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Treatment for Body-Focused Obsessions & Compulsions in OCD (e.g., Swallowing, Breathing, Blinking)

Treatment for body-focused OCD (ERP)

Treatment for body-focused OCD is paradoxical and involves intentionally leaning into your symptoms rather than away from them.

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 Beyond OCD. 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 to relieve this anxiety? (These are your compulsions.)

Compulsions may be observable behaviors or mental acts. Someone who is afraid of choking might avoid chewy foods, live on a mostly liquid diet, and count the number of times he or she chews before swallowing. Obsessions and compulsions also exist for individuals who get “stuck” on physiological processes like breathing, blinking, or swallowing. The compulsion (or ritual) in this case involves the strategies that the individual uses to reduce his/her anxiety. These strategies might involve exercising control over the sensation (attempting to blink, breathe, or swallow at the “proper rate”), analyzing the symptom to determine if it’s “normal”, or trying to forcefully distract oneself from thinking about the symptom. Although these strategies may work for a short time in terms of reducing anxiety, ultimately they are doomed to fail and can actually strengthen your symptoms.

Exposure and Response Prevention (ERP) for Body-Focused Obsessions & Compulsions in OCD

I have talked a lot about exposure and response prevention (ERP) in earlier blog posts, but it’s worth revisiting briefly in the context of body-focused obsessions and compulsions because many individuals with these types of symptoms have no idea they are experiencing symptoms of OCD. As a consequence, they never learn about this evidence-based treatment. ERP is a strategy that allows you to break the anxiety cycle that is maintaining your symptoms. Only by short-circuiting this anxiety cycle will your symptoms ultimately decrease.

As is pretty obvious from the name, exposure and ritual prevention involves two essential components: 1) exposure, and 2) ritual prevention. Exposure involves intentionally confronting situations that you know are likely to increase your fear and anxiety. Ritual prevention involves choosing to sit with your anxiety (without resisting it) and letting go of the unhelpful strategies (rituals) that are maintaining the cycle. When you do this, you will naturally feel more anxious at first. However, with time, repetition, and practice, your fear will decrease. Because fear is what maintains your symptoms and causes your attention to lock onto your physiology, decreases in fear will lead to decreases in your symptoms.

Your ERP should involve several discrete steps.

1. Setting a Target Goal
2. Identifying Anxiety Triggers
3. Systematically Confronting Anxiety Triggers Without Avoiding

Let’s walk through a hypothetical example of an individual whose attention gets stuck on his breathing behaviors. This individual reports that he cannot stop thinking about breathing. He feels that he is constantly aware of his breath and often is exerting voluntary control over when to breathe and how deeply to breathe. He also perceives a strong, near-constant urge to breathe, which he responds to by taking a breath. This is followed by attempts to fully exhale all the air from his lungs. In addition to being hyper-focused on breathing, he worries that he is not breathing at the proper rate which might have medical consequences (i.e., hypoxia resulting in brain damage). He states that his life is falling apart and that he cannot function at work due to the fact that nearly all of his day is spent analyzing and controlling his breath.

Body-Focused Obsessions & Compulsions in OCD: Setting Appropriate Goals (Step 1)

ERP often involves switching up your goals. Many individuals come to therapy with the immediate goal of reducing the attention they pay to their symptoms and/or reducing the symptoms themselves. Although these goals are understandable, they are unattainable at this juncture and will only lead to frustration. Early in your recovery, such goals are unrealistic. Remember, it is fear that maintains your attentional hyper-focus on your symptoms.

Here’s a more appropriate initial goal for this hypothetical case: feeling less distressed when you notice your breathing. Think of how much better it would feel if your hyper-focus was not accompanied by worry and distress. If you adopt something like this as your goal and work on it through ERP, eventually you’ll also reap the benefit of reduced attention to your symptoms.

Body-Focused Obsessions & Compulsions in OCD: Identifying your External Triggers (Step 2a)

In order to be effective, ERP needs to target your specific obsessional triggers. What is it that “sets off” your symptoms? For some individuals, triggers are external events or situations. For example, for people whose symptoms focus on swallowing, symptoms may be triggered by swallowing events like eating, drinking, or getting ready to speak. In the case of breathing, symptoms may be triggered by high intensity (e.g., exercise) or low intensity (e.g., lying in bed getting ready for sleep) activities. It is during these times that your attention is more likely to get stuck on your symptoms. If you can’t immediately identify your external triggers, track your symptoms over the course of a day. Identify when your symptoms occurred, where you were, and what you were doing. Never assume that you lack external triggers. If you fail to identify and address important external triggers, you are likely to have a suboptimal response to treatment.

Body-Focused Obsessions & Compulsions in OCD: Identifying your Internal Triggers (Step 2b)

Not all triggers are external. Sometimes thoughts just pop into our heads for no apparent reason. In these cases, the thoughts themselves are considered internal triggers. It’s still a good idea to track your symptoms over the course of a day and notice the characteristics of situations that are likely to be associated with internal triggers.

In our hypothetical case, external triggers involved walking up flights of stairs, getting ready for bed, situations involving frustration (in which the person would strongly exhale), and quiet places. Internal triggers were also quite common throughout the day, especially when the individual was at work.

Body-Focused Obsessions & Compulsions in OCD: Systematically Confronting Your Anxiety Triggers Without Avoiding (Step 3)

This is the step that actually involves ERP. Now that you have identified your internal and external triggers, you want to begin systematically facing these triggers without engaging in any rituals or escape behaviors. You should confront the easiest (least scary) trigger first and then gradually work on more challenging triggers. Your goal in all of these situations is to purposefully direct your attention to your symptoms and keep it there as long as it takes for your anxiety to decrease (“habituate”).

Remember, at this stage of treatment, your goal is to work on being less distressed by your symptoms, not to decrease the symptoms themselves. Purposefully directing your attention to your symptoms might be challenging at first, but it will get easier with practice. Make sure that you leave adequate time for your anxiety to decrease. Don’t attempt these practices when you’re busy with other things, multi-tasking, or having to interact with other people. Ideally, you should set aside time to be alone in a quiet place and work on feeling less afraid of your symptoms. To help keep you from getting distracted so that you can maximize your exposure time, it’s often helpful to have a looped recording playing in the background (“I am paying attention to my _______. The symptoms I am noticing are ________, __________, and ___________.”)

Habituation can be quick (within minutes), or it may take several hours. The key is to stick with the exposure until you have noticed some measurable decrease in your anxiety. A good rule of thumb is to stick with the exposure until your anxiety has decreased by half. At this stage, your anxiety is unlikely to decrease entirely, but repetition of the same exposure on different days will help it decrease even further. Never discontinue an exposure when your anxiety is increasing. In order to be successful with ERP, you must be more stubborn than your anxiety and stick with the exposure until you have noticed at least a small decrease in your fear.

For example, someone who is triggered by physical sensations in their throats might consider wearing a scarf to help direct attention to the throat area while listening to a loop tape to keep their attention focused on their symptoms. If this person is also triggered around mealtimes, he or she might consider purposefully eating sticky, dry foods like peanut butter without an accompanying drink. All exposures should be conducted mindfully-you should purposefully pay attention to all the physical sensations you experience rather than trying to ignore or suppress them. Internal triggers can also be addressed through exposure. In the case of a stubborn thought that keeps reoccurring, you might consider recording it and listening to it on a loop tape.

As discussed previously, somatic obsessions are also associated with very different feared outcomes. Someone who is worried that s/he might choke should approach exposure differently vs. someone who is worried that swallowing might be the sign of a serious illness (e.g., Lou Gehrig’s disease) vs. someone who is worried that they will have to live the rest of their lives noticing every swallow. One’s specific fears need to be targeted via imaginal and in vivo exposures.

The person in our hypothetical case might benefit from the following exposures:
1. Breathing the “wrong way” on purpose for an extended period of time.
2. Breathing through a straw or coffee stirrer.
3. Performing an extended handstand.
4. Going snorkeling.
5. Sleeping while wearing a stethoscope.
6. Wearing a girdle.
7. Hyperventilating on purpose.
8. Going for an extended run.
9. Exercising on a Stairmaster.

Loop tapes might accompany any or all of these activities. For treatment to be effective, this person must also abstain from any rituals used to prematurely “escape” from their anxiety (distraction, over-controlling breath, counting breaths, analyzing breaths, etc.). The overarching goal of all of these exposures is to become better at tolerating variability in breath, to be less afraid of changes in breathing, and to develop more confidence in the automatic, biological regulation systems that our bodies use to maintain homeostasis.

Due to the complex and often-changing nature of this form of OCD, I strongly encourage individuals with these symptoms to work closely with a therapist who specializes in OCD treatment. Treatment works, but it can be very tough to do it alone without professional guidance.

Questions? Comments? Tips for using ERP to combat your body-focused obsessions and compulsions? Share below.

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  1. Thanks a lot for the last article.
    At first excuse me for my poor english.
    I have swalowing obsession and my wrong ritual is swallowing multiple four times to feel better, but as you know this wrong cycle continues.
    Previously I had breathing obsession, blinking obsession, feeling shoulders touch my dents with tongue and neck obsession in same ritual manner (breathing four times, blinking four times more and more and … ) . I have 30 years old, and 13 years suffering from OCD.
    I am married , MS degree in engineering , everybody thinks that I am very happy but I am not. I prefer to be dead. I am going to pscotherapyst and eat 80 mg fluoxetine per day during last 3 years. Buy I have huge priodic recurrent obsession and compulsion.
    I have read alot of books and articles ad find your article more relevant to my problem. In my country I have referred to lot of phsycologist but I think their knowledge to treat my problem is outdated and wrong, so I should try ERP by myself, and as you said it is very difficult.
    Know kindly tell me about ERP details to consider swalowing obsession and my wrong ritual in swallowing for multiple four times.

    • Hi Mehrabi,

      Thanks for reading. I’m glad that you found the article to be helpful. Swallowing obsessions can be very different for different people, and it’s important that your exposures are designed to target your particular symptoms. From your post, it sounds like your symptoms involve completing behaviors a specific number of times until it “feels right” as opposed to the fear that your attention will get “stuck” on your swallowing. If you are dealing with a “not just right” symptom, your best initial strategy might be to work on changing the ritual. Your goal should be to better tolerate the anxiety and discomfort you feel whenever you modify the ritual. Ultimately, you will want to refrain from these rituals entirely.

      Begin by tracking your current symptoms. Record how often you are getting triggered and identify what activities/places are associated with your symptoms. This will help you establish a baseline that will let you know if you’re making progress.

      You should start with response prevention exercises that are less difficult and that are likely to be successful. Start small. Set a goal that reflects a small, positive change (keeping your initial baseline in mind). Depending on this baseline, you might consider working on swallowing only three times when triggered. If this is too hard, you might start with varying the amount of time between swallows. Do whatever you can to delay and disrupt the normal rhythm of the ritual.

      Try this several times a day, and track your results. It should get easier and less distressing with regular practice. Once you are habituating to your anxiety and better tolerating the discomfort, you can increase the difficulty of the exercises.

      I can’t overestimate the importance of finding a good psychologist. You might consider contacting the International OCD Foundation ( to see if they have any recommendations for providers in your country.

      Wishing you the best with this!

      • Hi Steve
        Thanks a lot for your valuable consulting.
        I try my best to exercize these ERP techniques.
        Best Wishes.

    • Thank you so much Dr. Seay! That was a wonderful piece. I am suffering from this type of OCD since perhaps I was 17 and now I am 50! Over the years, I have met several psychiatric consultants, but none could exactly diagnose the problem. Perhaps I was attracted to the female body parts when I was young even while I was caught in the moral dilemma of such act being a taboo and so they will think badly about me. In the process, I started worrying all the time where my eyes were looking. Perhaps, to internally justify this as an impartial ‘eye thought process’, I started worrying about my eye focus even when seeing men, later animals and now even inanimate things. Anything around the corner of my eyes distract so much that I worry whether I am actually seeing them directly. It feels as if these things/parts are cutting my eyes into half.

      This has been the constant problem whenever I interact particularly with women for obvious reasons of my being a male. My observation is that they have difficulties in maintaining the conversation without adjusting their dresses, but all the same do not seem to be disgusted with me. Perplexed, recently, I turned on the camera in my laptop while talking to a female colleague and replayed the recorded video later. I found that my eyes did not directly focus on the parts I was imagining for good part of the entire conversation (may be in a few frames only). I keep avoiding, to the extent feasible, interactions particularly with women. Plainly scared to meet anyone, but can’t avoid interactions altogether in my daily life. Surprisingly, despite this severe internal turmoil, I have never had any suicidal thoughts and doing well in my professional career. I am married with two children and no one in my family, friends or relatives has ever asked me about this though their “dress adjusting” keeps happening with me.

      As I am having this highly disturbing thought affecting since morning to night everyday, I will be grateful if you would advise how I can overcome this monster. Thank you so much!

      • SRINIVAS. OMG. I’m going exactly through the same type of OCD. I was feeling so lonely with this it’s so debilitating I haven’t told any one. I’m not attracted to women at all but I had an experience were I had someone doing a specific exercise and that woman was showing to much I think is natural to look, but then I think she adjusted her shirt and I started thinking what if she thought that I was checking her out,then the OCD started. Me always trying so hard not trying to see that area and now I have hyperawarenes of that part. It’s so hard to interact with women now I hate it so bad. I was normal year ago now I have this thing stuck with me so Sad. They also adjust their dress 🙁 any input from you Steve. It’s so hard to try ERP in this circumstance

        • You might find it helpful to implement some strategic exposures in this area. If it’s hyperawareness-based, the goal would be to get better at non-judgmentally noticing triggering body areas. You could start out with pictures and progress to in-vivo exercises. The more you wish the awareness away, the more likely it is to get stuck. Work on allowing it to be there despite your discomfort.

  2. Hello. Since May of this year, I’ve had a life-derailing obsession with my own breathing after a panic attack and a few days of hyperventilating due to being in an environment much more humid than what I was used to. I was under a lot of stress at the same time… a perfect storm of sorts. I was hospitalized twice, have tried many medications.

    From what I understand, the awareness itself is what messed me up most, though new fears and obsessive toughts spun out from that, such as a fear of sleep apnea (roommates insist I don’t snore much at all), not liking my breathing rate, feeling like I ‘stopped’ if I don’t notice a breath, and of course despair about the whole thing. Especially in the morning, I often feel forced out of bed by over-awareness of breathing, feeling like I’m not breathing enough or properly, that sort of thing.

    I’ve been doing mindfulness practices deliberately because they’re based upon breathing awareness to center myself in the moment. One thing that freaks me out is how every single breath is different, that its always in motion, always changing… I’ve even had an obsessive craving to stop breathing, in spite of all the obsessions above!

    I’m exposing to my fears as best as I can figure out. There’s a lot of spin-off fears… if you have any suggestions, please let me know. This is the worst thing I have ever experienced.

    Feel free to email me. Thank you for reading.

    • Hi Adam,

      First off, I just want to reiterate that it’s critical that you have the support and oversight of people trained to help you address these symptoms properly. Professional assistance will help you get the most out of your efforts and sidestep potential problems. Practically, this means having an OCD specialist and a medical doctor to help direct your efforts and make sure that you’re free of any other conditions that might counter-indicate the use of ERP.

      Regarding ERP, I think the approach can get confusing if you’re trying to address too many symptom domains at once. The key to habituation is to stick with one category of situations long enough for you to learn experientially that these situations are not dangerous. Break down your fears into different hierarchies. Develop a hierarchy targeting the humid environment/difficulty breathing symptoms (sitting in a small room with a space heater running, taking extended hot showers, hanging out in a steam room, etc.). Develop a separate one targeting the sleep apnea fear (consider the stethoscope example above) and the breath-regulation fear (also using some of the ideas above). Use of loop tapes for imaginal exposure will also be necessary b/c you can’t address all your fears in vivo.

      It is also critical to have the right mindset as you do exposures. Your intention should not be to “flood” yourself or torture yourself…but rather to develop a sense of competence, confidence, and mastery over several categories of anxiety-related situations. It’s also important to recognize and resist your rituals (i.e., reassurance-seeking from roommates, efforts to “breathe properly”, mentally trying to “figure out” the meaning of your symptoms). If these behaviors remain in place, the best designed exposures in the world will be rendered ineffective.

      Re: your monitoring fear below. If you are “watching your breath”, you shouldn’t watch it with the intention of seeing it normalize. Set a timer for this type of exposure and don’t dictate duration on the basis of a “just right” feeling. In addition to this, you can do active exposures like those above (hyperventilating, straw breathing, etc.).

      Many people struggle with these types of symptoms, and there are solutions. Don’t get discouraged; get active.

  3. One more thing… I find that I have an obsessive fear that by monitoring my breath I’m somehow controlling it.

    I’m not sure whether to watch the breath until it does its own thing reliably, to deliberately control my breath for extended periods, or both or a combination of the two.

    Your expertise is appreciated.

  4. Thank you for your swift reply. I had two additional questions:

    You suggested starting with the humidity or difficult air exposures. I find overwhelming anxiety from the breathing itself, not quite “trusting” it to be there when I’m doing activities, and simutaneously feeling anxiety when I notice it, with complications such as feeling it’s inadequate or imperfect. Should I start with the awareness or lack of awareness first due to the overwhelming nature of it? It feels unlivable in the moment at times, though obviously I’ve lived months with it, somehow.

    The second question regards medication: I was prescribed Zoloft and wanted to know your opinion regarding this medication. I haven’t yet taken it, but wanted to know if the anxiety spike that a lot of SSRIs can cause, not to mention insomnia and other things, may do more harm than good trying to overcome this obsession.

    • Hi Adam,

      I was merely suggesting that if you have different symptom domains, it’s usually best to address these areas in a systematic way (i.e., according to individualized hierarchies). The choice about which hierarchy to address first is yours. If the humidity-related exposures are especially difficult, start with something that feels more approachable. The goals at this stage are to build up your confidence in the process of exposure, to recognize experientially that you will habituate if you perform exposures without ritualizing, and to gradually see a reduction in your fear. Because early successes with exposure tend to enhance motivation, you should be setting the stage for these success experiences by purposely choosing exposures that are at an appropriate difficulty level. In your case, this might involve directed exposure to breathing itself (without added elements like humidity, etc.). In other words, if your ritual is to avoid noticing your breath (for fear that it might be “wrong”) or to over-regulate your breath, you might start by directing attention to your breathing while resisting efforts to control. Still another variation might be going through a normal day wearing headphones that play a looped recording of the word “breath” intermittently. When you hear the word, direct your attention to your breath and resist efforts to control.

      RE: medication, I would recommend talking it over with your prescriber. Many people take Zoloft for OCD symptoms and find it to be very helpful, but there’s no way to predict how an individual will respond. Because many medications have side effects, the choice about whether or not to take a medication often comes down to a personal cost-benefit ratio. One important fact that people often forget is that the SSRIs take ~3 months before they are effective for OCD. It’s really important to stick with medications over this time frame in order to determine if the medication will be helpful for you.

      RE: your comment below, there are many good free support groups listed at, as well as web-based support groups and forums. These can be a great way to meet others who are tackling the same challenges. These groups aren’t necessarily a good substitute for individual therapy, but they can help bolster the effectiveness of infrequent sessions. Local support groups can also be a good way to find out about providers who offer services on a sliding scale (FYI, lists sliding scale providers as well).

  5. One more thing: I am unemployed and technically homeless, living off the charity of friends. The only psychiatrist I have access to through the county is difficult to reach and can only be seen once every few months, and my therapist is rather good at her job but isn’t specialized in OCD. She emphasized mindfulness techniques, which have been somewhat helpful, but doesn’t specifically instruct in ERP.

  6. I’m feeling rather desperate… I’ve been hospitalized before for this but I don’t think that helped. I’m feeling at wit’s end right now.

    I suppose there’s no harm in trying an active all-day exposure to my breathing awareness. I have this strange fear/compulsion that I’m controlling it at least a little bit simply because I feel it. Do you have an exposure suggestion for that, or should I just accept that fear for the time being and get properly exposed to the awareness?

    I am very grateful for your replies.

    • We subtly change our experience when we observe it because we’re approaching it from a different vantage point. This is true of all areas of life. Recognize this as a process and appreciate that you’ll get better at it with practice. At this stage, when in doubt, dial down the exposure so that you can be successful with it. Start with a few seconds, a few minutes…focus on getting better at the process and then expand the duration from there. As far as your specific question, I think one thing you are exposing yourself to is the urge to control. Your fear rests on the fact that you hold yourself responsible for properly regulating a necessary biological process. Efforts to manually control breathing prevent you from having the types of experiences necessary to correct this faulty belief. Another way to think about this is that you’re using exposures to build confidence in your body’s own ability to take care of it itself.

      Adam, it’s really important to find a provider to help direct this process for you. If you don’t, you might not approach this in the right way which could lead to additional frustration for you. Contact OCF, and check out their support group listings.

  7. Hi Dr, Seay,

    I emailed you a couple weeks ago I did not get a response. Is there any way you post info how to treat focusing on eye movements? I’m taking meds for anxiety, but I still wake up in the mornings with the focus on being on my eyes, just the awareness and feeling of it. How can tell how to help myself, pls!! thanks

    • Hi Jenev,

      I did receive a confusing message from you a while back, but it wasn’t addressed to me, so I deleted it (I thought you had made a mistake in sending it to me). Regarding your question, I think you highlight an important issue: the necessity of consulting with medical professionals before assuming that your symptoms are related to OCD. There are many medical conditions that involve eye movements, eye sensitivities, etc., and I would recommend addressing your concerns with a specialist in this area before implementing any behavioral strategies.

      All the Best,
      Dr. Seay

      • Hi Dr. Seay,

        thanks for replying. I was probably so anxious that I typed someones elses name. I will get my eyes checked my an MD. However, if its just obsessional thinking about the eyes, like constantly being aware of it. My concentration is on my eyes, and its really frustrating. My question is, Does it get better in time? I’m really scared that it’ll be like this forever. All I need is a little support. if you can understand. My therapist says the thought and feeling will eventually fade away, that its my anxiety causing it. Thanks for replying, you are sweet!!


        • If your symptoms are obsessive, your therapist is correct in saying that your anxiety about the symptoms actually perpetuates them. Symptoms begin to resolve as fear is reduced.

          • Thanks, Dr. Seay

  8. Dr. Seay,
    I have read the above article and its very informative.I have this problem of thinking about my lip symmetry while talking to other people.i always ruminate about whether my lips are equally moved to left-right while speaking/laughing. I traced out the root cause for this.Whenever i got free time during work,i used to browse through entertainment news and used to closely see smiling pictures of actressess and i admired them about their lip symmetry.I also used to collect them.But i couldnt find how this problem started overnight.I am not able to concentrate on my work due to this.I keep on obsessing about my lip symmetry.It will escalate if i meet face to face with other people.I tried to pacify myself by putting my attention on eyes instead of lips of other person.But another strange problem cropped up.
    When i begin to talk to other person,i get confused about whether to focus my attention on the other person’s left or right eye.This has devastated me.
    I am unable to live a peaceful life.
    Please provide me some suggestions.

