sensation might become more pronounced
7. Mental Reviewing
   • Mentally reviewing how it must have felt before the hyperawareness set in, in an attempt to recapture that state

While these compulsions may provide temporary relief, they ultimately reinforce the obsessive focus on the thoughts and sensations, solidifying one’s attention on the obsessions and eventually exacerbating the problem.

The Compulsive Cycle

Compulsions are an attempt to regain the confidence that everything will be okay, that the attention to these thoughts and sensations won’t ruin one’s life, and that these thoughts will eventually go away permanently. 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.

Individuals may attempt to drown out distracting sounds with music, use meditation and mindfulness to control their thoughts, become workaholics to constantly occupy their minds with occupational tasks, or try to suppress their thoughts by effortfully shoving them out of their minds. Some sufferers may even change their entire wardrobe to avoid specific sensations or seek medical advice to determine if there is an underlying issue with their bodily functioning.

While these attempts are hopeful, they 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 it out of mind make it more present in their attention.

Embracing Awareness

To disengage from sensorimotor obsessions, sufferers must learn “the art of self-awareness.” They must learn how to invite in the sensory awareness with a relaxed and accepting posture, very much like the focus on diaphragmatic breathing during meditation.

Sensorimotor obsessions can be outsmarted by voluntarily paying attention to the relevant bodily process or sensation. Patients are instructed to allow the sensation to be present and to invite in any such awareness (exposure) with a casual, dispassionate focus. By purposely focusing on the sensations (exposure), patients stop relying on distraction (response prevention) as the tool for reducing anxiety. Repeated voluntary exposure to the sensations leads to diminished anxiety as patients grow accustomed to embracing any awareness without attempts to avoid or escape it.

Treatment Approach for Hyperawareness/Sensorimotor OCD

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a widely recognized and effective treatment approach for Hyperawareness and Sensorimotor OCD. The therapy involves several key strategies:

1. Cognitive Reappraisal: Individuals are encouraged to identify, challenge, and restructure their negative or unhelpful thought patterns related to the problem. This involves examining the evidence for and against their distressing thoughts and fears.
2. Cognitive Defusion and Acceptance: These techniques aim to normalize intrusive thoughts and feelings, helping individuals develop a more objective and detached perspective towards their obsessions and sensations.
3. Exposure and Response Prevention (ERP): This evidence-based technique, discussed in detail below, focuses on gradually exposing individuals to the feared stimuli or sensations while preventing them from engaging in compulsive behaviors or rituals.
4. Attention Training: Exercises are designed to improve attentional skills and behavioral flexibility, enabling individuals to shift their focus away from the obsessive thoughts and sensations when necessary.
5. Mindfulness Training: Mindfulness practices help individuals cultivate present-moment awareness and cognitive flexibility, allowing them to observe their thoughts and sensations without judgment or reactivity.

Within CBT, individuals explore the assumptions underlying their obsessions and compulsions, challenging the belief that they must control or eliminate certain bodily sensations or thoughts. The therapy aims to facilitate a more accepting and objective stance towards these experiences, reducing the associated distress and interference in daily functioning.

Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is a crucial component of CBT for Hyperawareness and Sensorimotor OCD. Unlike many other forms of OCD, the key to treating this subtype lies not in the exposure itself but in the response prevention.

The primary goal of ERP is to decrease an individual’s reactivity to bodily sensations. Since individuals with Sensorimotor OCD are overly aware of these sensations, the objective becomes to be aware of the sensation without paying it more attention than necessary.

1. Exposure: Individuals are gradually exposed to the feared bodily sensations or stimuli in a controlled and safe environment. This may involve intentionally focusing on their breathing, blinking, swallowing, or other targeted sensations.
2. Response Prevention: Individuals learn to resist the urge to engage in compulsive behaviors or rituals, such as mental checking, reassurance seeking, or avoidance, in response to the experienced sensations.

By repeatedly practicing exposure and response prevention, individuals learn to tolerate the discomfort associated with the sensations and break the cycle of obsessive thoughts and compulsive behaviors.