    • Without knowing you, I can’t give a lot of specifics, but the same basic exposure strategies discussed in the articles should be helpful. I assume the problem is focusing on the symmetry of others’ lips (and eyes), as well as your own. Exposure should involve purposefully adopting and viewing asymmetrical facial expressions. With regard to the former, you might practice talking out of one side of your mouth. For the latter, you might view photographs of celebrities with asymmetrical facial expressions, etc. You could literally paper the walls with them, if you’re looking for something more immersive. This will depend on the exposure hierarchy that you and your therapist create. There might also be some value in wearing crooked glasses, etc. in the context of exposure and/or response prevention. You and your therapist will have to figure out how to tailor treatment to hit all the necessary elements of your symptom profile.

      I think it’s also likely that there will be a necessary element of cognitive restructuring that will have to occur as part of your recovery. If you’re concerned about your appearance and/or attractiveness, this needs to be addressed through cognitive restructuring, as well as exposures.

      I expect one of the biggest challenges will be how to practice good response prevention, as this will be critical to your recovery. Checking must be resisted, or exposure will be ineffective.

      Wishing you the best with this!
      Dr. Seay

  9. Hello.
    I’m Mehdi. I’m suffering from conscious swallowing.
    My main fear is sound interruption during speaking or singing because of saliva drinking (swallowing).
    Please guide me about appropriate ERP.
    Thank you for your valuable website.

  10. My swallowing compulsion is situation-specific. The first time I remember it happening was during a voice lesson. I’d been going to voice lessons for awhile, but, on this occasion, my father was there listening to my lesson. I felt the urge to swallow, and I had to swallow during my singing.

    More recently, I was taking voice-over lessons over the phone. I had had several lessons without having the problem, but then during one lesson I started having to swallow in the middle or a read, which totally screwed up the read. After that lesson, I continued to have the same problem in all subsequent lessons.

    I am concerned that I won’t be able to do voice-over. I am fine recording an audition at home, but I’m afraid that if I get hired, and need direction, I will have this same problem again, and it will ruin the possibility of having a career in voice-over.

    A couple of years ago, I was in a play, and I didn’t have this problem at all during rehearsals or performances. Maybe it is fear of negative judgment by particular people. I have never thought I had anything more than very mild OCD. I do things like having to “even things up,” like if I do something on one side, I want to do it on the other, but these little things have never been a problem.

    Any suggestions?

    • Hi Susan,

      My post next week may address some of your questions, and I would also recommend that you read my reply to the comment above yours. This is a bit different than the other examples I’ve discussed previously. Based on your description, I’m also not entirely convinced that this reflects OCD.

      Is your swallowing volitional? Are you choosing to swallow in order to prevent phlegm from changing your vocal tone or in response to an urge to swallow? If it’s volitional, what happens if you resist the urge? What might happen if you don’t swallow?

      If the behavior isn’t fully volitional, it might reflect a tic. Tics are more likely to occur when we’re anxious (performing in front of others as part of a job) than when we’re not (practicing at home).

      Sensorimotor OCD symptoms are fear-based symptoms that are maintained by avoidance of feared outcomes. The more one tries to avoid their symptoms, the more they become sensitized to these symptoms. Attention amplifies sensation.

      Based on your description, I’m not sure if that’s what you’re experiencing. At this point, you would likely benefit from an individual consultation with a psychologist or neurologist.

  11. please reply i need all the help i can get.

    basically i have the breathing obsessions. constantly aware of own breathing, forcing myself to breath, manual not automatic, etc.. and it’s very very very distressing. my question is how do i expose myself to something that i am constantly aware of? like from the minut i wake up till the minute i fall asleep i am exposed to controlling my breathing because it is all i think about!?!?! are you suggesting i accept it and not let it depress me or upset me and it should fade away.. i’ve had this for months now and it’s ruining everything that is good in my life. i just want it gone.. i want my life back.. i feel like i am trapped in a nightmare that i will never wake up from. please help 🙁

    • The last few paragraphs of this post give some examples of breathing-related exposures. Most of these involve intentionally breathing the “wrong way” and purposefully amplifying the experience (directing your attention to it rather than away from it, physically amplifying it with headphones, using loop tapes, etc.). Trying to breathe the “right way” is your ritual. As such, this behavior must be resisted in order for your symptoms to decrease.

      Given how stressful and confusing these types of symptoms can be, I would recommend that you work with an OCD specialist on this. They can help walk you through the initial exposures and get you started off on the right track.

  12. Hi there,

    Firstly, fantastic job on this blog post! I hadn’t seen this information posted anywhere else, but It’s something that has affected me for a while.

    My main problem is thought control, the fear that my attention will forever be stuck on these sensations, and thus the fear that my mind will never be able to function optimally as it is ‘busy’ thinking about these sensations.

    During exposure i have become less anxious and more accepting of the symptoms, but also interestingly I am discovering that my mind can actually function normally and I can do complex things, even if some of my attention is nearly always devoted to these symptoms.

    My question is this – Should reaching a point where one can control thinking about Body-focused obsessions be a goal at all? Or is it wiser to focus on reaching a point where thinking about body-focused obsessions or not one can carry out their life normally and not be bothered by them be the ultimate goal?

    Thank you for any insight if you choose to answer!

    • Hi Shaun,

      This is a very thoughtful comment and one that I think I want to explore in a bit more detail in a separate blog post about thought control. In brief, though, your intuition is correct. The most helpful mindset to adopt when addressing these types of symptoms is to focus on moving toward your goals (despite any residual symptoms) rather than focus on moving away from your symptoms themselves. As you rightly noted, you are capable of accomplishing complex tasks even if you have some residual symptoms. The truth of the matter is that if you become too preoccupied with the goal of being 100% symptom-free, it’s easy to fall into an unhelpful pattern of body scanning, in which you actually increase your sensitivity to unwanted “body noise.”

      Hope this helps, and look for a new post on thought control in the coming weeks.

  13. Hi Steven,

    I’ve had OCD a few years ago, and was able to get over it after reading some books and finally understanding it. But still some small habits remained, but I suppose I was always in ‘control’, and knew what was going on. Until this happened (this being focusing on breathing, swallowing and blinking), I didn’t realise it was OCD, but then sort of realised I was going through the same cycle over and over again, which reminded me of my OCD-ridden days. After scouring the internet, I came upon the article on OCDChicago and this, which I have to say is excellent!

    But I have a couple of questions.

    Firstly, most of the situations I get this in is when I’m doing something, and the worry is I won’t be able to do it properly. I know this doesn’t make any sense though, since I have been doing it properly. Like if I’m playing sport, or doing some work, or watching TV. What should I think when I’m busy doing something? just something like “I’m fine with it being there :)”?? Seems to work alright.

    Secondly, when I’m actively trying to reduce my anxiety in the face of it, what exactly should be going through my mind? You say “I’m focusing on blinking, then noticing _____ symptoms”. What sort of symptoms do you mean? I’ve been doing a more “I’m focusing on my blinking, not using any strategies”.

    Also, suppose it’s with blinking, sometimes when I do nothing I feel like I haven’t blinked in ages, then do a long blink after? Is this just me or…?

    Thanks a lot 🙂

    • Hi Aadil,

      With regard to your first question, your intuition is right. The best strategy is to stay in the situation and allow the awareness to be there without neutralizing it or forcing your attention away from it.

      RE: your second question, the best strategy involves not trying to reduce the anxiety at all. The goal is for you to sit quietly with the anxiety and allow it to habituate naturally without any special efforts on your part. This typically involves purposefully paying attention to your blinking until your anxiety diminishes. You can’t be bored and anxious at the same time. Individuals will often set aside time every day to work on this.

      Re: your third question… It sounds a bit like a reassurance-seeking question to me. If someone asked me that, I would typically have them say, “It’s possible I’m doing it the wrong way and I’ll just have to learn to live with that.” It’s best to not seek out specific answers about what’s “normal” or not in these cases, as that just draws additional scrutiny/attention to the behaviors.

      Good luck!

  14. Dear Dr. Seay,

    Thank you for your articles. I was very glad to finally read a a rofeccional article that describes exactly the symptomes and the fears of the somatic obsessions.I am 37 years old. I have been suffering from somatic ocd for the last 20 years of my life. I have had all kind of obsessions, mainly the blinking one.

    However last week I got the swallowing obsession, and naturally the blinking obsession faded away. it seems to me now that iswallowing is the worse obsession i ever had to deal with. Basicly I am aware to my saliva all the time, and have a great urge to swallow it all the time. I swallow my saliva every 3-4 seconds, and I can’t belive that just a little while ago i used to do this without paying any intention. I have tried to follow your advices, but then, when i try to resist swallowing i feel that my mouth is getting full with saliva within seconds, and I feel that I can’t handle it anymore. this cycle is driving me crazy. and couses me a lot of discomfort and sadness. could you please advice me how to deal with my specific problem? my fear is that i will never stop noticing my salivation and swallowing. and i will always swallow every 3-4 seconds for the rest of my life. any idea how could i resist swallowing every 3 seconds? my mouth is full of saliva, and I can’t breath anymore..:( thank you for your advice,


    • Hi Rossie,

      I would recommend that you get advice from someone who can work with you directly. It’s important that your therapist help you understand the difference between your specific obsessions and compulsions.

      For individuals who have a difficult time tolerating saliva in their mouths, treatment goals often focus explicitly on habituating to excess saliva (rather than the swallowing behavior itself). In some cases, swallowing is actually serving more as a compulsion than as an obsession. For example, these individuals might practice having saliva in their mouths and breathing through their noses for extended periods of time.

      Good luck!

  15. Hello Dr. Seay 🙂 I’ve been reading posts and comments and i have a question. I also have body focused obsessions especially on swallowing. I’ve been for almost 3 years in touch with this experience and i learned to live with it. I have done/am doing therapy and talking about my problems really helped a lot. I found that i have many triggers for these sensations, especially emotional ones. I’m trying my best to deal with my problems (i tried exposing with the body-related ones also) involving life/family/school/relationships/fears/expectations. I’m just wondering that for some reason, paying attention to how i swallow has been an underlying condition for all this time since it started, even when i had other symptoms like (breathing/blinking/tactile obsessions). Of course i have a lot of times when i forget all about swallowing (mostly when i’m enjoying myself) but when i have to do chores, or to learn ( especially now since i have exams) or when i’m nervous it becomes very annoying. The question is : am i developing a nervous tic? Observing swallowing isn’t scary anymore (only sometimes). Do you think exposure techniques will solve this? Is this still OCD?

    • Hi Misk,

      Tics are a possibility, and your therapist should be able to give you some guidance in that regard. Your description doesn’t really differentiate between the two possibilities.

      If your symptoms are OCD-spectrum, then ERP will be the most effective form of treatment. You might consider targeting those situations that are still triggering for you.

  16. Hi steven
    Your article is a God send. Ive had issues with these bodily obsessions for about a year now and coudnt find a specific “grouping” for these type of obsessions untill today!
    Im very relieved so thank you.
    My question is probably me just seeking reassurance but as you are an expert i can be reassured once and be satisfied. Okay so your article mentions the breathing blinking swallowing etc. however is eye movement included also?
    For about a yr now i have had this obsession with asking what my eyes are always doing and being aware of their movements. Its frustrating however on my own i have learnt to let it be and focus more outwards and trust in myself to let my body do what it needs to do.
    Would you say this was a good way of positive thinking? I mean its worked so far.. Letting go of the sensation of uncontrolled eye movement so should i just carry on with this way of dealing with the obsession?
    Im pretty sure this is my ocd and not anything medically wrong as i had a lot of the symptons above prior to the eye movement obsession.
    Any advice would be appreciated.

    • Hi Anisha,

      I don’t think that experts are immunized against doubt. 🙂

      Nevertheless, hyperwareness of any bodily process (including eye movements) can fall under the sensorimotor obsession umbrella. Acceptance based approaches are often very helpful in the treatment of sensorimotor symptoms.

  17. Hi, it’s been a monthish since I first learned about all this stuff, I can say that ERP does work very well for this too. I had a problem with blinking which I exposed my self to, then breathing, then swallowing, and now my anxiety with them is quite low, but a bit remains.

    For me, I just made sure I didn’t think anything conciously to reassure myself, or do any action conciously either, and got on with my life. Also remembering the goal, not to make it disappear in your life or to forget about it, just to reduce anxiety when the thought is remembered. The anxiety at the start can be overwhelming as it is, but just hang in there and it will subside.

    Now I have a slightly different problem and I’m not sure about it exactly. When I’m reading something, and I remember some OCD ritual, like blinking, I feel like I can’t read properly or process the information. I end up focusing on individual words and not reading properly. I’m thinking I should just do nothing about it and just continue reading. Is this right?

    • Thanks for the update, Aadil! You offer some great advice for people with sensorimotor symptoms. RE: the reading symptoms, yes. For people with OCD who have issues with reading and/or understanding, the best strategy is to continue reading despite any “error messages” that your brain throws at you. You’ll feel anxious at first (e.g., like you missed something important), but this will habituate if you continue reading.

  18. Hi. I have been suffering for years with my breathing. I used erp to great effect to lessen anxiety but alas the I session will be with me until the day I die. However I am far more comfortable with it. My question is what causes OCD and is research near to finding a definite and complete cure to the disorder?

    • Hi Vincent,

      OCD is a neurobiological condition that is caused by a combination of factors that includes biologically-based, genetic factors as well as learned factors. These factors are associated with hyperactivity in certain brain regions. I won’t go into the neuroscience details here, but if you’re interested, I’ve covered the neurobiology of OCD in previous posts (warning: some of the writing is very technical). Some people have OCD that is more biologically-based, whereas others have OCD that is more learning-based. For a very small minority of individuals, symptoms may also be related to autoimmune factors (e.g., PANDAS or PANS), but this isn’t applicable to sensorimotor obsessions.

      Research is ongoing to better understand these causes and to develop better, more effective treatments. When will we have a “definite and complete cure?” I’m not sure. But I do know that many people with extreme symptoms recover every day, even based on our current science.

  19. Hi Dr. Seay!

    Throughout my life, I have had a breathing obsession. I have had a lot of what if thoughts about controlling my breathing, fixating on breathing, breathing the wrong way etc. I have read several different books regarding ways to deal with this type of obsession – Learning to Live With Uncertainity – for example. I have done some exposure to the situation (deliberately thinking about breathing in many situations – and this has led to a decrease in anxiety). For the past few years, I have not had a lot of problems with this breathing obsession. I seemed to have a pretty good handle on it. However, in the past few weeks, I have had some “flare-up’s of my breathing obsession again. I started having some what if thoughts about thinking about it, wishing it away, and worry about how my life is stressful again because of some old thought patterns emerging. Reoccurences seem to be a lot more scary. I don’t really know why. I have practiced some of the things that I have learned in the past, and the anxiety has subsided a lot. However, I am very impatient with having the nagging thoughts about breathing (what if i think about my breathing tonight, tomorrow, etc.) To combat these problems, I seem to make the situation worse because I re-read old books, seek advice online, etc., all in hopes of finding quick ways to alleviate these thoughts. In your opinion, do you think that I am trying too hard to alleviate these problems – is researching, analyzing, etc. leading to me thinking more about the breathing obsession? If so, what is a good way to refocus these thoughts to the background and try to make myself not want to analyze these thoughts – because trying to problem solve seems to lead to more and more anxiety and makes me feel all that much worse. Should I not be combating a lot of the what-if thoughts – which seem to be spoiling my days?


    • Yes, it sounds like your rereading, seeking advice, etc. are ways to “escape” rather than “accept” your symptoms. These types of efforts are likely to backfire and will end up making you feel more desperate because they make the current moment feel more intolerable. The best strategy actually involves the opposite approach – literally “welcoming” your symptoms rather than resisting them. This is why when I’m treating individuals with these symptoms, I have them practice purposeful exposures at scheduled times. If you have what-if’s that bother you, you need to come to terms with them through imaginal exposures. When you become less afraid of the what-ifs, your symptoms will lose much of their sting.

      When intrusive thoughts pop up throughout the day, don’t let them alarm you. Welcome them, but don’t stop what you’re doing. Gently refocus on the task at hand.

      As always, I recommend that individuals with sensorimotor OCD work with a psychologist who can personally guide them. Because everyone is different, you need a strategy that has been designed to address your specific concerns.

      Wishing you the best with this!

  20. Doc Seay – thanks for responding to by question. Awesome advice! I do have a quick question regarding exposure sessions for breathing obessions. I think I know the answer to this, but I wanted to ask you to make sure I am on the right path!
    During exposure, do I just purposefully fixate on the process of breathing, or do I also attend to the thoughts that will probably accompany this anxiety-provoking exposure (i.e. what if thoughts, what if i get anxious, what if this gets stuck in my head, etc.) Would the goal be to purposefully attend to breathing, and not attend to any of the what-if thoughts that come in to my mind (in other words, just let them be there in the background – allowing them to float in and out, but not addressing them specifically)? Attending to those what-if thoughts seems like it would be counterproductive in that I would be trying to rationalize and figure out answers to things that will lead to more anxiety.
    So, during exposure, should I learn to live with letting the scary irrational thoughts float in to and out of my head and also attend to the original breathing obsession in hopes of attaing habituation to that original obsession which caused me so much anxiety in the first place? – Your thoughts?

    • Hi Mike,

      During exposures, you should practice attending to your breathing in order to habituate to the anxiety it arouses. Your goal is to be able to pay attention to your breathing with little to no anxiety. I published a new post today about what-if’s that should address some of your other questions. But yes, your goal in exposure is not to solve what-if’s. It’s okay to notice them, but don’t engage in any mental problem-solving. In some cases, separate imaginal exposures are used to address any stubborn worries.

      Good luck!

  21. “When intrusive thoughts pop up throughout the day, don’t let them alarm you. Welcome them, but don’t stop what you’re doing. Gently refocus on the task at hand.”

    To all the fighters out there. Print this quote. It has to be your weapon of choice against ocd. Believe me, it’s the only way out.
    We can’t take ocd under control with rituals (we all know how it can change in few minutes: “Oh my god, i can deal with the swallowing, but with the breathing it’s impossible” “Oh my god, now the ocd switched to the movement of my hands, it’s the end!”), but only with the progressive mitigation of the fear/anxiety.
    It may take months or years, but i personally meet other extreme cases of sensorimotor ocd who took back their lives.

    • You make some great points. I really appreciate how you’ve characterized recovery as a process as opposed to a “destination.” Wishing you the best!

  22. Dr Seay,
    I am a 28yo pharmacist struggling like others with sensorimotor OCD of the breathing type. My issue is that after i become aware of my breathing i cant help but try to control it. Obviously no one can mimic autonomic processes. And this is when the anxiety comes in. A few months ago i very slowly (over a course of months) weaned myself off Effexor Xr which i believe heightened my sensations that led to this. I tried to restart a ssri without luck after a month, and went back to Effexor Xr. Its been about 10 days back on effexor xr(150). Ive read your suggestions about ERP but i have no idea to NOT control my breathing. If im aware of every breath in and out how can i not control that. Autonomic processes work well b/c they are without thought and thus being aware of them can damage this process. This has occurred before in the past and it eventually went away on its own(i didnt think about it anymore). I try to let my breathing take care of itself but it consumes the majority of every day. Typically im very outgoing but this has stopped me in my tracks. Im not sure if i should talk to a therapist to help me through this. Also i dont know which therapist would be best qualified to help me. I really appreciate your input. Thanks Also i tried to take xanax a couple of times but it didnt help that much, plus it just takes the energy out of me. I would like to get my active nature back.

    • I would recommend finding a therapist using the treatment provider database at who could then guide you personally through the breathing control issue. For individuals who worry about breathing the “wrong” way, exposures can intentionally target breathing “incorrectly.” Many of the mindfulness techniques discussed in earlier posts/comments might also be helpful, because it sounds like your awareness remains a source of significant distress. You might work on the goal of reaching a point at which awareness is associated with less distress.

  23. Hmm, it’s me again. I’ve been doing fairly well, went a little backward at one point as I didn’t realise I was using a compulsion to manage my worries, but now I’m doing pretty well, also with reading. One thing I wasn’t sure about though was, I’ve had a ‘worry’ that my exams are coming up, and this sensorimotor OCD might put me off and make me do worse. To counter this I was doing a past paper, but I keep worrying. From some thought and just now when I saw , I think I could just be worrying about these exams and continually trying to reassure myself. I guess the solution is to say, “you know what, I might fail the exams because of this, I’ll just have to deal with it if it does happen”?

    • You know what, don’t answer this question. I think I might just be coming here for reassurance…

  24. Hi Dr. Seay,

    I am a medical student and I have this terrible obsession with blinking while I’m reading. I’m on sertraline to help with the OCD, but I think the only way for me to resolve this issue is to have the facts on why my fears are irrational. I don’t remember being taught how to read, so now that I’ve become aware of certain questions I have about reading, I’m constantly worrying about how I should be reading. When I think about blinking, I blink more frequently. When I think about what I’m reading, I inevitably blink and this interrupts my thought so that I forget what I just read and have to reread. I read all day and struggle with this problem all day long. It takes me much longer to read things than it should. Even though I get all of my work done by working harder and longer than everyone else, tests are timed and I cannot afford to be repeating what I read.

    I started having obsessive symptoms last October (such as focusing on breathing while reading and needing a pointer to read and focusing on this). I’ve overcome those other issues, but the blinking obsession is more difficult. In order to overcome this, I think I’d need information that I’ve been looking for but haven’t been able to find.

    1. Does blinking mid-sentence or in the middle of a thought decrease one’s understanding or retention of said sentence or thought?

    2. Is there a pattern to when people blink while reading? Since I didn’t think about blinking before this obsession, I don’t know if I only blinked in between sentences or thoughts.

    3. If there is a pattern to how we blink, how do I ensure that I only blink according to that pattern?

    I am REALLY looking forward to your response!

    • Hi Alex,

      It sounds like you are attempting to over-control your reading/blinking behavior. Similar to some of the examples given in the original post, directed efforts to blink the “right way” will likely be unhelpful. Ultimately, it will be most productive to learn to be okay with blinking regardless of when it occurs (mid-sentence or not).

      • Thank you for your response Dr. Seay. Can I still have OCD if I only have these problems when I’m reading?

        • Sometimes symptoms are concentrated in one particular area or in response to one particular trigger. If there is one primary symptom area, this is the area you might consider targeting in your ERP.

  25. Hi Dr Seay. Im an Engineering student. And 3 years ago I suddenly got sensorimotor ocd with swallowing. The symptomps went better after time. But now it is worse. It is to such a point that I now count my swallow mentally. I dont try to count it but I have compulsive counting as I am focusing on the swallowing from my sensorimotor ocd from a long time ago,, but now I mentally count it without trying to. Every swallow imm holding track of the number of swallows. Its really disturbing. from my sensorimotor OCD. Im really afraid. Im a student and really trying to work hard. I dont want my counting and mid clutter as well as my sensorimotor ocd clutter my mind of studying. What do you suggest? What is this counting thing/ Is this still pure o?

    And also, just to elaborate. The counting isnt a compulsion to relieve my anxiety. I do not try to count but keeping track of my breaths make me fear of counting it. so I count it unintentionally. Is this a common form of OCD with sensorimotor ocd? Does sensorimotor ocd sometimes go so far as you starting to count your breaths or blinnking or swallowing.

    Also, I get unwanted thoughts while I breathe. I usually see images or images of numbers while I breathe and its very depressing. Its like inappropriate thoughts that come into my head as my mind focuses on my breathing. Is this common with sensorimotor OCD?

    • Hi John,

      There are many different types of symptoms associated with OCD. These include sensorimotor issues like you’ve described, as well as counting behaviors. Sometimes counting can be linked to sensorimotor symptoms (counting breaths or swallows), and sometimes these behaviors exist independently as separate symptoms of OCD. If you’re concerned about your symptoms, consult with your treatment provider. If you don’t currently have a therapist, I would recommend contacting IOCDF (, who can put you in touch with providers in your area.

      Your treatment would likely involve response prevention exercises designed to interfere with the counting behaviors/images, as well as specific exposures to address your focus on swallowing. Your treatment might also incorporate imaginal exposures.

      Wishing you the best with this!


    Iraj Noroozi

  27. HI, Steven. I dont currently have the money to go to a therapist. I am at Uni, and never thought of going to one. I heard alot of therapists are just in for your money. I don’t think we have OCD specialists in Auckland as I have searched for it before.

    Steven, I feel that If I do get a hold on a certain part of OCD, a new for pops up. Steven, I had OCD most of my life. I had the washing compulsionm I was also afraid of germs at age 13 and couldnt stop washing my hands. It went away, and then I suddenly had a year of focusing on Tinitus of my ears, my eye movements. etc. I also had social anxiety disorder and panic attacks.

    It is really troublesome for OCD suffers, because even I found that with GAD and with SA disorder, it does not interfere with your studies. And people usually understand you. With ocd your mind is the enemy. That is what makes ocd the hardest to deal with. Your mind keeps on playing tricks with you and trick you into new forms. I had sensorimotor ocd now for 3 years without counting . And now suddenly when I heard there was help concerning sensorimotor ocd with just focusing, my anxiety morphed into something more brutal. I think thats the thing with ocd.
    Whats your thoughts on this? I was in a group project last week and suddenly I couldnt think as I kept track of my breathing the whole time. I kept track what number of breath I took and although I tried to stop thinking about the breath count and focus, it was hard.

    • OCD can make life incredibly difficult, and it often targets your vulnerabilities. Moreover, it’s not uncommon for symptoms to change over time. Fortunately, many of the basic OCD management skills you learn in therapy are generalizable from one situation to the next. Even if your symptoms change in form, these general skills will help you know how to respond. People do recover from OCD, but it takes time and effort.

  28. Hello, my name is Tim and I have had various body obsessions over the past few years, mainly with blinking but swallowing has affected me quite a bit as well. It started with the obsession that I will be thinking of blinking forever and will never be able to concentrate again. I have had therapy for it in the past and it has been very effective. The best techniques I have found are not to resist the obsessions, accept them and do not judge them.

    The main problem I have now is being open and honest with people. This is affecting me very much to the point where I cannot get that close to anyone because I think that if I were to be honest and open about my obsessions (especailly the blinking one) then they would either think I am completely crazy, or worse is the thought that they might be vulnerable to this type of thinking (they may have OCD themselves) and in some way and addopt it.

    I fear that if I will not be honest with someone then it will keep popping up on my mind making any close relationship anxiety provoking, or, I should be open and honest about myself but that this could be dangerous to the other person.

    I was hoping for any advice on this kind of situation with the uncertainty of meeting new people and being open about sensorimotor OCD.

    I was also quickly like to say how releived I was for finding this website. The treatment that I have had has been very effective and mindfulness training has been a very good tool to learn, but to know that other people have been through extremely similar things has been a great relief.


    • Hi Timothy,

      OCD thrives in situations that we perceive as unacceptable. If your symptoms are targeting social relationships, only you can decide how you will respond. Your description resembles of fear of harming and/or “contaminating” others. Reading more on these topics might be helpful to you. Good luck!

      • Thanks for the help. I’ve had quite a bit of help with this already and know that I need to just go out there and deal with it. I was just wondering if this is what you meant by saying “only you can decide how you will respond.”
        Would you recommend being open to people about this type of OCD if I ever am in a situation when I am talking to people about my mental illness, and what about it has affected me the most? Thanks again.

        • Hi Tim,

          I know that many people struggle with if/how to disclose symptoms to other people, and this is even more complicated in your own situation due to some of your specific fears. My intention was to indicate that only you can decide if you should disclose your symptoms to other people. If you decide to do so, you’ll create opportunities to challenge those beliefs that you fear (i.e., what will other people think, can other people “catch” my symptoms). This is the true essence of exposure – to take calculated risks to modify beliefs that may be maladaptive. However, accepting uncertainty is never easy or risk-free. You’ll have to decide if disclosure is worth the potential risk(s).

  29. Hi Dr Seay,

    After three years I think I may finally have a firmer understanding of what’s going on in my head thanks to this article. My problem seems slightly different from the comments above in that I seem to be hyper aware of my arms and their movements. When it gets particularly bad they will feel almost alien to the rest of my body and I’ll have to restrict their movement or put my hands in my pockets until the feeling subsides.
    I have done a lot of reading about hyper body awareness and have mostly attributed it to what I thought was depersonalisation. But having read this article, I feel sensorimotor obsessions sounds more fitting.
    Have you had many dealings with, what I guess would be, limb-based sensorimotor obsessions?

    Thank you in advance.

    • Hi Paul,

      Thanks for your comment. Sensorimotor obsessions can involve virtually any sensory system, including limb micromovements. In practice, I’ve seen more examples of micromovements focusing on blinking, tongue movements, etc…but limb movement obsessions can also occur.

      You raise a good point. Sensorimotor OCD can certainly involve feelings of depersonalization/derealization, and it can sometimes be tricky to differentiate SMOCD from other body-focused syndromes. That’s why it’s always important to rule out medical causes before assuming that symptoms reflect OCD.

      All the Best.

  30. I just wanted to say one thing that helped me at least.

    It’s one thing to make sure you’re not using rituals, such as actions like controlling breathing etc and tryin to ‘figure’ it out, and it’s another thing to do that but also with a positive attitude. I suppose it’s to see it not just as some unlucky thing that happened to you, but an opportunity for you to learn more about yourself and your thoughts which will improve your life in the long run. 🙂

    • Such an important point! Optimism, hope, and a willingness to invest effort in the process can make a tremendous difference.

  31. Hi Dr. Seay, first of all I want to thank you for taking your time in this web site it really shows how you care about sufferers you don’t even know and that is very generous of your part. I suffer from the moment I wake up to when I go to sleep with obssesive blinking, to a point where my vision becomes all blurry and my eyes are burning no matter how much I blink. All this gets worse when Im around people. I have done MRI, CT scan and gone to 2 ophtamlmologists and they both said my vision is perfect, the MRI’s came back negative. I used to suffer from irrational thoughts before but this one has taken completely over me and I am afraid of going out in public to an extent where I dropped my last semester to finish my Biology B.A. I dont have any facial expressions because constantly thinking about it and I even videotaped myself with my right eye moving by itself, which I managed to do because of all the attention I had on my eyes. Its not something I want to do but somehow I cant stop thinking about it and it gives me sooooo much anxiety because people around me notice it and immediately start blinking weird and look at me bad as if I wanted them to have it. My upper eyelid twitches and I dont know how open or closed I should have them, I feel so bad because my mom just started blinking consiously and I hate myself for hurting her. Please let me know how to end this I would be the happiest man alive.

    • Hi Andres,

      Given the impact your symptoms have had on your life and the amount of distress you’re likely experiencing, it is important to work directly with a therapist who can guide you through the process of treatment. Effective treatment would need to target each maladaptive thought, and you would likely need to design exposures to lean into the social consequences you fear. There are other examples of the intersection of sensorimotor/social symptoms in various posts/comments on this website.

      Best wishes in your recovery!

  32. Andres. I know your suffering right now and maybe my story will change you. I had exactly the same. Youll be surprised over a year or so you wished you actually have your sensorimotor obsession only on the blinking because chances are, it will start morphing into something else like inapproapriate thoughts associated everytime you blink. YOu might start to count your blinking and see a picture appear everytime you blink in your minds eye that you try not to think about.

    I can tell you that I have focused on my blinking for over 2 years and it completely destroyd a part of my life. I couldnt participate in anything. But by that time sensorimotor ocd wasnt known to have a name at that point so I thought i went crazy. To be honest, now that I know about the name of it, it keeps morphing into more brutal thinkgs. LIke now I dont focus on my blinking only, but see images popup in sync with blinking as well as other things. Sometimes even sounds in my head. I try not to think about it and it almost feel like i cant forget about it no matter how hard i try., Your not alone buddy. trust me.

  33. Also, dr seay, I tried your exposre and prevention therapy. But for some reason more has come. I now hear an unconscious sound thats disturbing everytime I swallow. Im really scared as this takes up lots of concentration and I try to concentrate on my work but everytime I swallow i think about a certain sound and cant forget about it. Its like an inappropriate thought that I seem to try and divert my miind away from. I hear the sound subconsiously.
    Is this common to happen with sensorimotor ocd? To get inappropriate thoughts thats disturbing with your focus on your obsessions?

    To be more specific, its almost like everytime I swallow, i now have a thought associated with the swallowing that I cant seem to surpress and it takes alot of concentration away from me since my mind try to focus on presenting the images or sound to me everytime I swallow and I try tnot to think about it.

    I couldnt view your previous commetnt for some reason, dr seay. Please tell me about this. Im really worried.

    • John,

      For questions about your specific symptoms, it is important to establish a relationship with a treatment provider who can guide you through the process of therapy.

      Best wishes on your recovery.

  34. Hi Dr Seay,
    I had a breakdown of sorts 9 months ago which resulted in me developing severe panic disorder. Before my breakdown I had no anxiety whatsoever and handled life fairly well. I would never have considered myself someone who had ocd. I started to get a handle on my panic attacks and was feeling better though not 100%. During the last week or so I have suddenly developed this obsession with my eyes/blinking. It is exactly how you have described in the sense of my biggest fear is getting stuck on the sensation, being stuck with it forever etc which i suppose is creating a self fullfilling prophecy. Is it possible to develop ocd like this after a traumatic experience like panic disorder? It is the only obbsessive feeling I have and I have no other symptoms other than the high anxiety about panic attacks.
    I have another question regarding treating this problem. It seems hard to understand how picking moments in the day to specifically focus on this sensation will help when I am already thinking about it most of the time. Is the real key to try and use some kind of paradoxical intention? I.e. to wish the obsession on and to treat it like something I enjoy? I want my life back so badly I will try absolutely anything to fix this but at the same time am wary of making the problem worst.

    Best Regards


    • Hi James,

      Sometimes significant events can trigger increased anxiety, including OCD. Moreover, many aspects of panic disorder overlap extensively with symptoms of sensorimotor OCD (including hyper-attention to physical sensations). The effects of treatment are not related to paradoxical intention, although some people do find it empowering to directly confront their symptoms. Rather, exposures create opportunities to accept your symptoms and thus, become less fearful and distressed by them. You can think about it like this: If you’re trying to overcome a fear of the dark, you must dip your toes in the shadows.

      Only you can decide if exposure and/or mindfulness work will be part of your recovery plan. However, this is a decision you should make with the guidance of an experienced therapist. If you do it the wrong way or in the service of the wrong goal, it’s unlikely to work anyway.

      • Hi Steven, thanks for taking the time to reply to me, i appreciate it. Out of interest do you or would you consider long distance therapy by telephone, Skype (or even email). I really want to get on top of this problem but judging by the lack of information available online it’s not well understood by a lot of people and so i am worried that I won’t find a therapist locally with the relevant skills and knowledge to help me with this. I live in the uk.
        If you are unable to help I think my best bet would probably be to make my own plan based on the information provided on your site (allocating time to deliberatly focus on the symptoms along with daily mindfulness meditation)

        • Hi James,

          Unfortunately, I can’t provide treatment services internationally. I would suggest contacting IOCDF for provider recommendations in your country. OCD-UK might also have some recommendations. If you decide to go the self-help route, Dr. Jonathan Grayson’s Freedom from OCD is a very useful resource.

          Wishing you the best!

  35. Hi Dr. Seay,

    I was wondering if you had a recommendation for a therapist in the NYC area for body-focused/sensorimotor obsessions. I would prefer to deal with my problem on my own, and in some cases I have made progress. Last week I read an article by David Kueler who mentioned that one thing to do is separate the feeling of anxiety from your compulsion – which helped me through the week but I still felt some moments of panic/anxiety. I’ve found that like most problems, talking to someone (particularly a professional) is the effective way of going about treatment.

    Just to give you some background, I’m pretty much a common case of body-focused sensorimotor obsessions. My entire life, I’ve had irrational fears, but I never thought much of them until recently. To begin with, I’ve always had trouble sleeping. I feel like it’s simply that I think about sleeping. I find the transition from conscious to unconscious tough to do, and something I’m conscious of. When I was younger I always convinced myself there was someone in the house late at night when I was in bed. Every noise our house made would frighten me and lead me to suspect an intruder. That’s left me as I became older (I’m now 24).

    About 2 years ago, these symptoms became body-focused. Pretty much the first day of training for my first job out of college, I noticed I concentrated on swallowing my food. I was eating with my boss and would focus on my swallows, which is motivated by a fear of choking. I still think about this, but have kind of learned to avoid certain foods (steak is my arch nemesis), generally eat less, slowly, and drink liquid to help swallow.

    Most recently (probably 2 weeks ago) I started focusing on my breathing. This obsession has been most unbearable, since I’m obviously not always eating, but I’m always breathing. Reading some material has helped (yourself and David Kueler seem to have the most thorough articles – which I thank you for), but I just want to be done with this. I figure after recognizing that I’ve had these thoughts for a long time, it’s safe to say that I need to accept that I have a problem and need to put in the time and effort to treat it.

    The only times this isn’t an issue is of course when I’m distracted. Going out drinking with friends is the best. I’m definitely not an alcoholic but alcohol helps me overcome all of these symptoms. I eat and breath normally when under the influence of alcohol. Being distracted by being around so many people, loud music, etc. obviously also helps.

    So that’s my background, any recommendations would be great if you know someone around here (I live in Manhattan). I’m definitely going to try and follow some of your treatment recommendations, like forcing these symptoms into my mind and trying to cope with them instead of trying to distract myself (which everyone knows never works). Anything else you can offer would be great.

    I just want to say I truly appreciate your tackling of this issue. I feel like most people with this problem tend to think they’re the only ones, since it’s not the type of illness you can go get a prescription for. It definitely leads to feelings of hopelessness at times, since it’s effortless to just start thinking of something, at which point it won’t go away. I also appreciate that you seem to be very quick to respond to your blog posts – which is great for people who are looking for help.

    I hope all is well with you.

    Thank you,

    • Hi Danny,

      Check out Freedom from OCD by Dr. Jonathan Grayson, as it’s an excellent resource for individuals struggling with OCD. It is not geared specifically toward sensorimotor issues, but Dr. Grayson provides one of the most helpful models around for conceptualizing OCD symptoms. RE: NYC, I don’t have any specific recommendations, but check out the IOCDF’s website which lists a variety of OCD specialists.

      As you suggested, some of your symptoms (historically and currently) are common OCD symptoms that do not reflect sensorimotor OCD. For example, I would not consider the fear of choking to be sensorimotor-based, because it is associated with a specific feared outcome. Usually, the feature that differentiates SMOCD symptoms from others is the fear of constant awareness (and resultant feelings of hopelessness).

      Wishing you the best with your treatment!

  36. I have recurring problems with feeling I need to urinate frequently. I also do some of the more classic OCD rituals like checking and number phobia. Would this body sensation fit into the OCD spectrum?

    • Hi Dave,

      I would not assume that your symptoms reflect OCD. It’s possible, but it is critical to rule-out medical causes for your symptoms before assuming that they reflect OCD. This determination should be made by your doctor.

  37. Ok Steven, thanks. That is a shame but I understand. I will get the book that you mention and will try my hardest to find a therapist with some experience with this issue.

  38. Wow, this is the very first article i read that actually made me realise what im going through is a real condition! No where would really explain my obbsession with breathing and over night only realised that it’s linked to OCD and soooo much now makes sense in my life to a point where almost realising that has lessened my panic. My main concern was one that you mentioned- how will i ever forget this and am i doomed to an eternity of it and that immmediately gives me a sinking feeling in my stomach to which i somehow manage to tell myself well u haver to breath as much as you can never stop seeing, hearing etc.
    Just lately it’s been so difficult because i experienced this about 2 years ago and it went COMPLETLEY but has now returned worse than ever! It happens me when i have time on my hands and before bed as luckily im a dance teacher who runs a very busy school and it never affects me in work….just goes to show doesn’t it? All in the mind, but still trying to tell yourself to STOP is impossible! As u said recognising that i have to face the fear and ne happy to sit feeling this way is my aim becasue ultimately it will then once again become second nature…as it has been for the last 30 years of my life! I need to belive this is possible….and i will try so much to make this work! Is it better to do this with a professional, will they fully understand?

    • Hi Marie,

      Thanks for sharing. I think many people benefit from having professional assistance with this, but it’s up to you. If you do decide to work with a therapist, I would recommend finding a provider who is experienced in treating OCD.

      Wishing you the best with this!

  39. Hi,

    Ive had symptoms of sensori motor obsession for about 4 years now. Before any of it started I had a fear of never being able to fall asleep again. I realized that it was anxiety that was keeping me up and after I had dealt with the anxiety it was easier to fall asleep. After that, I was tormented with a breathing obsession, where my muscles involved with breathing would get so tense that I would have to control it. As such, I would be aware of my breaths.
    I also caught on to a blinking obsession which seems to be the worst one.The muscle involved with blinking would get so tense when i think about blinking to a point where I would have to blink with my own efforts. Anxiety associated with this makes me ocd about my blinking. Ive had periods where blinking or breathing would not bother me at all because there was no anxiety associated with these thoughts and my muscles were not tensed, so I could go about doing my own thing.
    However, recently, the blinking obsession is back and I cant seem to let it happen on its own. Do you think muscle relaxants would work? Or if there is a way for me to lose control of blinking on my own, via surgery or something? The fact that im blinking does not bother me but its the fact that im forced to blink on my own due to muscle tension that tires me out.

    • Hi Ashley,

      It sounds like you’re having some very disruptive symptoms. I would suggest consulting with an OCD specialist to get some clarity on these issues. Good luck!

  40. I have been having conscious blinking. Honestly, its become quite debilitating. Is hard to concentrate and be around people when I’m conscious of my blinking. I read your article,but I am still confused as to what techniques I should use to help. Can you give me some advice?

    • Hi Chris,

      This article is just a general roadmap. For specific advice, please seek the help of an individual therapist who can tailor treatment to your specific symptoms. Good luck!

  41. thanks alot sir u hv chnged my life

  42. sr i m a medical student. i m sfrng frm ths dsease snce 1yr i tried vry much bt in vain.i tried ur procedure it gives approx 95% cure. i hv tw qusn?
    1.upto hw mch days i hv to follow ths procedure?
    2.i fls little stress whn the day i try ths procedure whtr i should stop ths procedure or not or i hv to try ths rst of life?
    pllllllllssssssss reply. u r my god

    • Unfortunately, timelines are variable, and there’s no established treatment length. The answer is pragmatic…you can dial down exposures and see how it goes. The goal is to find the balance that works for you.

  43. Hi

    I recently suffered from very bad post natal depression and anxiety which led onto constant awareness of my breathing. I have been trying to be ‘ok’ with it for a few months now and not let it make me anxious. My question is in your experience how long does it take to go away? I know my main fear is that it will not go away and this is what keeps it going I guess. Also with this sort of thing, lots of thought associations occur e.g. ‘I can’t enjoy myself because I’m having the thought’ or ‘I’m not going to be able to watch this film as I’ll keep getting the thought’ which again perpetuates the problem. I find it hard to accept this is just me at the moment and not to feel like I’m strange. I have got over a fear of not being able to sleep once before and techniques which worked were constant rationalising of the problem and mindfulness in saying ‘it’s just a thought and can’t harm me’. What I find most hard about it is the endurance needed to keep going and not despairing over it.

    • Hi Kay,

      Timelines are variable, and the fear of not knowing when your symptoms will resolve is central to this condition. Acceptance of this uncertainty is an important component of your recovery. As you’ll see in various articles here and in certain comments, sometimes exposures involve willingly combining pleasurable activities with an awareness of your symptoms. I would suggest working with a therapist to help you structure and guide your recovery plan.

  44. Hi

    I haven’t been here in a while, but I just wanted to say, thanks to this article, and the Dr. Keuler’s, I’ve pretty much eliminated all the anxiety that was associated with this. It seems so distant now that I could be worried about these things to such an extent that I couldn’t think straight. It took time and I learnt a lot of things, and in the end I’m really glad this happened to me 🙂

    I think it pretty much took 1-3 months for it to go away. The anxiety decreased rapidly in the beginning, began fluctuating and switching to different obsessions, but eventaully stopped altogether, and I would barely remember it, maybe once a day if that even.