A key aspect of ERP treatment is helping individuals understand the difference between attention and awareness. While they may initially struggle to shift their focus away from the targeted sensation, over time, they learn to allow the sensations to be present without fixating on them or attempting to control them.

Mindfulness-based Approaches

Mindfulness-based approaches, such as Acceptance and Commitment Therapy (ACT), can be highly effective in treating Hyperawareness and Sensorimotor OCD. These approaches focus on developing psychological flexibility through several core processes:

1. Acceptance: Learning to accept bodily sensations and functions as natural and harmless, without attempting to control or avoid them.
2. Cognitive Defusion: Techniques to distance oneself from negative thoughts and reduce their impact, such as recognizing thoughts as mere mental events rather than facts.
3. Present-Moment Awareness: Encouraging mindfulness and present-moment focus, helping individuals direct their attention to current activities rather than obsessing over specific sensations.
4. Self-as-Context: Understanding that one’s identity is separate from their OCD symptoms, reducing self-stigma and promoting self-compassion.
5. Values Clarification: Identifying personal values and using them as a guide for meaningful actions, beyond managing OCD symptoms.
6. Committed Action: Setting goals based on personal values and taking steps towards them, despite the presence of OCD symptoms.

Mindfulness practices, such as body scans and breath awareness exercises, can help individuals develop a more fluid and accepting relationship with their bodily sensations. By cultivating a non-judgmental and curious stance towards these experiences, individuals can learn to observe them without becoming overwhelmed or engaging in compulsive behaviors.

The combination of CBT, ERP, and mindfulness-based approaches provides a comprehensive and tailored treatment plan for individuals struggling with Hyperawareness and Sensorimotor OCD. These evidence-based techniques aim to reduce the distress and interference caused by obsessive thoughts and compulsions, enabling individuals to regain a sense of control and improve their overall quality of life.

Overcoming Hyperawareness/Sensorimotor OCD

Understanding the Obsession

Sensorimotor obsessions involve an excessive focus on automatic bodily processes or discrete physical sensations. The common precursor is selective attention – any bodily process or sensation that one selectively attends to can form the foundation of this obsession. For instance, individuals may begin to selectively attend to their swallowing and become anxious about being unable to stop thinking about it. Attempts to distract themselves fail, leading to higher levels of anxiety, perpetuating the focus on swallowing.

Common sensorimotor obsessions include:

1. Breathing (whether shallow or deep, or other sensations related to breathing)
2. Blinking (frequency, physical requirement)
3. Swallowing/salivation (frequency, amount, sensation)
4. Movement of the mouth and tongue during speech
5. Pulse/heartbeat (awareness, particularly while trying to sleep)
6. Eye contact (awareness of the act itself or which eye one is looking at)
7. Visual distractions (eye floaters, subtle eye movements)
8. Awareness of specific body parts (perception of body parts like the nose, feet, or fingers)

The primary fear is that these automatic bodily processes or physical sensations will fail to return to their previous unconscious state, potentially “driving the sufferer crazy.” This fear is often accompanied by the broader concern that the obsession itself will be unending, a phenomenon termed “obsessing about obsessing” by Dr. Jonathan Grayson.

To disengage from sensorimotor obsessions, individuals must learn “the art of self-awareness.” This involves inviting in the sensory awareness with a relaxed and accepting posture, similar to the focus on diaphragmatic breathing during meditation.

Psychoeducation

The first stage of treatment focuses on teaching patients that selective attention to previously automatic or unconscious bodily processes or sensations is not dangerous in itself. Patients are reassured that once their anxiety dissipates, the sensory awareness will shift. This reassurance often sets the stage for “inviting in” the sensations as a means of reducing anxiety.