    I don’t know much, but if anyone wants to ask me anything then I’d be happy to help…

    • Just reiterating, very grateful for you having such a detailed article like this 😀

    • How I decrease blinking anxiety

  45. Hi aadil…can I have your email so I can ask you questions?

  46. thnk u sr for prveus rply, sr i wana know tht ths typ of ocd is 100% curabl or not,or rather 4% to 5% remains in my rest of life,some time like tody i m flng ltl bit relapse of swallowng ocd whn i m gng to sleep,wht is the bst time to do ERP morng/evng,At th start of ths disease ,ths disease had broke my heart,i had all the three[breathing,swallowing&blinking] obession,sr i m suffering from ths disease from 11 month,&the dy i was gng to sucide i read ur artcl and i tried ur procedure 3month bck&i gt cure about 95% i m a indian sir,in india i dnt thnk so ths typ of ocd is not common sr,psycatrist r hardly concern about ths disease,i take flouxtiene 60mg OD & etizolam 0.5mg BD&dizapam[benzodizapen] SOS during sleep,sometime i feel vry hopless,if i cn gt out of disease totally or not i m jst 21yrs old,mbbs 2nd proff. student,bt last bt not the least i wana thnk u frm core of my heart tht u r my god,u save me from doing succide,sometime in my life if i bcm a good doctor,i definately cm in u r place to meet,sr i also wana know tht alchol drinking&smoking ocassionly can also show advrs effect on ths disease,?in the end i jst wana say’ i hv no words to explain ur thnks

    • Unfortunately, there are no hard and fast answers for these questions. Some individuals reach a point where they have very few symptoms, but others continue to experience residual symptoms. To be honest with you, I would actually suggest trying to be less focused on being 100% symptom-free. This is because individuals who are focused on complete remission can become sensitized to their symptoms. I expand on this idea here:

      Try to accept every day as it is without comparing it to the ideal.

      RE: smoking and drinking, I don’t think that these behaviors have been shown to be related specifically to OCD, but you might consider cutting down just for the health benefits.

      Good luck!

  47. Ashley and all other blinking sufferers out there I wanna say to you that I understand you completely since I am going through the exact same situation right now it seems like if thinking that I have to blink soon gets all my eye muscles so tense that I loose focus rapidly and have to rely on hard blinking just to break up the tension. Oh and thats not all, after every single blink I fall into a trance where I evaluate it and ask myself how conscious it really was, and if I blinked the whole way. I thought I was the only one going through this, one question can you sleep well at night? My blinking muscles are so constantly twitching, my eyelids open and distracts my peace of mind thereby not letting me sleep at all, yes ive been a week without sleeping and I wanted to know if you found a way to sleep well I guess that would be a good start, im on trazodone to sleep but doesent seem to help much. I am going to try with what I just read and think about blinking (which is not going to be so hard since I cant seem to get my mind off it) and find a way to relax my eye muscles and to alliviate the tension and stress without blinking, not letting the blink be the muscle relaxer. Ive thought about surgery or botox as well but I guess that would be among the last of the choices because I dont think they are cheap and second it would be a little embarrasing walking into a doctors office saying ok I want some botox because I cant seem to stop blinking manually. I think we could help each other out, if anyone else is suffering from this as well please lets help each other out and if anyone has gotten completely cured of this awfull blinking sensorimotor OCD please help us out my email is I know well be allright this cant keep our rational mind kept in the dungeon for ever i bet there are hundreds of people that have gotten out of it, its just that they are not looking for any information of it online no longer.

  48. Steve,

    some of us live in third world countries and have no access to a qualified therapist. What should we do, we are obviously on our own? You recommend working with a good therapist, but sometimes there is no one that can help. What is your advice for people like us ? Apart from the excellent articles here, can you recommend any other resources, books, materials?

    • Thanks for the question. I recently wrote a post on that very topic. It’s located here:

      Many people with mild to moderate symptoms can do very well if they follow a structured recovery plan like the ones described in those resources. Medications can also be a helpful adjunct to a self-help plan.

      Good luck!

  49. My breathing/swallowing compulsions actually cause my throat to get very sore, and then I develop a nasty head cold. It happens every time I get the breathing, swallowing obsessions and compulsions. Any advice on this?? Have you ever heard of this happenIng before? It is so very depressing. I have several different obsessions, but this one is the worst because it causes the most pain. Any advice you could give me relating to this matter would be greatly appreciated.

    • Hi Harper,

      This isn’t something I encounter regularly (at least it’s not something that people tell me about). I would check with your doctor to rule out any medical causes.

  50. First off I want to say thank you. If it wasn’t for you posting these articles there would be nothing on the internet about Sensorimotor OCD. When looking on the internet for help with my problems you were the only site that came up about it. (The only other article I could find about it was the OCD Chicago article you posted about in one of your articles.) It doesn’t hurt that you are also a doctor.! If it wasn’t for you and these articles I would of felt there was definitely something wrong. “Ok I’m having these body focused OCD problems and in the whole huge internet there isn’t one person with information about it”.

    I can’t stress again, how great these articles are. Personally I have been obsessing about mostly my breathing and sometimes my blinking. I thought I was crazy. I would tell myself, why am I worrying about stuff that my body automatically does. I must be crazy. What if there is something wrong with me. Thank god for people like you my counselor, and loved ones! Ok enough kissing up! The thing is I don’t worry about not being able to breath, or not breathing fully enough. But I’m worried this is always somewhat going to be on my mind. And it will effect me in stuff that I want to do.

    I will always have this thought in the back of my mind about making sure I breath. Even though I do it naturally. Whatever I do I can’t get this stupid thought out of my head. Everything reminds me off it. My worry is that this will never go away. (Hopefully this doesn’t come off as me feeling sorry for myself) But I went with something that really ruined 2 ½ years of my childhood. Thankfully it is over now. I’m just afraid this will do the same thing to me (this wasn’t at all an OCD thing, and this thing is thankfully gone forever from my life.) Whatever I can do to not have this take over my life I will do. This will not defeat me!

    I have been doing some ERP stuff by myself. The amount of stress it relieves is amazing. But I don’t feel like this can get rid of the problem. I haven’t talked to anyone that professionally specializes with this kind of OCD. I should probably go to someone like that right? Luckily I can call my counselor whenever I want and I see her once a week. She is amazing at what she does. I printed her some of your articles too. We have just started talking about this yesterday. I think the key reason all of this is happening is because I’m afraid of my future.

    I’m scared to death about graduating from high school and going to college. And then living on my own. My grades are definitely not the greatest (which is of course my fault) and I’m just scared. Even my extremely nice father has told me he doesn’t have faith in me once I graduate. I feel like I have an extreme talent in writing. The problem is whenever I start to write this breathing thing happens. This is definitely, definitely for sure when it is the worse. I can’t write at all!

    In this paragraph I made it sound like a lot worse than it actually is. It’s not ruining my life. And I don’t think about it as much as it might sound. And it is DEFINITELY not as bad as the previous problem I had. I think it always coming up when I write for sure means something. I think I have an extreme talent and especially motivation for it. And I think this always coming up when I’m doing it (and not letting me perform 100%) must mean something. Thankfully we live in a time when we have technology like this. Imagine we were living in the 12th century, and this was still driving me crazy.

    People would think there was something wrong with me, and I probably wouldn’t get much help at all. People wouldn’t know what to do. Definitely a way to look at it. Hopefully this wasn’t too long. And thank you again for your articles and knowledge on the subject.

    • Hi John,

      OCD often flares up during times of stress or transition, so it’s not surprising that this is popping up as you begin to think about graduation. Given the complexity of sensorimotor symptoms, I would recommend getting some professional guidance in your efforts. In addition, you might want to check out my post on books related to OCD for additional information. Although none cover SMOCD in detail, Dr. Jonathan Grayson’s book has some sections that are relevant. Here’s the reading list:

      Based on your description, it sounds like some of your exposures might target writing activities. The goal of those exercises would be to write despite your symptoms, even if the writing isn’t up to your usual standards.

      Wishing you the best with this!

      • Ignore my comment that I made about my sleeping. That was definitely a “what if” question. My sleeping has been fine, not a problem at all. When you say I should get professional guidance in your efforts (for my sensorimotor ocd) does that mean I should get some one who works with OCD, and OCD patients? I have a counselor currently, but she doesn’t specialize in OCD.

  51. Ok I will do that thanks for the advice! If I keep writing even with the sensorimotor ocd will my writing (& focus) go back to the way it was before? That’s what I’m afraid won’t happen.

    • OCD involves needing to have certainty in fundamentally uncertain situations. See my post on unwanted thoughts and sensations, if you haven’t already.

      • Thank you. I haven’t read that article so I will check it out!

        • I actually haven’t been doing enough of the Exposure Response stuff. I’ll make sure to do that. So I’ll be doing that. Hopefully that will help me with my breathing + blinking. My counselor is also doing EMDR with me.

          Thanks for understand this, because 99 percent of people would think your crazy if you told them you worried about your breathing and blinking. It’s great your helping these people.

          Also, it might be kind of hard to keep track of all these comments with all these articles you wrote. I could make you a forum which would be so much easier to keep track of all these comments. It’s free and very easy to do.

          • Thanks for reading, John. And you’re right. For some individuals, it can be very difficult to understand how devastating these symptoms can be. Thanks for the offer on the forum. I’m going to keep things as-is for now, but thanks for your generosity.

            All the best…

  52. Dear Dr Seay, thank you so much for this article. It has given me so much hope.

    I started experiencing tinnitus in my ears in 2006, and whilst I dealt with my tinnitus by reducing my anxiety of the tinnitus rather than worrying about whether the tinnitus will go or not, I started having anxiety. I didn’t fully understand anxiety and wondered why I could not stop focussing on my breathing. However, I think this was just because my breathing was different as I was anxious or a few days. I overcame this. However, I then read an article about someone with a breathing obsession and it scared me so much that I started focussing on my breathing. The fear of me becoming as sad as the other I read about kept coming into my mind. I did all I could to distract myself from it and often I would forget about it. I spoke to my mum about it and she said something about you would worry about your blinking if you had a breathing obsession. From that time I started worrying about my blinking. However, it would disappear after a time. But the thoughts would keep coming into my head out of the blue and I would feel more anxious (what if I will never forget about my blinking/breathing) but then something else would pop into my head and then I would forget about it.

    I started going to yoga and my yoga teacher told me that focussing on our breathing actually makes you breathe better and soothes the body. After this, I no longer obssessed over my breathing. But my blinking remained a problem, and for years I have been scared of doing nothing in case I get stuck in my blinking obsesession.

    I started taking anti depressants last year, partly due to this and depression from moving home and anxiety. I found I completely forgot about my obsessions over the year I was taking them.

    However, after a year of being off the anti depressants this problem with focussing has returned.

    I have read your article, which provides me with so much hope. However, I have read some other stories and found that I am now focussing on my swallowing too!

    I think my question then is, do I have an OCD or a health anxiety? I am a bit worried about doing the ERP in case it is not the correct treatment and makes it worse. I live in the uk and don’t think any doctors know about this wonderful treatment here, so I will be doing it alone. But knowing it is the right treatment will give me the strength to start it and keep to it.

    I forgot to say that I do worry about my health a lot. When I was little I would not sleep worrying about getting cancer and I constantly worry about becoming mental ill (psychotic) even though this has never happened and does not run in my family.

    • In reality, many cases of “health anxiety” are simply examples of OCD. Effective treatments for both tend to be exposure-based.

  53. Hello,
    I’ve read your articles with interest, but I’m a bit confused as to what sort of OCD I have (having been told I have it by a psychologist). I have lived on an inadequate diet of liquids and a few foods that dissolve in the mouth with water for a year and a half now. It started when I sort of choked on a cracker during a time when I was extremely stressed and was experiencing a huge amount of hypnic jerking any time I sat or laid down to relax. My ability to swallow got bad enough within a couple weeks that I could hardly swallow my own saliva. It improved a bit, but recovery is impeded by the fact that many times my tongue/throat will ‘misbehave’ and not initiate a swallow correctly and cause me to gag or have to cough.

    I have always been a bit paranoid about choking, perhaps stemming from having witnessed my dad almost choke to death. When I had babies, I was obsessed with chopping their food into tiny pieces and even though they are now teenagers, I cannot bear to watch them eat ‘choking hazard’ foods such as grapes. Regarding my physiology, I’ve had a barium swallow test and a few of those hands-on neurological exams, with nothing untoward discovered.

    I don’t understand quite what is at play in my situation, and I have no idea how to improve my swallowing when it feels as though there is an actual element of choking risk. If there wasn’t, I feel that making up an exposure plan would be much easier. I would be very grateful for suggestions.

    • Hi Elle,

      It sounds like your fear of choking is quite powerful, especially since even watching other people eat is triggering. Ultimately, you will probably benefit from a swallowing-based hierarchy that targets eating behaviors. In the meantime, though, you might begin by targeting situations that involve watching other people eat. Any habituation that occurs in that context might make the eating-based exposures easier to tackle. This is one of those situations, though, in which you might need to work with a psychologist and a medical doctor to design appropriate exposures.

  54. thank u sr fr previous reply,before rcvng ur rply i visited to my doctor,i told him that there is still some symptoms,then he increase my dose & now i m tkng flouxtiene 80 mg instead of 60mg-OD,+etizolam 0.5mg BD,aftr rcvng ur rply i totally undrstand my disease &wht u r tryng to say by ur valuable blog, i thnk due to mdcn,i feel asleepy in my medical school classroom ,i also feel acidity sometimes& sometimes is about 1year from whn i m taking medicene,now i m jst tird of tkng ths high dose mdcn,wht should i do,?sr i do ERP procedure in evening time,now habituation is vry quick,i dnt feel anioxus in bgng nt in end, it almost same,so i do it 30 min 10 min each for degglution,breathng &blnkg,i thnk it is sufficient. Upto how many days i hv to follow ths procdure,i m afrd tht if i stop ERP i gts rlapse,or i hv to do ERP rst of life,the day whn i remain busy in my clinics & i forget doing ERP ,the whole dy passes & the dses existence bcm 0%,bt whn i do ERP the whole day symptom noticing range varies from 1% to 5%,ths range also gts exaggregated if i do self study(since i was doing study,whn i feel ths symptoms first time,& it was my education skill which was most badly effected by ths dsease)atlast pls answr my respective doubts?waiting for ur valuable rply sr(THANK U SIR)

    • Recovery is a process. You’ll have to discover how much maintenance ERP is necessary to maintain your gains.

  55. Excuse me for my poor english.
    In addition to obsessive swallowing, I have perspiration in my hands due to anxiety. Obsessive swallowing was started when I was reading the holy book in front of the students in a high school morning ceremony (I was 17). Anxious perspiration was began when I was 22 (third year of university). In a meeting, our university psychiatrist told: One of my patients was very anxious and the drops of perspiration was visible in palm of his hands. Just then I looked at my palm of hand. Perspiration can cause difficulty for me too, I said by myself. After that, the beads of perspiration was appeared in my palm. Those days I had an important examination and my main fear was inability to hold (control) pen in my hand because my hands are wet.

    Now I am 27 and my question is:
    Is there any relation beween perspiration (circumstances that I described above) and obsession?
    Thank you

    • It sounds like you’re afraid that sweaty hands will result in a feared outcome (holding your pen). In that case, it’s possible that the fear of sweaty hands is an obsession. FYI, perspiration on your hands due to anxiety can be a pretty typical experience.

  56. sir i hv an confusion wht is the actual meaning of compulsion,whn i was reading ur post.i suddenly see other post ,in one of ur post a patient was telling about his problm of sweating in hand,suddnly a unwanted thought pops up in my mind,that it can happens to me,now a unwanted thought come up wth anixety in my mind,now wht i hv to do?
    1 . ths s a normal brain noise,i let it free & try to feel less distress or less afraid,without doing any thing?
    2.i thnk positive,it does not happens with me one time,&let it free

    i m trying to say that if i thnk positive for a unwanted thought it is a compulsion or not?this is one my question that positive thnking to neutralising negative one is compulsion or not,or what should i hv to do whn such type of thought comes in my mind,pls rply as soon as possible

    • A compulsion is a behavioral or mental ritual designed to reduce the anxiety brought on by an obsession. People who have “bad thoughts” and who then think “positive thoughts” to prevent something bad from happening are performing rituals. People who have bad thoughts and who then think, “I can cope with this bad thought, it’s not the end of the world,” are practicing healthy coping.

  57. Is this treatment known in the UK by psychologists/psychiatrists? and is this type of OCD known about?

    Many thanks,

    • These treatment ideas are consistent with exposure and response prevention (ERP) and acceptance and commitment therapy (ACT), which are approaches that are not specific to the US. As such, treatment providers should also be available in the UK. I don’t have any specific names of providers there, however. Check with OCD-UK or the International Obsessive-Compulsive Foundation for OCD specialists.

  58. Is it normal to have so many OCD sensorimotor obsessions. My listy seems to be growing every day. Blinking, breathing, tongue sensation, whether my bladder is full or not, whether i need to yawn or not. The more I read about, the more I adopt.

    It is almost as if I have a few to deal with each day. In terms of doing the ERP, does this treatment become more difficult with many different sensations. ie, do you have to deal with one at a time, or deal with them as and when they arise, some sensations are stronger than others on different days.

    I feel as if as soon as I have conquered one symptom (by being less worried about my attention given to it), I seem to get another one and another one. I am hoping that I will run out of new ones soon.

    I am also starting to think this is more about health anxiety than OCD. It is almost as if I am checking to see if every thing was ok.

    I appeared to have become less anxious about noticing my breathing, and then as I was swimming, I felt as if I was unable to get enough air and that I was breathing in a strange way. I tried to stay swimming as much as possible, and got out when I felt physically tired. However, the focus on the breathing continued. I had to check I was breathing enough and correctly. Towards the end of the day I relaxed more and eventually went to sleep, and then in the morning I awoke hyperventilating. I think I have a cold at the moment though that is making it easier to focus on my chest area, and possibilty affecting how I breathe.

    Thank you so much for your great article.


    Sorry, one more question. I read on Dr Keuler’s article and other articles that you need to sit down for half an hour one your own and try to invite your symptoms in and focus on them as much as possible for that half an hour.

    However, how does this fit in with the triggers mentioned in this article. Do I sit for half an hour with my symptoms and also do it when the anxiety is triggered, or should I only sit for half an hour once my anxiety about focussing is triggered.

    Many thanks again for this fantastic article, which I am sure saves lives as well as gives people with this condition hope. I have been speaking to my cousin today and she has been suffering from the same problem. No one ever mentions it though, it is still a taboo, but soon enough I am sure the millions that suffer with this will come forward, and will discover this effective treatment.

    • If you’re afraid that your symptoms reflect an underlying medical illness, then you might need to address that feared outcome in your treatment.

      RE: Dr. Keuler’s approach, the exposure should be targeting the most relevant stimulus and/or sensation. If an external trigger contributes to your symptoms, this might be included in your exposure plan. If the main problem is over-attention and it is not mediated by activities and/or specific triggers, then mindfulness to your body’s sensations may be most appropriate.

    • Hi Sally,

      I too have sensory OCD and it definitely centers on my body and functions and whether something is off. It’s nice to see that I’m not alone on this. For many years, I thought it was just anxiety or panic disorder until recently (2011) I was diagnosed with Pure O. It feels nice to put a name to such a problem in my life and I am lucky to have counselors in my area. If you ever need to chat, let me know!

  59. My sensorimotor ocd focuses on saccadic eye movements. What drives me crazy is I get better, spend several weeks not thinking about it at all, and then one eye movement re-alerts me to the issue and I relapse. Is this common? what can I do in my exposure practice to try and ‘accept’ and get through relapse? It’s so disappointing when it comes back

    • Gauge your progress not by the non-occurrence of the unwanted thought but rather by how well you handle it when it’s there. If you can handle re-emergent symptoms without getting overwhelmed or catastrophizing, you’ll be on the right track. It is key to shift out of an all-or-nothing mindset about these symptoms.

  60. If anyone has success stories of using this method to over come their sensorimotor ocd using this above method, please place them here. I am now starting therapy with an OCD specialist and it will give me hope to see success stories, that there is light at the end of the tunnel and that I can have my life back again.

    Many thanks,

  61. you know what i have been dealing with this myself and people will say dont think about it and them saying that drives you up the wall but like what someone said here you worry about one obsession and then you think about another and end up worrying about that one but it completly takes away the other one, it gives you abit of an understanding of how it works and that it is down to anxiety and how you feel. when you worry about it, it brings you down and your mind is on it more, but when you dont worry about it or dont let it bother you it melts away just as fast, there are still times it gets to me especially when my mood isnt the best sometimes but there are even times when my mood is up and if i did think about it, it wouldnt bother me at all and my mind just lets it go just as fast. but reading this page and knowing that there is actually a name for something like this and its not just me thinking this is something ive done myself and messed up my head, going crazy but theres actually treatment which works and everything is such a relief theres actually a medical term with something im going through and it can be beaten. almost made me cry thank you so much for this.

    • Thanks for commenting, Lee. As you mention, an acceptance-based view of these symptoms can help you become less entangled by them.

  62. Dr Seay, I just wondered, in your experience, does having several different forms of this ocd at the same time (ie worried about focussing on blinking, breathing and bowel/bladder movements) make it more difficult to treat this ocd and do they all have to be worked on at the same time?

    • Yes, I think treatment is more straightforward if you can target a single type of symptom. However, because many individuals with SMOCD have multiple symptom areas, this isn’t always possible.

  63. Sally, i read your first post, the one in which you talk about the medications. As you know, med can help in about 60% of ocd cases, but work much more against anxiety. If you are in a strong anxiety moment, please consider going on med again. I’m suffering swallowing(mainly)/breathing/etc. for three years now. I experienced a full year of relief (symptoms lessen by 95%), but then i stopped med and the nightmare started again.
    Now i’m fighting and i have much more weapons than before. IMHO, the complete acceptance of all those awarnesses it’s the only way out. Mindfullness based therapy (ACT) worked a lot by strongly lessening my sympthoms. I know by now your life is hell but, believe me, things always change. Try to do sports, stay with friends & family and, soon or later, things will go better and better. Learning the art of “let it go” and having an optimistic point of view will give you the possibility to fully enjoi life.

    Stay well

    • what medication were you on? im thinking about going on a ssri. ive taken celexa before

  64. Hi Gabriele,

    Thank you for this. I do feel so bad now, but thank you for your reassurance. Today I am constantly focussing on my mouth, as it feels so dry and cannot take my attention off of it,and I have felt like this for days.

    I too went on medication and obtained complete relief and then it came back after I stopped taking the meds. I have been back on them for five weeks now but it appears to be making it worse!

    Thank you so much for your reassurance. do you feel better now? what is IMHO? what do you think helped you to accept and let go?

    Thank you so much again.

    Sally xxxxxx

  65. I’m having up and downs, depending on the mood. Some days i’m almost symptoms free, others i feel terrible :).
    Maybe you can get some relief by this: i personally know 3 other people here in Roma (i’m italian) who take back their lives after YEARS of swallowing/breathing obsession. They are not symptoms free, but without anxiety and with a huge lessen of obsessive thoughts (they have a family, a good/very good work, etc.).
    Medications work, but can takes 3 months on full dose to have first effects. And the second time you may need even more time or prescription change. A personal advice: keep doing everything you did before, even if you can’t enjoi anything, even if you feel awful.
    IMHO=in my humble opinion.
    To accept those toughts you have to stop to be afraid. Fear is the glue of ocd. It’s not easy and, at the beginning, all your efforts are going to fail. Just don’t give up. Don’t link every sensations to the classical “oh my god, it will last forever! My life is ruined!”, just think “ok, it’s only a though, not big deal”. Last thing, all the obsessions you have are different faces of the same medal, so you have to use a “let it go” attitude for all of them. When an obsession shifts to another don’t panic, it’s the same thing! Let it go the breathing, tongue, swallowing, heartbeat.

    Don’t worry

  66. Thanks Gabi, your advice is a massive comfort to me. I will try to get my life back too. Please keep me updated with how you get on and I will let ou know also.
    You are so kind, thank you xxxxxx

  67. If I am a hopeless case then I understand if there is no answer. But hope there is. I cannot stop thinking about how much saliva there is in my mouth, and my breathing and blinking. My mind just gets stuck on them and I worry that I will never stop thinking about it and enjoy life again. I am not sure I have compulsions other than to try and direct my attention away. But I have stopped doing that now as it does not always help anymore. Now I am stuck with what to do. I have had physical examinations with no medical problems showing up and I am working with an OCD specialist, but we have not started on the ERP and he thinks it is anxiety rather than OCD ! I feel like I will never get better. I know I will always notice my symptoms l, but I do not want it to upset me anymore. I seem to switch from one symptom to another. And will think about it 24 hours a day for a few days and then it will switch. So I am always focussing on something. Please please help me

    • Sometimes the compulsion is avoidance-based and involves comparing daily life to how life would be if symptoms didn’t exist. Other compulsions involve wishing (i.e., wishing that symptoms didn’t exist). Both of these compulsions interfere with acceptance of your symptoms.

  68. Hi,
    I agree with Gabriel. I have been going through the same problems, first swallowing, then blinking and now breathing. It’s extemely tough but I think the key is habituation. The more you get used to the awareness and carry on with your life regardless slowly but surely the anxiety starts to decrease. The more the anxiety decreases the less the awareness bothers you and the less it bothers you the less it occurs. I myself am not sure if this is OCD or something else like panic disorder. I was diagnosed with panic disorder before this started to happen and cannot relate to other OCD fears that I read about or compulsions. I think however it’s described it’s really just plain old anxiety. If something scares you, I.e getting permanently stuck with over awareness then it sticks in your brain and you become stuck. Eventually it will get better, every time you can be aware but carry on regardless it loses some of its power until eventually it has no power. Good luck everyone, better days are ahead

    • Thanks for your description, James. You make many good points here. I think that aspects of sensorimotor symptoms can resemble panic, but individuals with panic tend to be more worried about the consequences of panic (e.g., what if the panic symptoms are actually something dangerous, what if the panic causes something embarrassing to happen) than people with SMOCD. With sensorimotor symptoms, fears largely focus on the fear of regular life being “contaminated” by hyperawareness.

  69. Thanks James. You are so kind. I will hold on to that hope. Thing is I think about at least one symptom all day and so wonder why I have not habituated yet. However, I am constantly anxious so maybe that is why. Thank you so much for your kindness. I wish you all the best too

    • Sally, the goal of exposure with SMOCD symptoms is to face them and to accept them, so that they lose their power over you. If you are only willing to accept them in order to be rid of them, you are likely to find the process overly frustrating. See my post on unwanted thoughts and sensations, if you haven’t already.

  70. These compulsions seem to be what I have. Thank you Dr Seay for your time and for making the treatment more well known.

  71. This is all fantastic. Thank you very much Dr. Seay. I have started to change my mindset and think: well I am thinking about these processes all day long. But they cannot hurt me and it cannot get much worse. I say: I know you are there, but I am not going to let you upset me and I am going to carry on with me life regardless. Yes I may think of blinking/ breathing etc for the rest of my life but that is ok, and I am finding this acceptance is helping me to lose the focus that I have, but then when it comes back it is ok as I have coped with it before. I find this helps quite a lot. Thank you so much.

    • That sounds like a healthy mindset, Sally. Treat it as a work-in-progress, and do your best to move forward.

  72. Hi,

    Thank you very much for this article.

    Well, I have been suffering for OCD for most of my life (I’m 16).
    When I was a child (ever since I was about 7 years old I think) I had obsessions with touching things a certain amount of time and sometimes obsessive thoughts including loved ones dying. But they were very infrequent and did not interfere with my daily life at all because I would do these things at home mostly in my room for a small period of time a day if I even did them at all.
    I am also very organized and my room is always pretty clean/neat.

    Well, now I am 16 and in the past couple of years I have had some OCD panic attacks I think, just where I was thinking about 1,000 things at once and my mind was racing until I literally had a headache.

    But all of these things were pretty controllable.
    Except now the absolute worst has come:
    I have recently developed this horrible sensorimotor OCD and I have obsessive swallowing which in my opinion, is the absolute worst of all of the ones you can have.
    I mostly do this when talking to people or in class so I think it is related to a social anxiety disorder I might also have.
    Anyways, I have only had this for about 3 weeks but it is already driving me crazy.

    I am worried that it is going to get in the way of me having a boyfriend and having friends and getting into college and having a job.
    I feel like people only think about how I swallow so loudly and frequently and compulsively and they will be turned off and think I am crazy.

    I am so stressed out about this that I just want to die!!!

    (PS, OCD is definitely not the only mental illness I have. I am so screwed up. I suffer from EDNOS, ADD, BDD, and several other things I think.
    But I do not have a psychologist, these are all self-diagnosed for the most part.

    Please respond, I am desperate for help!!!!!!

    Thank you so much!

    • Hi Isabel,

      It would probably be helpful to have a psychologist help you sort this out. Based on your description, there may be some important social anxiety components of your sensorimotor symptoms. If you haven’t seen my post about the fear of swallowing or choking, you might find it helpful. In addition to the social components that may involve specific feared outcomes, it might be important to address hyperawareness components through mindfulness and/or exposure.

      Wishing you the best with this!

  73. Dr. Seay, thank you so much for this wonderful post. It has been so helpful for me after years of suffering, I have gotten better and will continue to do so now that I know what’s wrong. You’re doing an amazing service to save/change lives and I can’t thank you enough

    • That’s wonderful, Al. Way to go! Glad the post was helpful!

      • Hope that this would do the same to me:))

  74. hi there,
    thank god some one out there understands my ocd! i use to have panic attacks npow on meds but went to see a pychologist who told me to think about my breathing and now im stuck with it .it drives me mad, im scared i will loose my job over it then my home then kids!
    i just want it to stop. i swear my doctor thinks im mad and others in the past its been years now . i just want to live a normal life! its got so bad in the past that ive ended up depressed.
    ive tried cbt four times. hypnosis once. im on an sssri takes the edge off the depression side of things.
    please can you help me any ideas welcome and what do you think of hypnotherapy some claim it cures but i dont think so if only it were that easy .

    forgot to say with my breathing ocd im scared i wont breath especialy breath in. the hardest thing is i know its irrational but i cant stop it. please can you give me advice on how to improve i so wish i was normal

    • Most research studies on OCD suggest that CBT and SSRIs are the most effective treatments for the condition. I don’t know of any research suggesting that hypnotherapy would be helpful for OCD, so I’m skeptical about its effectiveness. RE: the breathing fears, if you haven’t worked with a CBT therapist who practices exposure and response prevention (ERP), you might consider finding a therapist via the International OCD Foundation who uses ERP. Exposures could then target specific aspects of your breathing fear.

      Wishing you the best with this!

  75. Dr Steven,
    I have a slightly different obsession.
    I have a constant urge to take a deep satisfying breath every few minutes (urge slowly builds up). I end up sighing, attempting to yawn and hyperventilating myself.

    Have you seen something like this before?

    • Hi Aman, it’s important to rule out medical causes of physical symptoms before assuming they are driven by anxiety or OCD. Check it out with your doctor. However, yes… OCD can involve attempts to feel the “right way.”

  76. Hi,
    I am doing a mindfulness course at the moment. Focusing on breathing during the ‘mindfulness of breathing meditation’ practice has actually made my breathing obsession get a lot better. It is strange..purposely focusing on the thing that I was trying to get out my mind made it better, because I was thinking of the breathing in a different ‘innocent way’..just being curious of it, instead of wanting to get it out my mind.
    I have a saliva issue. I am obsessed with the feeling of fullness and subsequently swallowing. Dr Steven…if I purposefully focus on the sensation of fullness in my saliva glands etc, in a curious/innocent/mindfulness manner, will this gradually reduce my obsession with it and help me to be free?
    Thanks for the clarification in advance.

    • Mindfulness-based approaches can be helpful for many different types of OCD symptoms, and I think it’s likely to be a promising strategy for addressing the saliva issue. If you have other specific feared outcomes (e.g., fear of drooling, fear of not being able to enunciate and having other people notice), then these things should also be addressed via ERP.

  77. How can you be sure that these types of sensorimotor obsessions are actually OCD at all? From my own perspective the usual OCD symptoms don’t fit at all, neither do the pure o type obsessions that I read about. For me this started after an extremely stressful event and it seems to have left me with a different perception of myself. Like a sudden heightened awareness of sensations that I didn’t even notice before. When all other OCD features are absent, none of the other types of obsessions produce any fear and no compulsions how do you know that there is not a completely different biological basis for this problem? Have you ever treated someone with these problems using erp and seen them make a full recovery? I.e no longer have the symptoms at all as opposed to being a bit less distressed by them?

    • Sensorimotor OCD is a construct that is understudied and, thus, is poorly understood. Because the research base devoted to SMOCD is virtually non-existent, much work is needed to clarify SMOCD’s underlying etiology. As mentioned in some of the articles, in some cases, symptoms may be better accounted for by panic or social anxiety.

      Perhaps contrary to what you’re describing, in the cases I have seen, SMOCD appears to be associated with notable mental rituals and avoidance behaviors. Many people with SMOCD do benefit significantly from exposure- or acceptance-based treatment. However, recovery is a process that does not occur overnight.

  78. Hi Steven,

    I emailed you yesterday. I have a problem with swallowing but I’m scared to say what it is on here in case I scare anyone. I want to try ERP on it but I’m not sure what one of the triggers is exactly or if it is a trigger. If it is a trigger then I dunno how I get control over it but I would say it’s internal. Part of me knows I need to learn to accept it and not get scared when I feel it but I dunno how to get to that place, like how to expose myself to it. I am having treatment for my sensory motor OCD but it’s not well known and I haven’t seen many articles about it. I’m thinking to print it out though and take it to my therapist but yeah I’m stuck on how to expose myself. Sorry to be a pain but if it’s possible could you email me?



  79. Thanks for the response to my question. I have had problems with ADD most of my life, and have a tendency to hyper-focus so I was wondering if it could be linked to that. I think the thought that once I have noticed it, how will I ever forget it is the thought that keeps me stuck in the loop. Because ofcourse there is no answer to that question, it creates the anxiety cycle. I suspect this is the same question most who struggle with this problem have trouble with. The more you try to forget it the harder it gets to forget it. I can see how accepting it is the only way forward, so I dont disagree with ERP, its just extremely hard to accept something that is so uncomfortable. Also the more I deliberatly expose myself to it the more uncomfortable it seems to get which makes me hate it even more. Its interesting that you say nobody is investigating this problem as you have dealt with it quite extensively, I am surprised other therapists worldwide have not had more experience of this and it isn’t getting greater attention?

    • I hyper focus on my swallowing and I have the whole once I’ve noticed it what if I can’t forget it? What if I keep noticing it? I have fear about swallowing which might scare other people so I don’t wanna say. I wanna be able to accept it but yeah I find it very uncomfortable, very scary, scary how you can’t just stop thinking about it and feeling it and my brain has marked it as dangerous. I also wish it was more known about. I feel like the only way to get over this is if there was some kind of pill that wiped the memory and emotion about it from your brain. I have managed to get over anxieties about being aware of breathing and blinking though but swallowing feels harder.

  80. To be honest I feel the only way out is ending my life but I want to get well and stay with my family and friends but I’m suffering.

    • dont get hopless.i m also a medical stud. U r in right as doctor steve say. U will ur normal life back

      • Thank you xyz. Things have got a little better but I still finding it hard accept and not be scared.

        • talk to a professional. it will get better, please don’t give up.

  81. sir i am suffering from body focus ocd since 1 year.sir it was about october,2011 when i becm hyper focus on my natural body process such as blinking,breathing and obsession start during exam time.i was too much conscouis abt my studies .i got irritated with every thing which hamper my studies.due to lot of stress i suddenly got trap in this psychologist prescribed me fluoxetiene 60mg and etizolam .5mg i am taking this medicine since from 1 year.In first 6 months of my treatment,i only take medicine no psychotherapy were used there was only 40% relax after then i read ur was awsm it help me alot .i was cured up to 95%.ur therapy works amazingly .At present i used to do ERP daily 10 min each for physiological process . Now since from one month i have left ERP. About whole month i was symptom free about 100%. As my ocd is associated with my studies especially during exams ,and this is my exam time. I am a medical intern. now i wana know that,can i restart ERP,actually i fill littlebit anxious about 5% in that day,but if i dont do then in months there is a day or 2 days when i fill little hyper focus and this subside gradually, i wana know that wat should be my schedule of doing ERP.i also wana know that,is there r other therapy with ERP which help me to gain some more profit,also can yoga help me.i also feels that when i try to achieve something big in studies this ocd will make obstacle in my path,sir pls help me, waiting for ur valuable answer

    • You’ll really have to experiment with identifying the right amount of ERP practice you’ll need to maintain your gains. Some people with body-focused symptoms also benefit from mindfulness practice, which is a component in some meditation practices.

      • can you tell me how much amount of ERP is needed?

        • please dr steven help me i live in a third world country and im pretty much on my own can you please in layman terms give me a simplified daily practice of what you described ? please from what i understood you said YOU SHOULD focus on your problem my brething and try and get used to the fear if im not ocrect i know im askign the worldh ere but please give me a simple eazy description of what i should do

          • Everyone’s situation is different, and what’s helpful for one person may be unhelpful (or harmful) for another. The way a person thinks must be incorporated specifically into their treatment. That’s why I try to discuss more general principles of treatment rather than giving specific commentary about people’s individual situations. My suggestion is to pick up a book on OCD treatment. I have quite a few listed on on my “OCD Books and Websites” page — maybe start there?

  82. Dear Dr Seay:

    “Not all triggers are external. Sometimes thoughts just pop into our heads for no apparent reason. In these cases, the thoughts themselves are considered internal triggers. It’s still a good idea to track your symptoms over the course of a day and notice the characteristics of situations that are likely to be associated with internal triggers.”

    I’ve read your article and understood the steps described to curb OCD body-related anxiety, but my problem is with the internal trigger: I focused my attention on my breathing and couldn’t stop it. And my internal trigger for this hyper-focus on breathing is ANYTHING.

    Anything I saw in my environment and any thought that pop into my head I could mentally relate to this hyper-focus on breathing, for example, a girl I saw on the bus that I wanted to talk to, a bright color object near a shop, or ideas like how I could manage my life or how frequently such thoughts will pop into my head. Once related, I have to focus on my breathing for an extended period of time, which is tiring and annoying.

    My biggest fear is whenever breathing comes into my mental focus, I will have to shift my attention to breathing, and thus unable to do other things. This is for my the CRAZIEST thing because breathing can come into my focus at ANY time of the day and interfere with my daily activities (like talking to people, or walking across the street).

    I tried to use the ERP method to calm myself whenever triggers happen, but there seem to be an endless amount of triggers because anything I saw, hear, think, or feel could potentially become a trigger.

    Please help me with some advices or a step-by-step process on how to deal with this issue, Dr Seay, thank you very much!

    • I’m a OCD patient in China, the professionals here are not familiar with ERP procedures, and I don’t EVER want to take any medication. So please help me with this problem, Dr Seay, thank you!!!

      • Hi Andy, your best bet is to find a therapist locally or to travel to see one for short-term intensive therapy. Some also provide psychotherapy over Skype, but this is harder to do in cases of body-focused symptoms (at least in my experience).

    • Sorry to hear your having trouble with your breathing. I used to have the breathing thing too but now I’m not as bothered about it as I used to be so it is possible to get through the breathing one. When your aware of your breathing it does not effect your attention to do other things. I have found I can still do all things I did before whether thinking about it or not. My old CBT therapist from years ago got me to realise that your breathing works naturally whether your focused on it or not and that you can focus on it without it feeling uncomfortable.

      • Thank you, now that I realized the same thing, breathing works naturally whether you focus on it or not, I still have this underlying fear that, if I do not pay attention to my breathing, something might go wrong, and this is what I have to struggle against every day on an almost minute-by-minute basis. I want to rid myself of this irrational fear, but it persists. Now I have to live in this constant fear, which is destroying my life.

        • It’s just OCD making you feel like something will go wrong if you don’t focus on your breathing. I use to be scared of taking medication but it’s recommended to take whilst having therapy. I’m sure I read some where that medication makes it more easier for your brain to change it’s thinking. I take medication myself and although one of my medication isn’t keeping the OCD and bay it has kept the anxiety down but I need to change my medication.

          I would say if you feel something is going to go wrong, don’t give in to it by paying attention to your breathing. I started to find by not giving in when I felt something was going to go wrong help because I would later find that nothing did you go wrong and that it was just false information from the OCD. The more you see nothing goes wrong when you don’t give in the more your see OCD has as a load of rubbish.

          I struggle with my swallowing and wish I knew how get over that. I do a bit of ERP on it but I dunno if this can help me.

          • Thank you for the reply and let me know what you think, I’m now starting to take Zoloft, not sure if it can help

          • Thanks for sharing this, Rosemary.

        • This fear–the fear that something might go wrong–is something that you can target via ERP.

    • Andy, you really need a therapist to develop a specific plan for you to target your symptoms. In general, ERP isn’t an all-day event. It’s a series of pre-planned, discrete activities that you can use to target specific aspects of your symptoms.

      Many people that I see have focused ERP-based homework assignments that they do daily, as well as separate strategies that they use when unwanted thoughts pop up unexpectedly. When an intrusive thought pops up when you’re at work, your goal is to notice the thought but not overreact to it.

      SMOCD thoughts are like mosquitoes.

      If you are attending an outdoor party in an area that has lots of mosquitoes, the mosquitoes should not be the defining part of that experience. Sure, it would be nice to attend a mosquito-free party…but that’s not always an option. You have to learn to be okay with experiences that include some unwanted parts.

      At the same time, if you are overly sensitive to mosquito bites, you may need to actually practice getting bitten to desensitize yourself.

      This is the essence of SMOCD treatment.

      • Dear Dr Seay:

        Thank you very much for your reply and your suggestion, indeed SMOCD thoughts are like mosquitoes that can bother you and lead you to experience pain at any time anywhere, often totally unexpectedly.

        After having this breathing obsession for over a month, and taking two weeks of Zoloft, I found that now my problems had developed into a type of phobia: meaning, because I’m afraid that I could be aware of my breathing during the course of me performing some actions, like combing my hair, opening door with a key, eating, and reading(especially reading), now whenever I perform these types of actions, my attention would automatically “shift” to the awareness of breathing, thus impairing my ability to successfully carry out the actions, and causing me to experience a heightened sense of anxiety. For example, when I read an article, if during the time when I read a specific sentence, my awareness of breathing begins, I have to stop reading and take a breath in, before I can read on and finish the sentence, or else my nose just stop breathing all together. This caused me tremendous distress and made me afraid of reading, and likewise for almost all the actions I have to perform during the course of which my awareness of breathing might begin.

        Dr Seay, have you ever seen patients who had experienced the same symptoms as me? Can you give me some advice on how to deal with such SMOCD-induced breathing awareness phobias?

        Thank you very much!

  83. I use to take zoloft years ago. I found it ok but different drugs effort different people in different ways. What works for one person doesn’t necessary work for another. I hope helps you to feel better.

    • How long did you take it? And how did it help you cope with symptoms, like breathing and swallowing?

    • Very true, Rosemary. Thanks for your comment.

  84. I just read your article. I had a fear of choking when I was very young. Throughout the years I would start focusing on my breathing and became scared that I would stop breathing if I did not focus on it. Lately, it has become very intense. It happens after I eat sometimes, making me think I am having a food allergy. I have never had allergy testing for food, but I am thinking maybe I should just to eliminate that part of the fear.
    However, sometimes i will be trying to sleep or even sleeping and I will wake up suddenly feeling like I can’t breathe. I sit up really quickly just feeling like all my breath is gone.
    I understand that the food thing is a trigger but I don’t understand the sleeping one. Is there anything else i should be checked for before I focus on the possibility of it being OCD?

  85. Steven these articles are excellent. I wonder if you, or anyone else, could offer some advice for me! My issue is yawning, or rather not being able to yawn. It all stems from a paranoia about my eyes, which tend to be a little red at times, and the fear that not being able to yawn properly worsens them.

    When I try to yawn my mind stops me. I have got into a way of being able to yawn by actively thinking about something else, or imagining times when I could yawn quite happily (this started 4 months ago) but after reading your articles, I fear this technique is actually a “compulsion” and may be making things worse. I usually manage to yawn successfully a number of time seach day, but never unconsciously and I always have to put a lot of effort and employ mental tricks to do it. I suppose my biggest fear is I will never be able to yawn properly again.

  86. I have suffred from this problem through out my life, iam very concious of my tongue and how my teeth feels when my mouth closed, i think the main trigger of these feelings is the free time, but once iam occupied with other issues in my lif i tend to forget it. But lately, iam getting in a relationship that i was always waitting for and i do not have free time. But i remeberd theses thoughts and does not seem to go away. It mke me feel unhappy and get me into depression. I keep wondering will i ever get back to my old self again and pull off my relationship

  87. Hi Dr. Seay,

    Thanks for all you do! I’m also having a terrible time with eye movement obsessions – they alternate with obsessions with sound and movement. I’ve just started doing mindfulness meditation regularly and am hoping that will help. I’m waiting to get in to see an OCD therapist.

    I’ve tried Luvox, Zoloft and am currently on a very small dose of Prozac. All of the SSRI’s seem to make the obsessions and anxiety worse. Have you seen this before?

  88. I also have a sensorimotor obsession problem. Right now It’s mainly being over obsessive and distracted with my nose in my vision. It’s hard to focus on anything else. I had this problem 4 years ago and it went from breathing to nose to blinking to my tongue to everything. It lasted for a couple months then went away for the 4 years in between. Now it’s back again but this article makes me hopeful. I hope there is a solution to our problem. This gives me hope. If any of you guys who are also having trouble with this want to chat, email me. It’s nice knowing that I’m not the only one out there with this problem and that somebody understands me. It’s a very tricky topic.