Exposure and Response Prevention

Sensorimotor obsessions can be outsmarted by voluntarily paying attention to the relevant bodily process or sensation. Patients are instructed to allow the sensation to be present and to invite in any such awareness (exposure) with a casual, dispassionate focus. By purposely focusing on the sensations (exposure), patients stop relying on distraction (response prevention) as a tool for reducing anxiety. Repeated voluntary exposure to the sensations leads to diminished anxiety as patients grow accustomed to embracing any awareness without attempts to avoid or escape it.

Body Scan and Mindfulness

Patients are often unaware of the changes in perception that occur when selectively attending to their bodies. These changes in awareness can be frightening, as they may represent an uncomfortable and disquieting level of awareness of previously unconscious bodily processes. Patients tend to believe that they must purposely shift attention away from these unusual or previously unnoticed sensations to restore them to their unconscious state.

Participation in a body scan can help patients fluidly move in and out of their awareness of these sensations without resorting to forced attempts. Mindfulness, the art of paying close attention to an experience without criticism, judgment, or defensiveness, can also play an important role.

Eastern meditative practices in mindfulness often involve choosing certain bodily processes as the focus of meditative practice (e.g., breathing, the rise and fall of the chest or stomach, sensations of air through the nostrils). Patients are instructed to allow their particular sensory preoccupation to become their meditative focus. They are to accept all sensations without criticism or judgment and observe any sensations with curiosity and interest. Over time, patients begin to experience a fading of sensory awareness (or much greater tolerance of it) as their anxiety diminishes, and their willingness to invite in the sensations grows.

Conclusion

Living with hyperawareness or sensorimotor OCD can be a challenging and distressing experience. However, it’s important to remember that these conditions are treatable, and with the right support and therapeutic interventions, individuals can regain control over their lives. Cognitive-behavioral therapy, exposure and response prevention, and mindfulness-based approaches have proven effective in managing obsessive thoughts and compulsions, fostering acceptance, and cultivating a more objective perspective towards bodily sensations.

At Inquire Talk, we understand the significance of mental health and well-being in relationships. As an online counseling and therapy platform, we are passionate about providing support and assistance to individuals navigating the complexities of their emotional lives. Seeking professional help and support is always a valuable resource in managing stress and promoting emotional well-being. The journey towards overcoming hyperawareness or sensorimotor OCD may be challenging, but with perseverance and the right support, individuals can find relief and regain a sense of control over their lives.

FAQs

What are the indicators of hyperawareness anxiety?

Hyperawareness anxiety manifests through a variety of symptoms, including but not limited to:

• Excessive awareness of blinking, swallowing, and breathing.
• Constant monitoring of heartbeat and hunger levels.
• Sensitivity to bladder or bowel pressure.
• Noticing itches or minor pains more than usual.
• Being overly aware of hair touching the forehead, ears, or neck.

How can one manage and reduce hyperawareness?

To cope with hyperawareness, consider adopting the following approaches:

• Remain calm and practice slow, deep breathing.
• Look for factual evidence before responding to a situation.
• Take a moment to pause before reacting.
• Recognize and acknowledge fears or intense emotions without succumbing to them.
• Practice mindfulness to stay present in the moment.
• Establish clear boundaries with both others and yourself to maintain mental health.

What causes someone to be extremely aware of their surroundings?

Extreme awareness or hypervigilance is often triggered by trauma. This heightened sense of constantly scanning for potential threats is common among individuals who have experienced combat, abuse, or have posttraumatic stress disorder (PTSD). Various traumatic experiences can lead to PTSD, contributing to a state of constant vigilance.

Why is Obsessive-Compulsive Disorder (OCD) categorized separately from anxiety disorders?

OCD is distinguished from general anxiety disorders because it involves specific patterns of obsession and compulsion, which are not present in typical anxiety. As Ibrahim notes, it’s possible to experience anxiety without the obsessive and compulsive behaviors characteristic of OCD. Research indicating differences in brain chemistry and function among those with OCD further supports its classification as a distinct diagnosis

Inquire Talk certified therapists who you can get in touch and book a therapy session with:

Dr Simon Cassar

Glen Gibson

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