  89. there is a name! SMOCD. thank you for having this blog. typing blinking/breathing into a search engine makes me feel nuts. i think my obsessions started with early childhood trauma- i would hold my breath to be invisible. then, i tuned out of my body for years- i didn’t listen – smoked, drank, whatever to feel distance. then, when i checked back in to my body i was very hyper-vigilant- i noticed everything!!!! every blink, every breath, every twitch. and the noticing made me anxious, so i would breathe/blink less or more and either way i felt messed up, i judged myself. to make it worse i feared i would “give other people a blinking/breathing obsession” and that they would be miserable like me. i still worry about that. but what i’ve come up with is mindfulness and self acceptance. really, loving myself through this. sitting with it. not running. much like panic, it will eventually disperse. even if its a day later. meditation helps, staying sober helps, noticing the imperfections in others and loving those imperfections helps, and letting go of the idea that i will ever be free of this helps. i just accept it. it’s a human response to trauma- we get hyper aware. we are ninjas! but, we also need calm and rest. so, i try and love myself through the triggers and the SMOCD moments and work towards activating my parasympathetic response when i can. anyhow, thanks for letting me be honest for the first time in public. i’m a mental health clinician and this is never spoken about. i don’t feel crazy anymore. xo.

  90. sir i am confused about how much quantity of ERP is required,sir 2 to 3 days (kindly give me answer in number plaese)
    back i just got a relapse,i was not doing ERP for 2.5 months,sir i am just making a opinion that may be medicine course get completed in a year.but i have to do ERP for rest of my life,sir i have a question, is this ocd is same that of classic ocd,or different or sever type,becoz many classic ocd(contaminated hand) get totally cured,i know some of them, they even have not taken medicine or any ERP, even they get cured 100%,its ok if i have to do this exercise rest of my life, it is just an exerciseERP. but i think it is a more safer style to live, instead of getting a sever relapse,kindly clear my respective doubt,and sir many of psychiatrist in india have not heard about this type of ocd since i am also a final year medical student,even in HARRISON details are not given about this ocd, can u tell me name of any medical book in which details are given about this particular type of ocd, so that i can tell about this to my senior boss, who is a psychiatrist?thank u sir

    • Please give your mobile no. or call me on 8087329963 im also from India and having same problems that you are facing please contact me friend I want your help or just give me missed call.I am glad to talk with you thank you

  91. sir can u tell me about use of gamma knife therapy for ocd?

  92. i had breathing obsession for about 6 months andduring thosetime i didnt know it was ocd or any related illness i got rid of it because i was going through a real life stress situation.i totally forgot about it for about a year and during those times if i would remember it i would find it funny and just live with it and let my body control it automatically without having to control it but recently a month ago after one complete year of relief i got this obsession again and i have always been in control of it though. i personally think from my own experience that this can be cure there is a hope. There are somethings in life that you have to live with. Right now am pretty sure am gonna get rid of this in a couple months because am faithful and i always see a hope in every challenge so anyone out there that is going through these obsessions don’t lose hope. you will be healed sooner or later there’s a cure to every single disease on planet. By the way i personaly think the ERP is a great start to recovery so guys if this work for you stick with it. sooner you will find this a minor problem and straight after you never know you might grow through something which will make you totally forget about it like i did. Their is always a hope.

  93. Dr. Seay. At the beginning of this year I was preliminary diagnosed with Vocal Cord Dysfunction. My life has completely changed since then. I have become completey obsessed with my breathing and live in constant watch and alertness. I have been hospitalized in patient and outpatient and I have been under treatment for around six months mainly biofeedback and CBT therapy. I made some progess but I feel stuck and I am completely obsessed with my breathing; I feel I need to regulate/control my breathing, gasp for air, feel like I need to get out for fresh air, chest tightness, dry mouth and dry throat, constant coughing, thorat clearing and have great difficukty focusing in eveything else. I want to be able to feel comfortable, be with my loved ones and enjoy work again. I have been pushing myself everyday to keep going as I tell myself I am going to get better but it is difficult somedays. This morning I had a terrible time getting out of bed but I pushed myself to come to work. After reading your articles I felt a new sense of peace and hope and new strenght and determination to continue to work in getting better. Any referrals or treatment recommendation will be well taken. I guess my challenge is finding good ERP exercises that will help me face this fear. One more thing, this whole thing has has a big toll in my family especially my wife and daughter. Any treatment or any other recommendation are more than welcome. Thanks

  94. I just stumbled across this website, and was amazed at how what you describe relates to a problem I’ve been dealing with for a number of years. My main problem is that I value my smile, and feel that this used to be a really important tool for me in socializing. Now I’ve become aware of my smile, and feel that when i focus on it, it looks fake, and people can tell, and as a result people don’t really like me, or like me less then they would if I didn’t focus on it. I know deep down that my thoughts are probably OCD related, and I have had previous problems with eye movement and arm mvoements which i got over with the help of CBT, I was wondering as I can’t really access CBT at present, if you could reading from my post help me identify my compulsions?/ how i can confront this problem. Many thanks.

  95. Hi, i read your article on erp around a year ago and it was massively helpful knowing that reducing fear is the key! My ocd is mainly with blinking. I just wondered if you could advise some specific home treatments for me to practice reducing the anxiety. It’s difficult finding expert help in the UK. My life is so positive even though i have suffered with this problem on and off for many years but i would like to move forward to even better things and i hope you can give me some individual homework etc to assist me. I am more than happy to pay for any specific individual advice you can provide. Many thanks Nick


  97. Dr Seay – A bit over three months ago my brain snapped and i began this hyper blinking awareness. It has taken over my entire life. I have been given a multitude of meds and even tried hynotherapy. Nothing has helped. i have gone through many bad periods of my life, nothing compares to this. Reading was always my escape. I cannot read anymore. i cannot watch television. I feel like my life is just a big ball of negativity. Where do I start?

    • I have the exact same problem! I used to love watching tv and movies and lately all I can focus on is blinking, especially when I’m in front of a TV. :/

      • I understand how both of you are feeling. It gets better so long as you learn not to fight it. Because you hate thinking about blinking and feel this will ruin all of your good experiences of course every time you sit and watch the tv or read the thought pops up. You have to just let the awareness be there and not try to fight it or get rid of it. Just accept that your aware of your blinking. If you dont keep fighting it your brain gets bored of thinking about it and being aware of it naturally. Its the fighting and aversion and trying to work out why your doing it that makes it continue. If you read a book or watch tv and are aware of your blinking just carry on reading or watching tv and be aware of blinking. You will find regardless of your awareness its still possible to enjoy the tv or book. Eventually you will just not think about it at all because you dont fear it any more however that will only happen when you get to the stage where you dont care if you think about it or not. It can be a little uncomfortable but if you allow it to just happen its never really as bad as you percieve it to be. I have been struggling with this problem and conscious breathing for about 2 years and although it bothers me for short periods now and again its gotten a lot, lot better. I think about it a lot less and when I do I just accept it and it always passes.

  98. Hi,
    I really love this article. It really makes me feel like getting over my hyper awareness is possible.
    My problem is related to my heart beat. I feel each beat, and it just leaves me annoyed and sometimes unable to sleep. I’ve only felt this way for about 4 days, though. I recently got my wisdom teeth out, and I was having a lot of difficulty breathing afterward. The thing is, though, I’ve never had any hyper aware problems. This is my first, and I think it’s just a reaction to being monitored during surgery. Perhaps my subconscious is still very away that I was being monitored, and it’s still in the awareness stage.
    I was wondering, though, is this natural? Am I just really sensitive right now due to all of that happening? Was it anxiety over not being able to breathe for sometime? I’ve never had breathing problems, either, so maybe it’s paranoia? I have a lot of different theories. But, mainly, do you think with time this will go away?
    Thank you so much for any answers. (: You’re a huge help to many.

  99. Hi Dr Seay,

    This article has been so enlightening and I am reassured that I am not alone. I always thought that I had classical symptoms of OCD until I came across your page. Now, looking back on my childhood these symptoms were always present. i.e couldn’t get good sleep because I always thought my bladder was full, felt like I swallowed something wrong and was choking (taken to emergency room) When of course, this was not the case. I also struggled with breathing, blinking and swallowing. But more recently…for seven years to be exact I have struggled with being conscious of my eye contact. It started out as a small obsession but gained more and more presence, to the point that I have withdrawn from any social activities. It is truly paralyzing and unbearable. I am currently seeking therapy, but I do not believe my therapist is helping to employ the ERP technique. Is this something I can practice on my own? Because of the nature of the obsessions I recently decided to try medication (paxil). I am worried about the side effects and withdrawal symptoms and whether or not the medication will even show improvement. This article seems to show that ERP is an effective way to treat this form of OCD, does this mean that medication should be avoided/ not necessary? And lastly, what causes this certain form of OCD? If it is a chemical imbalance, than can ERP work without the help of medication? Thank you so much.

  100. Hello Steve ;D I’m from brazil.. and i suffer from OCD.

    When i was a kid my main problem was with instrusive thoughts.. religious and morals with mental compulsions.. like praying or making promisses.
    I had a little bit of Classic OCD … Thinking that i had cut my self and checking for that.

    I start med school in 2007 and since than my OCD got worse.

    I start a body focused OCD sintoms. Manly in the area of Mouth.

    I was heavly obcessed by how my tongue was … or the teeath … the obcessions move a lot.

    They stay constant with me for about 1-2 months .. than i forget about it. But it always come back.

    I went to a psychiatrist .. he prescribe me fluvoxamine and a lit bit of quitiapine XR.

    I dont think that help me that much..

    Lately my OCD sintoms came back … I am Heavly obcessed by my salive.. Every minite that i

    am awake i have a constante flow of salive that a need too swollow or spit every 10s or so.

    Its online stops when i very interrested in other think or when i’m sleeping.

    I have a mix of feeling about that:
    1- that its never going to end .. and i wiil be like this forever.
    2- that will affect my relationships with my girlfriend.
    3- that will affect my studies in med school.

    I am willing to make CBT or ERT but i have NO ideia where to start…

    I cannot find a therapist where in my city.

    i never saw someone with that much knowledge of my problem.

    What can i do? If i can find no body where i thing to go there.. spend some time in therapy

    with you.. learn as much as i can to make my sintoms better..

    it’s always good to have someone listen to you.

    Your blog is great ;D Thank you for that great work. I bet you have helped a lot of people ;D

  101. Hello Dr. Steve.

    Firstly, I would like to thank you for your very wonderful job and I believe that your works have helped countless thousands of people all over the world who suffer from this unique and challenging mental game.

    I’m 23, male, and was never formally diagnosed to have OCD. Because I went to nursing school, I knew that many of my symptoms (some traced to have started in high school) are OCD-related. I was never obsessed with cleanliness or diseases like what many OCD-gifted have. Mine are purely intrusive and highly pervasive thoughts that are illogical in nature. It started when I was in second year of college life during our Anatomy and Physiology class. My professor was discussing on muscle contraction when thoughts of “What if I will always be aware of every single body movement I make?” “What if body movement becomes voluntary forever?” “What if I don’t forget about it until the day I die?” —-suddenly popped up. Then I panicked inside my brain because I was extremely afraid that this obsession was going to suck all my happiness and peace of mind, my dreams and goals, my happy life and days of genuine smiles. It lasted for days to weeks and months, and gone for a while. And now it is back in the form of breathing obsession. Dr. Steve, I just feel so low right now.

  102. Hello dr,
    Your article was really helpful for me. I had severe breath awareness in 2011. It lasted for 1 year!!! the Dr in my country gave me escitalopram and clonazipam. After almost a year the symptoms became very mild. However at that time i was hospitalized for a reason other that the above cause. After getting discharged i completely forgot my breath awareness and became completely normal. Now! after 4 years IT HAS COME TO HAUNT ME AGAIN!!!! Pl guide me how to get rid of it.
    Will i again have to go the traume once again!!! pl help me!

  103. Hi, I have had a breathing obsession for years now, but it has recently come back strong. It has a continuous hold on me because the more I think about it, the more dizzy and lightheaded I get, until I find a way to control it so that my body feels balanced. I found many ways of controlling it before, such as focusing on breathing out when i feel dizzy because of extra oxygen. However now its as if I am even more aware of each breath. It is getting virtually impossible to get my body and head to feel normal instead of dizzy the minute i remember my breathing. I am in constant fear and apprehension because I know the minute I think about it, my breathing will get abnormal and cause me to get dizzy. I am terrified of it getting worse, such as making me pass out if I get dizzy enough.

    Do you have any suggestions on how to get it physically under control, so that it would not bother me mentally? I know that the minute I find a tactic to control my breathing so that no matter how much I focus on it, I will not get dizzy, the obsession will not bother me anymore.
    Really appreciate your help. Thank you so much.

    • Find things that you enjoy and would do regularly. The worst thing is if you are just staying in your bed thinking about it. Look into medication as well. It has helped me a lot. Good luck

  104. Hi,
    After a revisit of my OCD symptoms such as constantly worry about the way I move my body, I can no longer avoid the problem. Symptoms started occurring in my beginning teenage high school years about wanted to be perfect. I have always been an anxious, type A person but not in this way. When I would spend a lot of time getting ready, I would freak over my every move trying not to mess up anything. Near the beginning of these impulses and obsessions I would have somewhat control over the way I move my body. However, as time went on I could not even handle how to deal or take control. At this time I tried seeing a psychologist to go the natural route, but after not “clicking” with her and feeling I was not getting anywhere I stop going. I then resorted to a an antianxiety/depression. That seemed to do the trick but of course after a few month the relief wore of. I then went through various episodes of obsessions that would come and go. Currently as I am surfing the web I am struggling even writing this because I am suffering from a pretty extreme episode. This was the first time that I goggled what I am feeling. I feel miserable and want it to instantly go away, but the more I try to stop thinking about it, the worse I feel. I feel like I am doing the total opposite of what I am trying to achieve, by moving my body perfectly. I move in way that are making my body worse off such as sore or stiff. It just doesn’t make sense. These obsessions and compulsions have taken so much of my life already, and I just want to move forward. Usually what happens is one step further and a million steps back toward achieving being “normal”. Just thought I would share my story.

  105. Hi everyone,

    Its great to see there is a article that is directly related to my symptoms.
    I see there is a lot of people that are going through similar issues. I am glad there is a resource where we all can get together and help each other out with this tough mental illness. My issue that I currently have is swallowing. I seen that people have mentioned it in the past. I find if i think about it, I get more saliva. It is frustating thinking about these useless things. I want to think about changing the world and not thinking about these small things. If you can offer any suggestion, it would be helpful.

    Thank you,


  106. my all bodily functions are gripped by sensorimotor ocd since 5 years.Moreover igot fear of doing wrong in the past n now thinking that i will not get ok because of its curse,m helpless,i cant lead my”life”.

  107. I don’t know if this helps but I’m only thirteen. I became obsessed with swallowing when it was the night of my first day of school. I couldn’t sleep at all and became strangely aware of my saliva pooling under my mouth and started swallowing over and over. Ever since then It was hard for me to sleep and get extremely anxious when night is about to come. Although I’m fine when I’m having fun and socializing with people. But when I go to my classes and all I have to do is be silent and listen to my teachers lessons, I couldn’t. My thoughts immediately go towards my swallowing. And basically any time I have nothing to do and just sit in silence and listen I became anxious and aware of my swallowing. I know I’m supposed to face this and to do it alone in a quiet place but it makes it hard if this happens at crowded places unexpectedly. I think my external trigger came from my own bedroom and at evening. My internal triggers is all over. Sometimes it randomly pops up when I’m in the middle of swallowing and I end up doing it over and over again. Do I just keep swallowing until my thoughts are calm and in a different topic? Thank you and please reply.

  108. hi steven on night i had this bothering thought of excessive saliva in my mouth since that it has become a obsession i can’t stop thinking about it do you have any advice?

  109. It started about 2 months ago where I became aware of my own breathing, then I started researching on net about this then I came to know it was sensorimotor ocd I read the cases simlar to me by reading one case I also got blinking obsession now it is blinking obsession whole day and breathing when I close my eyes and when I am sleeping, the biggest problem is that whole day I keep thinkig about how my earlier life what has happened now I cant enjoy each second of my life, I am engineering student and I think how will I concentrate on my studies with thinking about blinking all the time what my future will be, I think like a black hole and see no light I have panic attacks some times if I keep thinking, I feel like sucide is the only way now.I found one case here in comments he has not mentioned his name but has written xyz as his name he is also from India he was also having same problem as I was having. So xyz please contact me my no. Is 8087329963 I am very glad to talk to you I am waiting for your phone call please xyz contact me.

  110. I am getting cure, yes its happening nothing is impossible in this world the key is we have to accept it instead of showing anixety towards it this is not that simple it requires lot of hard work you have to be mindfull, I am now 50% cured within one month I will make it 100%.

    • Hello Sumeet.
      I am suffering from this type of OCD myself – mostly the breathing awareness, but also others like eye movement/blinking, swallowing, bladder fullness and others. It is VERY frustrating. It has been going on for a year now. I am also an engineering student and i find that this OCD is ruining my life. So i would really like to hear how you are dealing/beating this type of OCD? And are you 100% cured by now? 🙂

      • Hi Kristiana.So I will tell you my story.So it was the time when I was having the best days of my life.One day I got tonsils in which throat becomes swallon.So I was finding it difficult to while sleeping I thought what if I stop breathing from that time I got breathing obsession first two three weeks I didn’t tell it to anyone. But it was so worst that I didn’t get a sleep no matter how much I was tired.So I told my mom and dad about this.when I told them they were looking at me like I was allien,then I went to psychiatrist from big cities in India.They have not heard about this kind of obsession. They gave me meds which didn’t showed effect. I was fool I wasted three four months because we had a famous psychiatrist at our place and I didn’t trust him.So I went to him he gave me meds. now after two months I am seeing light at the end of tunnel.So find a good psychiatrist who knows what is ocd and how to treat it.Clomipramine is the med. which helped me.So best of luck good life is waiting for you.

        • Hi Sumeet! I am always conciliatory about my breathing and it seems to last all day every second without triggers. It has led me into deep depression and I see that u take meds. I wanted to know till this day have you been cured and have your life changed around. It is very dreading and fristrating. I read all your comments and I wanted to thank you for taking the time to respond to everyone because it really gives someone with no hope hope again

  111. Hello Sumeet Pande, how did you get help for this. Do you seek therapy? Or medications ? Thanx!

    • Read the above comment Carlos.

  112. Hi all,

    i developed a fear of choking about 2 years ago having had 3 different experiences in a 3 week time frame where I felt like I couldn’t complete the swallow thus was going to choke. The first and last time sent a panic through my body, shaking, nervous, felt like I almost choked. Since this time I haven’t been able to eat solid food, when something doesn’t feel right in my throat I get a quick jolt of panic last about 5 seconds which causes me to stop and go back to liquids. Also, recently when lying on my back at times, I get the feeling that I can’t swallow or need to swallow in order to clear my throat which also causes panic.
    Anyone have any suggestions?

  113. I am dealing with this from 4 months first it was breathing and it shifted to blinking now , though I am trying mindfulness but not yet cured completely it ranges from 50% to 70% throughout the day. I don’t have triggers it is for each and every second of the day trying mindfulness just reduces anxiety but it doesn’t removes the obsession. For first two months I was like zombie having no energy at all I was thinking that my life is now wasted, I left my engineering college and was just thinking of sucide. I want to tell all sufferers that don’t show anxiety towards it it will be there but just keep doing your work. I know it is little difficult to do the work with full concentration but you can still do your work successfully.

  114. I have been struggling with the swallowing version of this for the past 2 months. It is unbelievably tough and I am having some real dark days. Can anyone offer me hope that this does get better with time? It feels like the only way to get over it is to accept it but that’s easier said than done! Also, has anyone found that medication makes a difference?


  115. I am struggling badly with the swallowing OCD. If anyone is reading this and has experisncrd singular, please can you advise me if you have had any luck with medication and if so, the name of the medication.

  116. Hi Doctor Steve. thanks for your article,it gives me a lot information i need to know. I am constantly aware of breathing and the saliva produced in my mouth. My attention is stuck on the awareness of breathing and saliva. When my attention is stuck on breathing while I am reading,I keep reading and try not to think about my breath. Am I not doing exposure and response prevention in doing that? Am i doing a kind of ritual? Thank you very much.

  117. Hi doctor Steve,

    Thank you for your articles,they are very helpful for me. When I ‘m talking to other people, I am aware of the positions of my feet or hands and am also aware of my breath. My attention is stuck on the awareness and I can not concentrate on the talking. The other people will complain that I am flying somewhere else. what is the exposure and response prevention targeted at this problem do you suggest? thanks.

  118. Hi all

    Just wondering if anyone reading this has had any luck with medication working to help with the sensorimotor swallowing obsession? I have had this now for 2 months. I am a bit reluctant to go on meds unless they really do help as they come with some major side effects.


  119. Dr Seay

    Do you see patients from abroad?


  120. Hi all the suffers.
    I am suffering from sensorimotor ocd from last 6 months so I am now master in this subject. So basically I will tell what actually obsession is.obsession means constantly thinking about same thing again and again.this thoughts are unwanted and it causes anxiety because we cannot control this thought,they just keeps popping in mind and we find ourselves out of control. it is not yet found what causes this.
    Sensorimotor ocd is one of the type of obsessive compulsive disorder. Which is very less talked.we find our life greatly affected.we have difficulty concentrating at work.we just keep thinking that it will never go and my life is ruined,I will never have peace of mind.even if we look at begger we think his life is better than ours,we also have suicide thoughts popping in mind we find it almost impossible to get rid.
    So you will ask me what to do.

    We are living in 21st century there are medicines for ocd. It takes time about 3,4 months or more but you will find that your quality of life improves you will start enjoying things,your creativity increase and eventually your interest in life comes back.
    I was prescribed clomiparamine and setraline. So find a good psychiatrist

    • Hi Sumeet

      I’m interested to know how much of an improvement you have noticed since you went on the SSRI medications? I have been prescribed Setraline myself but have been reluctant to start it due to the many side effects that I hear of. I also feel that if I start the medication I will have to be on it for life and I worry what would happen if the effects started to wear off. If this happened surely I’d be in an even worse place than now??

      Kind regards

    • Hi Sumeet

      How are you getting on with the medication? Do you feel it is making your symptoms better? I am struggling with a hyperawareness of my tongue and I’m wondering if an SSRI would help so very interested to know how you are getting on. Thanks

      • Hi Anne,

        I struggle with the same and I do not try SSRI’s at first because of the side-effects. It can give you a dry mouth and with the awareness of my tongue I think it will only make matters worse for me.

        I try to put my tongue in a place where it feels the most comfortable and try to habituate to it slowly. I have it since december 2014 and it becomes less, but it takes a lot of times.

  121. Hi Ray and Anne

    Yes medication makes us feel better and Yes there are side effects of SSRI,like constipation,dizziness whole day,dry mouth,lack of interest in sex etc.
    Though there are side effect we have to take the medicines.its better to have side effect than this hell ocd.I have not asked my psychiatrist about how many months I have to take medicines I will ask him the next time I have appointment with him.
    There are certain chemicals in brain which controls our mood,sexual behavior,emotion’s etc.
    Serotonin is one of the chemical which controls our mood.SSRI’s boost the serotonin level in our brain.After taking SSRI for three four months you will start noticing that difference.You will start getting your life back.The ocd thoughts will not trouble us.That’s it what we want.We are suffering because we show anxiety towards the ocd thoughts.I hope you will take the medicines.

  122. Dr. Seay,

    Thanks for this article…I have suffered from all of these my whole life. I generally suffer all of the time, but there are definitely times when it is somewhat better and times when it is worse. Currently, I am struggling with the swallowing, but I am not sure what the underlying fear or obsession is…it may be part fear of choking, or fear that I will never be able to eat again and will wither away, or fear that the feeling will never go away and I won’t be able to enjoy life or sustain a meaningful relationship. I have a whole list of internal and external triggers and do have compulsions. You provided 9 steps for a hypothetical case for breathing…could you do the same for a hypothetical case of swallowing? For me, the SSRI drugs have not helped with this because the side effects often make my appetite decrease which only makes it harder to eat! I am currently taking Buspar and Ativan (as needed) to decrease the anxiety…hopefully, these will help me with the ERP. Thanks again.

  123. Dr Seay…just a suggestion but I see you have stopped responding to comments nowadays. I believe before your advise would have helped a lot of people dealing with this horrible form of OVD so maybe you could reconsider posting again to help out us current day suffers? Thanks 🙂

    • You’re right, Jack. I’m back and trying to be more available now. Sorry for the absence.

      • Hi I would like to know what would be the best thing to look for in a therapist or treatment, also what should I say to a Psychiatrist or what meds could be even more helpful, and also what should I look for physical symptoms in a doctor check, please answer and thank you

        • Therapists who use ERP and mindfulness strategies will be best-equipped to help. Regarding psychiatrists, do the best you can to explain your symptoms and your experience, and allow them to use their medical expertise to guide the medication selection process. If you’ve been diagnosed with OCD or another anxiety disorder, share this information with them, so that they know this. If your symptoms are associated with anxiety or depression, make sure you share this information as well.

          RE: physical symptoms, explain your symptoms to your medical doctor and ask for their opinion about what might be causing the symptom you’re experiencing. Your doctor might directly tell you what they think, or they may order more testing or refer you to a specialist for more information.

          • What should I do if in my country no one seems to know about this condition,and what kind of therapy and meds should I ask a Psychiatrist about?

          • Hi, what should I do if it seems like no one seems to know about this condition, and what kind of therapy or meds should I ask a Psychiatrist about?

          • It’s important for your psychiatrist to do their own assessment and make a recommendation based on their expertise and training. Your role is to describe your symptoms to them, and to ask whatever questions you might have. As you’ve read about in the post, ERP and mindfulness-based strategies are considered useful for treating OCD, and the medications that are most often used to treat OCD are the SSRIs. Your doctor would have to determine whether or not these are the appropriate interventions for you specifically.

  124. I am still suffering with concious swallowing, (pretty much all the time
    during my waking hours), it has now been 3 months. It is now really starting to have an impact on my life to the point I am having to take time of work due to stress and insomnia ;-(

    I am desperate for help on how I can beat this but not really sure how I should be going about treating it. I have seen 3 therapists in the UK and none of them have any clue on what to do as they have had no prior experience with this type of OCD, it seems it is such a rare condition, literally one of the rarest things on the planet?! Please can anyone reading that has experience themselves with this problem help me. Thank you

  125. Hello Steven, I found your article while looking for some remedy for my issues. I am diagnosed with an anxiety disorder for over 13 years now. Early in my sickness I was confronted already once with sensorimotor obsession (blinking, breathing) but it eventually disappeared. Unfortunately the obses-sion came back 6 months ago. Mainly with blinking-obsession but also swallowing. Luckily I am only suffering phases of “hyper-awareness” and after one or two weeks it is gone again. Although deep down the fear of return is always there. But I try not to think about it too much and then it comes back with full impact. And what scares me even more, is that ever since it started again, it happened quite often (every one to three months) and the phases got longer. Reading through your treatment I have difficulties breaking it down to my blinking-obsession. I am aware of my blinking all the time combined with thoughts “that it will never go away”; “I will never be happy”; “my life is destroyed”; this causes a panic attack and sheer hopelessness. If I understand correctly, I should focus on the blinking while letting all the thoughts and anxiety rise to its maximum? Trying to face the real issue behind all the blinking/swallowing? I am not sure if I got this right.
    I am in therapy right now (cognitive behavioral therapy) but we are not really working on the “hyper-awareness” but on the source of the panic (“working with the inner child”; reliving the panic and getting to the core of it; finding the center of myself). Do you think this will also manage to solve the occasional “hyper-awareness”? I would be more than happy to receive some feedback on my issue.
    Thank you very much.

  126. Hi. I have been strugling with sensorimotor my wholE Life and i have given years of thought only to address yhis matter. It started with breathing, then it went waaay worse with swallowing (to the point I couldnt socialize because I did this weird swallowing, it was more like an urge. For the past five years I have been focused 247 with blinkin and has been the more debilitating so far. My eyes dont blink period, it just gets to the point they just itch too much and I blink consciously to relief thr pain. Every time I blink my eyes loose focus and im preetu sute they move upwards every time I blink. My whole face twitches from time to time.since I am sO Consious about my eye muscles. Ok here comeS the good part. I have been giving a lot of thought to this and I have had a beautiful revelation I wanted to share with you guys. the way I overcame swallowing is by realizing I was putting all the attention I could offer to the little bell that is abovr putlr tongues, yes that little bastard. If yoi pit all the attention there it feela like you are going to choke since it is just hanguing there but once you accept this you realize you dont have to swallow you just have to accept there is a part of your throat that is there and feels like saliva or mucus but its just that. Ok I overcame that but now the hard one (at least for me right now)….blinking, every time I blink my head goes blank. I forget everything I was thinking aboit and its hard to articulate words or thoights this way. It is also hard to have any emotions since all you feel is fear about yourself. I also cannot sleep since my whole eye muscles keep twitching beacusr of how uncomfortable they feel to me. Today after five years of misery I think I Finnaly understand my fear. If you fill your throat with air your eyes pop out and i found that I have been doing that the whole time and that is why my eyes felt so weird and possibly why they didnt blink or whu they felt so weird when I blinK. Please let me know if I was able to help anyone. I still feel very uncomfortable and in a weird sad way, entertained by these thoughts so I would love to have communication with people sharing these thoughts and mayne we cpuld help each other out. That why I am giving my email to everyone who reads this and feel free to contact me anytime, I will recieve yoir email instantly and it will notify me on my phone. Perhaps later we could share phone nmbers. Thanks for reading this and sorry for the typos its hard to write on a mobile. will ne waiting for you

  127. Thanks Steven for your great article. I obsess about my vitreous eye floaters and it causes me great distress. I have been seen by an ophthalmologist, who said my eyes are healthy and my floaters are normal. I also have diagnosed OCD. I don’t know why but seeing the floaters causes me great distress and even panic, despite me knowing they are no threat to me. My anxiety levels skyrocket ahead of going in to a situation where I know I will notice the floaters more.

    I am working on my OCD by acknowledging I have the condition, knowing what causes it and re-focusing my energies onto something enjoyable when the obsessions and urges to perform checking rituals mount. I also see a psychologist about this and other anxiety and depression issues.

    Where I feel stuck is striking a balance between avoiding situations where the floaters are more noticeable (and thus more anxiety inducing) and going in to those situations where I will more likely fixate on them, check them repeatedly and measure my emotional response. I may feel OK briefly after fixating on them but the urge to check comes back very quickly. I need to get the ‘right’ feeling, which never happens. So I feel I’m damned if I do and damned if I don’t. An example is lying in bed with the sun coming through the window. Looking up at the ceiling I notice the floaters, which can cause me to panic, which, in turn leads to compulsive checking. I can either stay there and face the anxiety (the floaters are impossible not to notice when thinking about them), or I can avoid the situation by closing the blinds or leaving the room, which is avoidance.

    Your thoughts?

    Thank you,

    Rod, Australia

    • Hey.

      How are you doing after these years? Have you seen any improvement in your condition?


  128. Dear Dr. Seay.My name is Bernardo and I am from Mexico I just found your website and I am amazed by all your knowledge about OCD. I do have OCD , specifically Somatic verifier type and I am taking Luvox (fluvoxamine)and pregabalin. I constantly feel a muscular tension in the back of my neck which produces me anxiety (annoying and stressing sensation. and also i perceive visual non normal phenomena which is part of the symptomatology. I have been felt better ultimately but has been a long and hard way and i don’t know if I am doing things correctly.It would be incredible and a great help to know your opinion about my situation. Thanks a lot and peace and love

  129. Dr. steven

    i am greatly worried for the mental health of a close friend of mine. every word you used to describe this form of OCD he has expressed when he talks to me about this. he feels helpless and i try to tell him he is not. the upside to all this is he has been trying to go see a therapist but either he has to wait for an extended amount of time, or the therapist’s rates are far to high. i was just wanting to ask if you know of any therapist in the northern part of Texas that would be able to help my friend with out making him feel used for money.

    • You might want to check the website of the International OCD Foundation. They have a database of providers that might be helpful. Unfortunately, I’m not terribly familiar with specific providers in different parts of Texas. You should know that effective treatment DOES exist, however. ERP + mindfulness can be especially effective for sensorimotor symptoms.

  130. Hello everyone

    I had this sensorimotor ocd 2 years ago I was in little depression, my focus went to breathing and the thought came to my mind what if I could never take my mind of this breathing, from this point my life went upside down the ocd thought was there from time I woke up to the time I went to sleep, getting sleep was a very tough task. Whole day I used to fight with my own thoughts after some days I went in severe depression and lost interest in everything. The life became hell,and I even had suicidal thoughts. I didn’t seek psychiatric help for two months as I was ashamed after wards I started taking meds,It took 5-6 months and my life was in track after that and continued taking meds for another 6 months.

    Now one months back I developed new obsession that was focusing on saliva and swallowing it. But this time I was not depressed as I know I can throw this out anytime by taking meds. Having one month of positive thought it went away and I recovered.

    The purpose of me writing this article was not telling my personal life and experience, I wanted you to tell that what keeps this OCD going is the fear of not getting mind of it,it will ruin your concentration,you will not enjoy your life. If you overcome this fears you will easily overcome this OCD.

    • I love this success story. Thank you so much for sharing your experience! Fear is what keeps this going…

  131. Hi iam from the philippines. Iam dealing this hyper awareness of breathing last oct 13,2016, because i cant sleep suddenly breathing pops to my mind and after that it became an obsession to the point that i cant sleep and my sleep is to shallow that iam just closing my eyes. So this december 2016 ive search because the psychologist i thought didnt help me. And i thought she doesnt have idea in ERP and CBT. I also read the thread of janet singer. And i apply those mindfulness and ERP. i do erp by being aware of my breathe without any judgement. This help me reduce my anxiety and habituate to it. I also have my note for my imaginal exposure by writing that i will be forever thinking of my breathe, sometimes my blinking, my swallowing, or salivating, but my anxiety arises when i dont have a good sleep. I can tolerate the sensation and i can accept it but im afraid because i cant sleep because of this its like im on a circle its always repeating. I accept the fact that i have this obsessions and think that my sleep will improve. And before i sleep it comes to my mind that i cant sleep because of my obsessiom

    • It sounds like you’ve been using some healthy strategies related to the breathing hyperawareness. Perhaps you could apply some of the same mindfulness strategies to sleep and/or the thoughts you have about not being able to sleep.

  132. Dr. Seay, I really appreciate this article, as I have found that information on this topic is limited online. I personally have struggled many years ago with an issue that seems to fit the description you have provided. The issue came up again today and yesterday and so I am researching it. Basically, I have this hyper-awareness of one particular finger occasionally because of a strange feeling in my finger. However, I’m certain the feeling is completely a result of my mind, because I only feel it when I am not focused on something/I’m not directing my attention to anything in particular. I would really appreciate if you could read this response and offer some options of treatment for my case in particular.
    Thank you kindly.

    • Even if you think you know that it’s anxiety-based, it’s probably still important to begin by seeing your doctor and ruling out physical causes. This should be done in moderation (not excessively), but it’s an important step.

  133. Hi Steve,
    I have had GAD for about 3 months now and it has escalated. I initially had tracheitis which went away but I have been over focusing on my breathing since and this has just got worse. I now have 4 problems:
    1) I dislike the feeling of my own breathing process.
    2) I feel like I want to stop breathing.
    3) I often feel like I am going to stop breathing when I feel exhausted.
    4) I imagine myself never being able to stop thinking about it and see having to breath as a life sentence.

    These feelings are making my life intolerable and here in the UK there is little to no help for this kind of specialist condition and I have been left to deal with it by myself so I am hoping you can help me get my life back on track.

    • It sounds like a treatment approach based on mindfulness strategies and ERP might be helpful. Mindfulness would help you develop the ability to notice your breath with nonjudgmental awareness, whereas ERP might be helpful for addressing the fear that you might stop breathing when you’re exhausted. Is there anyone near you who practices “ACT” therapy? This might really help. Check

      • Thanks for the reply. I have been practicing mindfulness for a couple of years and it had always really helped me but I struggle with it since my breathing obsession.
        There are hardly any therapists, let alone ACT ones but have been reading the Happiness Trap book which is based on ACT. What ERP would you recommend? I can’t get over the thought I am going to have to breath for the rest of my life which is crazy when I was fine with breathing for 34years until now!

        • If you’re catastrophizing, imaginal exposure can be very helpful. You might consider combining that with practicing mindfulness to breath.

        • By the way, I do think the Happiness Trap is a great book. For further reading, you might also consider “Get Out of Your Mind and Into Your Life.”

  134. Hallo Dr. Seay, hallo Steven,

    I mainly suffer from the blinking and the breathing (and sometimes the heartbeat).
    I have tried several times to do ERP for the blinking, but then I felt
    tension in my eyes for a longer time, so I couldn’t continue.
    My question is therefore, does ERP also work for the blinking issue?

    My second question is regarding minfullness and body scan.
    When I close my eyes, I often feel my heartbeat and there is a
    tendency that I focus on my breathing (and I feel tingling in my
    feets). In such a situation I have difficulties to do the body scan
    and focus on other parts of the body. I find it also “strange” to do
    so, as I actually “don’t want” to focus all the time to these body sensations
    (when I am not doing these exercises).
    So, do mindfullness and body scan exercises help (evidence based) for
    these issues? Did you experience positive results with your clients with this?
    Do you recommend any mindfullness and body scan method?

    THANKs a LOT
    HIHGLY appreciated
    Kind Regards

    • The approach can differ from person to person. ERP is best often for people who have thoughts related to their blinking (e.g., if they’re worried about blinking “wrong” or if there are social fears related to blinking). Developing the ability to be nonjudgmentally aware of blinking would most certainly be useful, especially in the context of mindfulness practice. RE: your second question, body scans typically are helpful in that they do help develop the ability to be nonjudgmentally aware, as well as the ability to shift your focus of attention. In my experience, these strategies DO help, but you should have an awareness of the intent of the exercise and not just do it blindly.

      • Thanks a lot for the reply Steven,
        what do you you mean with: “you should have an awareness of the intent of the exercise and not just do it blindly”
        Do you mean: I should have an awareness of the “goal” (“intent”) of the exercise?
        Or do you just mean I should do it with a guided body scan method where a person guides you?

        • The overarching “goal” of the mindfulness practice is to get better at being non-judgmentally-aware. This is true both during the practice itself, but also overall in the context of your own life and your moment-to-moment experience. In other words, if you happen to notice unwanted sensory awareness when you’re not doing the exercises, that’s as it should be. It’s the perfect opportunity to actually apply these skills in your real life. That’s the very reason you’re practicing them. Thus, we would try to regard these break-through sensory experiences not as failures or as something to be avoided, but rather as something to notice.

          One of the biggest problems I see in people who implement mindfulness to deal with sensory awareness is that sometimes they’re using mindfulness “mindlessly” as a way to escape or stop their symptoms. This makes mindfulness a ritual and goes counter to the very intention of the practice, which is to make space for these experiences.

  135. OK, I see the point when you are not doing the excercises. But during the excercises, what actually can you do wrong? I mean, lying with closed eyes you will be aware of anything, like a thought or a body sensation, and you cannot “escape” that.
    Can you give me an example about “using mindfulness “mindlessly”” ?
    (I really find hard to apply this on the blinking problem, as a can get uncomfortable tension in my eyes).

    • Using it mindlessly is when you’re applying the technique without regard as to why you’re using it in the first place. If you understand that mindfulness is a way to get better at practicing nonjudgmental acceptance, this may be a non-issue for you. With blinking specifically, the intention is much the same — to notice unwanted sensations and to allow these sensations to occur with less judgment and less push-back.

  136. Hi Steve,

    Thanks for the great article. I have GAD and as I enter a bit of a relapse the breathing awareness creeps in again. Last relapse I had was the first time I became conscious of my breathing and it was devastating and I wanted it to go away ASAP. That caused intense insomnia and anxiety. However, this time around, I am aware but not as anxious because I am trying to accept the conscious awareness.

    I want to know if me mentally telling myself ‘I accept these thoughts” and “Who cares if this never goes away” is an indirect mental ritual to calm myself down? If so – what should I be mentally thinking about, if I should be mentally thinking about anything.

    When I am practicing mindfulness I solely try to focus on my breath, and let any other thoughts come and go. My biggest external triggers are laying in bed, as I have a lot of trouble sleeping when I begin to be overly conscious of my breath. I know we are supposed to face our external triggers and sit with the anxiety. So while I am doing this, am I just supposed to focus on my breath and let any other thoughts come and go, even the thought that this will never go away?

    I am trying to get used to the thought that I may be like this forever, as a way of exposing myself to that anxiety, as it is what i am most “anxious” of.

    Thanks in advance!!!

    • There is a role for healthy self-talk, and from your description, I think what you’re doing is okay. If you find that you’re repeating it or using it to “escape” from anxiety, though, then it might be slipping into ritual territory. It also is unhelpful if the self-talk becomes more of a conversation. In the context of mindfulness, the goal is to notice your breath and to let thoughts come and go, as you’ve mentioned. Some people will also find it useful to incorporate imaginal exposure to feared thoughts.

  137. Hi steve i have thos problem with swallow and blinking for the past 2 months besides this in 2016 i started having depersonalization and severe anxiety.
    The problem started only with blinking and lasted 2 days in his severe form i mean i can do things and no pamic about this but always in the back on my so i started to read about this problem and panicking because people struggle with this for years so i got a panick attack and the fear become enormous so o started to being aware of my blinking 24/7 i was scared a lot because i got the catastrofic thougt of beign aware of it my entire life and when i read this problem is ocd related i panicking more and more about this so i continue reading for answers amd i found that are other related obsessions like swallowing etc. I develop the swallowing issue just by reading it so i felt devastated and weak but im going to therapy now and i hope to get better but should i ask my therapist if he knows erp to treat me or no? And should i stop to obssesibe searching about this problem?

    • ERP (and especially mindfulness) are key to addressing any variation of hyperawareness OCD. This would be something to work on with your therapist. It could be helpful to do some additional reading on mindfulness (e.g., the Mindfulness Workbook for OCD, etc.), but I wouldn’t encourage any type of obsessive searching.

  138. Hi Steve,
    I have had my share of sensorimotor OCD sometime back.. breathing, blinking and all but I got rid of it by using some above mentioned techniques. But now I have a new problem and I don’t know wat to do about it. I am paying too much attention to my voice when I speak. I m unable to get rid of it. M consciously listening to my own voice.. does it fall in the same category and how to deal with it.

    • Yes, this would fall in the same category, and the same treatment strategies would apply — i.e., ERP + mindfulness. Much like the other forms of hyperawareness OCD, trying to “get rid of it” will only make it worse. Best practices involve ERP and mindfulness around noticing without judging.

    • Roop are you Punjabi? I am also Punjabi and I am seriously struggling with body focused obsessions..

  139. My story. I started having breathing Sensory Motor OCD as of 5th December 2016. On that evening I was listening to music through earphones connected to my laptop, when the song had finished I noticed that I could hear my breathing. (due to the earphones in my ears, allowing me to hear my breathing more)It was at that moment I had this thought “What if I can’t get my mind off my breathing?” I started to panic a little as I couldn’t seem to ignore my breathing, but after a while it went away. That night I went to bed at 10:30pm, constant torment as my mind kept on reminding me of my breathing until like 5am. It was these moments that had caused my OCD to last for 2 months. During which time I worked very hard to get rid of it (Without help, only me and no medication either), and it was trial and error as I had my up’s and down’s with the OCD but I kept trying. It was very hard for me to get over it when I had a relapse around New Years Eve and a small relapse on 1st February. But I’m pleased to announce that I have no symptoms of the OCD now, I’m OCD free. I just thought I’d share my story because I want to tell you all YOU CAN DO THIS! You can get over this, no matter how long you had had it or how bad it is. (Be it one week or 50 years). I managed to get this far mostly because I came across your article Dr. Steven J. Seay and I’d like to say thank you so very much. Once I confronted my fears, got rid of my anxiety, learnt all about my type of OCD, done 1hr of ERP/CBT p/day, learnt about mindfulness and finally accepted my OCD I was able to get rid of it. My symptoms and my subconscious mind reminding me of my breathing diminished within a few weeks. My story also proves that there is a possibility that you can solve your OCD without getting help or taking med’s, but it’ll be very hard and take a lot of perseverance. But I’d still highly recommend seeking help or even taking medication too if you feel that it is the best route to take. It is easier to overcome OCD with medical help, but my route worked for me. There were times when I felt hopeless and that I might have to live with it forever, but the last block for me to overcome was to keep positive and keep believing that there is an end to OCD and that it will go as long as you accept and don’t fear it. Remember fear (anxiety), carrying out compulsions and obsessing over it is the fuel for the OCD engine. Stop those and the engine will eventually run out of fuel and stop. No more OCD. Good Luck! 🙂

    • Thanks for sharing your story! It’s so helpful for others to hear that it can get better. I wish you all the best in your continued recovery! 🙂

      • Thank you. 🙂 I’ve learnt to keep my OCD at a minimal and prevent it from morphing into any other type of OCD (Only 1-3 triggers a week atm) as OCD is a life long condition it wont go away. But OCD is very manageable and doesn’t bother me anymore. Touch wood.

    • I have started doing ERP and CBT about an hour a day as well. Sometimes I’m very impatient and just want this gone.. Any tips on how to fully accept this? And how did you notice it was getting better? I’ve noticed I’m more easily distracted and can get things done. I still have problems relaxing and sleeping, though. Sometimes I feel like it’s not getting better, and it’s hard to tell. I’m going to start seeing a therapist about this. But I’m glad that you have a victory over this and that you’ve shared, because sometimes I really feel hopeless about this never going away. But you’ve proved that it can be overcome! 🙂

      • Glad you’re actively working on it! Hopefully, you can share your success story as well.

      • Hi Anne.
        I too was feeling impatient on wanting to get rid of my OCD fully when I started doing ERP/CBT. But accepting your OCD being present will help allow you to overcome it.
        Your first question “Any tips on how to fully accept this?”: – Usually it’s the fear that it will never go away that re-enforces it, keeping it present. But remember that it will go away, but to only as much as you don’t fear it and are not bothered by it. As to how you can accept it, I’d say try to keep positive, remind yourself that it’s not dangerous (It’s only a thought), by doing the ERP/CBT you have the mental tools needed to control it. Then you should not fear it and so be able to accept it. The ERP will allow you to not be bothered by it and not to have an anxiety response from it. Also I want to mention that I found it easier to get rid of my OCD when I wasn’t setting a deadline to get rid of it fully, refusing to think that it will not get better as I remind myself that Ii have already made progress, so it can get better. Also by not thinking that because I had the OCD for a long amount of time I wouldn’t be able to get rid of it, because other people have recovered from their OCD after having it for longer amounts of time. Avoid negative thinking about your OCD, as it will only fuel the OCD itself. Think to yourself, it’ll only be there for as long as you fear it. Because you’re bothered by it, your subconscious mind is being told that its dangerous so it reminds you of it a lot. So it’s good to see it as only anxiety, not a danger. It’ll go when you don’t have a response to it, just like how you felt before you had this OCD.
        “how did you notice it was getting better?”
        I’ve found out that when I was not making much progress, I was obsessing over it by monitoring how bad it was. I was also mistaking my breathing OCD with naturally being aware of my breathing, which only slowed my progress. Throughout the day its normal for people to notice their own breathing on occasion and also quite a bit whilst doing sports or while not doing anything at all. So it’s good to identify what the obsession and compulsion symptoms are. But try not to monitor them, yet at the same time don’t try to escape it. When your OCD is present, try to accept it being there and don’t see it as a bother. I noticed my OCD was getting better after following these rules I mentioned, I was focusing on my breathing less, my mind wasn’t reminding me of my breathing as much and I wasn’t feeling anxious when I did notice them. (The ERP will allow you to not have any anxiety response and feel ok with your symptoms being present). After doing ERP/CBT and practicing Mindfulness (Processing my OCD thoughts in a positive way) for 6 weeks I was then free of my OCD “fully”. As in terms of me not having a trigger for over 7 weeks now at the point of writing this, which I consider a full recovery as I am content with it being present at that level and it doesn’t impact my life, plus I can fully relax without it bothering me. But OCD is chronic, which means it can still re-occur, BUT ONLY if you allow it to bother you. It’s possible to recover from it 100% as long as you know how to treat your OCD and prevent it from becoming a problem, weather that involves seeking professional help or taking medicine for it, or doing self-help, by choosing the right path to take, you will recover in the end. I wish you the best of luck! 
        Note: I followed this blog and also Dr. Steven Phillipson’s video’s to recover from my OCD.

  140. Hi Steve. I am struggling so bad. I have been hyper aware of my eye movements. I have a fear that I will never be able to look at someone’s whole face again. I keep checking to see if I can look at someones whole face without any eye movement. It is so hard to deal with. I cant even enjoy tv or pictures anymore because I don’t know where on the face to look. How do I look at both eyes and get the whole picture of someones face. Its so hard so I end up looking and analyzing peoples pictures for so long. It starts to make my head hurt. I cant even talk to my family properly anymore because I don’t know where on the face to look at them.. What should I do. I have also been diagnosed with OCD. So I do know it is all cause of my OCD. My compultion is to keep on checking peoples faces and trying to see if I can look at there whole face and actually mentally get the full picture of them

    • It would probably be useful to get some professional help in working on this. A good OCD specialist could guide you. In general, though, it sounds like your attempts to perceive someone’s whole face is the ritual. You need to get practice accepting the uncomfortable feeling that comes from perceiving incomplete parts. This would be the foundation of your ERP. Mindfulness will also be a useful strategy in this regard.

  141. about a month ago, I was sitting down to eat dinner and I took a deep breath and couldn’t get a full one, which freaked me out. Turns out I had bronchitis. But since then, I’ve been constantly focused on my breathing, thinking that I’ll never be able to stop thinking about my breathing. I am a college freshman, and this is really bringing me down. The counseling services offered at my school aren’t sufficient for solving this problem. My parents say it’s just anxiety that has been built up through the years (as I’ve struggled with panic for most of my life) that needed to be addressed. I’ve been doing CBT and trying to do ERP myself, but I feel like I need professional help, but I have to go back to school in a week. Even though it has been getting better, it’s still very debilitating and very difficult to function. I feel like I’m doing ERP wrong… Or maybe I’m just expecting fast results. Either way, I’m just scared that this will never get fixed…

    • If the counseling services available at your school aren’t helpful, you might consider seeing an outside OCD therapist near your school. It can be very helpful to have professional guidance as you’re beginning ERP and learning mindfulness strategies. Medication can be helpful, too — particularly, if you’re feeling a lot of hopelessness and depression in relation to your symptoms.

      • One more thing- part of me feels like it’s not sensorimotor OCD because 1.) if someone mentions an obsession, I am unphased by it and it doesn’t cause me to think of it or obsess over it and 2.) I had a traumatic incident with not being able to swallow a few days ago, but I haven’t been focused on that. I saw a therapist while I was home for spring break and she took my whole “feeling like I can’t breathe” as a traumatic incident and have been having some obsessive compulsive tendencies associated with it. I’m not really sure what my compulsion could be. I have an urge to take a deep breath a lot, but I think that’s about it. I’ll have to discuss this all with her, but I’m just confused as to why I would only focus on my breathing from a traumatic event but not my swallowing after a traumatic event. Could it just be constant anxiety about something or uncertainty?

        • Usually, the compulsion is trying not to think about it. Also, SMOCD can be specific to one symptom — it doesn’t necessarily have to generalize to other areas. Regardless, it’s great that you’ve gotten connected with a professional! Hope things go smoothly!

  142. I have breathing obsession, started about a year ago, then afrer a month kinda went away, thought about it every day, but was not really bothered by it. Few days back it came back in to my mind and I was again thrown back in this loop of having constant awareness of it, and it really casts a huge shadow of my life. Haven’t been to any particular specialist yet, but I am kind of afraid to waste my time and money on the wrong OCD specialists. Because in country where I live I have not managed to find a single article, commment or a post about this type of OCD. There are very few information about OCD itself, and jsut a handful of specialists… I think I need to be put on some meds and be done with it.

    • Medication can be helpful, so that’s a reasonable option to pursue. If the benefits are limited though, behavioral treatments like ERP and mindfulness-based approaches can also be very helpful for reducing symptoms.

  143. Hi Steven, I don’t know if you can help me but I don’t have full blown OCD but I do suffer from social/general anxiety which makes me fidget a lot.
    When I developed my social anxiety I convinced myself the best way to interact with people was not to plan out conversations/ interactions so I told myself dont tell yourself say “Hello then do this etc” but just do it. And this helped.

    But then I convinced my self this what I should do with itching/blinking etc and when I thought too much about itching and was too aware of it I should not tell myself “itch your arm” I should only itch when I am not aware I am doing it. But is this right should I only itch when I’m not aware of it? Or do we sometimes purposley say”oh I have an itch let me itch it”? thanks

    Please ask for clarification.

    • Pre-planning conversations can definitely perpetuate symptoms of social anxiety. It’s a “ritual” and therefore ultimately works against you.

      RE: the itching/blinking question, I’m not entirely sure I understand your question. What I can say is that self-talk and self-instruction are a normal part of our internal experience, so I wouldn’t expect you to be able to eliminate those phenomena. Yes, treatment may involve strategically noticing urges and not responding to them (depending on a person’s symptoms). But this doesn’t mean that we would have you try to globally eliminate self-talk or self-instruction around these urges.

  144. Dear Steven
    I have had a blinking obsession with severe anxiety for almost a year. I beleive part of my problem is “mental checking” In an article on the subject I read the following:

    “Preemptive resistance requires that you have an awareness of your OCD tendency to check. If you have developed this awareness, you are more able to see opportunities for mental checking . This as an opportunity to resist checking. Use this urge as evidence that you should re-direct your focus, rather than seeking certainty that the obsession has been dealt with. In other words, the urge is your clue – it is your signal to resist doing the compulsion.”

    Steven, should I resist my urge to mentally check or my blinking. I always thought this type of resistance was counterproductive?

    • Resisting compulsions is entirely different from resisting obsessions. Resisting compulsions is a foundational component of effective ERP. Resisting or avoiding obsessions can often be counterproductive.

  145. i am 43 year old
    from 13 of April 2016 i am suffer from berthing ocd some time i have
    good situation from berthing ocd and some time my situation become so bad
    my brain dont stop remembering me about breathing operation my life become like
    dead man walk

    can you help me

    • Mike, the article here provides some basic information about treatment, but you might do better working 1:1 with a therapist who can guide you more specifically. Ideally, you’d work with someone local to you. Are you in Florida? If you live in Florida, Missouri, or certain other areas where I am able to provide “virtual” visits, my practice might be able to help.

  146. Dear Steven,
    I suffer from being aware of my blinking, which causes pain and tension in my eyes (like I posted before).
    I have experienced several times that when a family member was around my for several hours, that “they” also complained about feeling pain in their eyes. This caused me feeling panic and anxiety, thinking this could be caused by me or because of my symptoms.
    Do you have similar experince with your clients regarding their faimilies and friends?
    How can I deal with such a situation ?
    Thanks a lot
    Kind Regards

    • My first thought is that if there’s pain, it’s important that you consult with your doctor to rule out physical causes. Make sure you don’t overlook this important step. If your family members are complaining about pain in their eyes, too, then this is all the more reason to be proactive in ruling out medical problems.

  147. Hallo Steven,
    thanks so far.
    Actually according my experience, it all started with my symptoms, that I feel the blinking of my eyes all the time. Because of this my eye muscles get stressed out during the day and then I feel tension and pain.
    Further, I have experienced many many times during the last 8 month (since I have this issue), that when I am talking to somebody and looking at their eyes, that those person rub their eyes at certain moment (especially when I am suffering strongly under my own symptoms).
    This happened with family members, but also with “strangers”.
    My therapists don’t believe me, or they argue that those people probably doesn’t experience that much discomfot in their eyes as I think.
    Before the 8 month, actually almost 40 years long I have never experienced such symptoms and such scary “situations”. Not with family memebers and also not with strangers.
    At the beginning I also tried to negate this experience and don’t believe that it’s related to me and my symptoms.
    But once one family member complained personally and verbally to me in my presence, I got really scared.
    I know this all sounds “unbelievable” and scary, but that’s why I seek help here.
    I don’t know how to deal with it.

    I had several blood tests and my eyes has been checked by an eye specialist without any findings. Next week I will have an intake interview with OCD specialists (who are hopefully also familiar with sensorimotor OCD and neurology).

    One extra thing maybe to mention. 17 years ago I suffered several years from anxiety and panic disorder after one time soft-drug consumption.
    But the last 9 years I have been symptom free and I was almost never thinking about those times anymore (I have closed that chapter).

    Thanks a lot for understanding, trust and help
    Kind regards

    • Hi guys,

      I found this artice that will really help if you have fidgeting/blinking/breathing and other ocd problems.

    • My condition has improved as I did not experience the “scary” situation any more.

  148. Dear Dr Seay–or any other person posting.

    I have had terrible sensorimotor “blinking obsession” OCD for almost 1 year. While I am getting treatment from a general psychologist, I have a very specific question that my psychologist can’t adequately answer…that I am hoping you can shed some light on.

    There appears to be conflicting advice in articles on how to deal with sensorimotor OCD (specially blinking). In an excellent article written by Dr. David Keuler ( he clearly says that best treatment for sensorimotor OCD requires:

    “Sufferers must learn how to invite in the sensory awareness with a relaxed and accepting posture.”….. “In short, sensory 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.”

    However, in another excellent article on the same topic , (Pure “O”) written by the OCD Center in LA, ( the author writes:

    “The initial behavioral compulsion that puts this OCD cycle into motion is the mental checking, and it is among the more challenging behavioral compulsions to resist because it often appears to precede the unwanted thought….. Preemptive resistance may appear impossible until you are well into a course of (CBT). Preemptive resistance requires that you have an awareness of your OCD tendency to check. If you have developed this awareness, you are more able to see opportunities for mental checking before they happen, and to see them as opportunities to resist checking. If you have OCD, you may feel an urge to check when you become aware of the absence of your obsession. Use this urge as evidence that you should re-direct your focus.”

    It seems like these two pieces of advice are contradictory relative to thinking about how to deal with my blinking obsession. Do I truly invite into my mind and become voluntary aware of my blinking? Or do I resist the urge to “mentally check” and become aware of my blinking? I have tried it both ways and I am terribly confused! Can I do both…I don’t think so. They seem to be mutually exclusive.

    Can you help me with a very specific answer? Thanks in advance for you help with this!!

  149. Dear Steve

    Whenever I have something exciting to look forward to I obsess as to whether anxiety will ruin the moment or not, which causes me to dwell on my anxiety and therefore develop the fear of anxiety about having anxiety. But now I have a dream holiday coming up in 2 months and I am afraid of some new mental illness or a new OCD theme suddenly appearing and ruining everything. Currently, I am terrified of getting a sensorimotor obsession!

    I have a fear of getting a breathing obsession which has actually caused me to sort of become aware of my own breathing. And I am terrified as to whether this will lead to an actual breathing obsession or whether I am already there. I am also terrified of getting obsessions with other bodily functions such as swallowing, blinking, or even certain thought processes! I also have ROCD fears and I terrified about how all of this will affect my feelings for my loved one.

    Can the fear of sensorimotor OCD (or other OCD themes) actually cause one??

  150. A couple of questions. First is it ok to use headphones for the looped message? Second how often should I do this? Once a day? Multiple times a day? I have multiple issues like obsessive awareness of my breathing so can you work on more than one at a time and if not how do you know when to move on to the next one? I cant afford a therapist so your help is absolutely invaluable! Thank you so much!

  151. Dear Doctor,

    I have swallowing OCD for 3 years. My external trigger is that worrying about my coworkers/friends/dates would think badly about my swallowing behavior, they would think I am wierd or abnormal because of the sound of swallowing and high frequency if I swallow too much. Another complication is that when I swallow saliva I also swallow some air, which makes me belch constantly and even fart, and feel uncomfortable in my stomach and throat, sometimes leading to cough/diarreah and etc.

    I have been taking Zoloft for 1 year with 200mg per day. I tried to find group therapy or ERP therapist but failed finding one. I also tried meditation and it helps a bit but when I am in the situation (quiet working environment with co-workers or talk with them, or lying on the bed with my date etc.) I cannot help worrying about my swallowing and am very anxious. I tried meditation at work but it does not really help. The medicine helps me reduce anxiety. But recently it seems the symptom gets worse, back to days before I started medicine.

    This symptom makes me feel disappointed, distracted, and unhappy, especially when I would like to be a good performer at work and also develop romantic relationships. What can I do now? I am so helpless and frustrated.

  152. Hello Dr.Seay. This may sound strange but I think I have a fear surrounding having this disorder. I have an anxiety disorder (that was diagnosed by a psychiatrist) and it includes me having fears about my breathing. Specifically, when I am going through a changing period in my life, this fear flares up and causes me to have anxiety attacks and constant focus on it. However, this fear is that I could stop breathing and die, and is not merely just blame being aware of it. I focus on it because of the fear of death I have. Also what is strange is that this generally only pops up in my mind during stressful periods of time along with my anxiety. I have had many other fears of having schizophrenia, going blind, becoming paralyzed and oddly enough, one of my main fears is having OCD (specifically this one). I don’t know if I actually have it or if I worry about having it and than my anxiety imitates it. I hope this makes sense as I am trying to makes sense of it myself. One thing I will say is in general if I don’t fear myself suffocating, my focus on my breathing goes away completely. It doesn’t just happen for no reason, it happens when my anxiety flares up and that fear begins to ruminate. I’m currently 19 and my mother has bpd, bipolar disorder and depression, however so far I have only been diagnosed with anxiety (GAD) after going to two or three psychiatrists now. I did ask them about this but none of them really thought I had this or diagnosed me with ocd, although they did mention I have obsessive symptoms. Anyways from my description do you think I should go see an ocd specialist? Do you think I have this? I am confused myself and a bit scared I do and I’m not getting the proper help I need. My anxiety started one day back in high school where I was in science class talking about the respiratory system, and suddenly began to worry about what if I stopped breathing, and ever since this fear has come and go, along with many others. Please respond to this question as I am curious what I should do about this. Remember, as I have anxiety this could just be that or an imitation of this disorder (as from looking st the symptoms I worry about having them). Thanks and look forward to your response

  153. Dr. Seay. I see in a lot of your comments about finding the right ocd doctor for this and I have tried many but it doesn’t seem to be a common ocd subtype and it causes so much depression and no hope. Is there anyone here who has recovered that I can speak to please. I really need help. God bless you.

  154. Dr Seay,

    I have a breathing obsession where I worry about not being able to stop thinking of my breathing, but I am also manually breathing. Is breathing manually a compulsion? I don’t know how to stop.

  155. I’m 28 year old from Australia and I suffered with this horribly initially. I was really really scared,that I’d come to so hyper aware (blinking smocd). for a solid year before I read a few things on here and implemented my own trial and errors. I was able to overcome it without the use of mindfulness or even focussing or reminding myself of it which didn’t work in my particular case. Instead I chose the path of letting my body do what it needs to do, whether your aware of it or not you are gonna need to blink. And after about a year of continuing on I’m more than totally fine with it. I barely notice it. Maybe once every couple of days if that. Which started as 24 hour constant concentration on my own blinking. For some people they need to pay attention to the smocd until there brain gets bored. In my case I chose to totally avoid reminding myself of it on purpose. And if you do notice them. Don’t worry cause in life you’ll be so distracted it’s nearly impossible to focus on your eyes 24/7 when you have to work a job and other things. If anyone wants any advice, I have plenty of my own experience overcoming blinking smocd. Thanks dr seay for pointing my in the right direction and made me aware of what happening

    • Hi there,
      I suffer from blinking sensorimotor ocd, i’m very interested by your experience if you have time !
      Thanks !

  156. Dear Phil, i am really relieved after reading your article that sensorimotor ocds dont have to be a life sentence.

    I have been struggling with blinking and breathing ocd. But i have somehow managed to eliminate the anxiety part.

    But awareness is still there.

    What comes next for me.? Am i done with the treatment. Please guide me .

  157. I have breathing ocd and I have tried erp and I think I managed to reduce my anxiety but now I experience awareness breathing without being axious or maby very little anxious but most of the time I am not anxious so why does my symptoms still continue if I managed to not be anxious anymore. anything I m doing wrong.

    • In general, it’s important to adopt an acceptance-based mindset when it comes to your symptoms. Acceptance should be absolute rather than conditional, as conditional acceptance isn’t really acceptance at all. If your anxiety has gone down, that’s great. However, it’s important to continue to get comfortable with your symptoms. If your focus is on pushing them away or getting rid of them, that’s likely to backfire. If you need more guidance, seek out an OCD expert who can help guide you directly.

  158. Thank you so much for this article. I have read other articles indicating to have the exposures be to actually swallow as opposed to stop swallowing. The purpose is to notice the swallowing process because the response prevention is distraction (try not thinking about swallowing), so the exposure should be to swallow and get comfortable with the swallowing. This is contradictory to the exposure task for refraining from swallowing. If the compulsion is swallowing, shouldn’t the exposure be length of time not swallowing. For example, start with not swallowing for 5 seconds, and go up the ladder to 5 minutes. Alternatively, like you said- eating dry food without a drink. Just trying to figure out if my exposures should be to keep swallowing or stop myself from swallowing. The fear is that my throat may close.

    • The exposures should be targeted to address the specific nature of the obsession. In this way (as you’ve noted), some individuals might engage in swallowing exposures where they refrain from swallowing whereas others might engage in exposures in which they repeatedly swallow. You sound like you have a good handle on this! If you’re afraid of your throat closing, you’d practice whatever exposures would evoke this fear.

  159. Hi there ive suffered with sensorimotor ocd for years now and it has come and gone I’m the past.
    But recently the swallowing one was triggered again by someone talking about it the other week. And I don’t know what to do. 😩 I never had therapy in the past I think that my mind just got very distracted to the point where it went away Or it switched to the blinking or breathing one (which just goes away eventually because it’s more natural) but I need to do something about it this time.
    So, with me, i feel like a lot of saliva is building up In my mouth and then I have to swallow it and even swallow if there isn’t much there either.
    The only fear, i have that comes along with this, is “how long is it going to stay/will it stay forever this time ect” and even by being positive and thinking that it will go away-the symptoms aren’t decreasing.
    I’m looking into getting a therapist now but have you got any suggestions that may help me in my own time? (Especially considering we’re in lockdown)
    And have there been success stories with the swallowing ocd?

  160. Dear Dr Seay,

    I ‘ve been dealing with swallowing OCD for 10 years now, since I was 17. I ‘ve read many times about ERP and I also went to 3 different doctors (psychologists and psychiatrist/psychotherapist). I don’t know how to write without expanding much. For me the problem has been perplexed very much because it briefly contains the following things:

    — typical thinking of not wanting to think about swallowing
    — frequent swallowing tic (when being idle I suppose it ‘s twice per minute)
    — occasionally feeling like my epiglottis is slipping (? I ‘m not sure) making a gulping noise (after many subsequent swallows or when in bad stance with dry throat)
    — I move my head to the right to ease my swallowing (annoying when I try to relax)
    — my left side of the throat (sternocledomastoid muscle) is very tense (I suppose from years of frequent swallowing).

    The whole thing began when I was anxious feeling isolated when studying for my university entering exams. Because I ‘ve always had tics throughout my life but not serious at all, I suddenly made a new one. I was frequently swallowing and at a point I could not swallow because of dry throat. The turning point for me though was this unknown thing that was slipping occasionally on my throat. All the above altogether with the fact that I sometimes find it more difficult than usual to swallow are that concern me. I have visited an ENT doctor, a neurologist, a pathologist (for anatomical explanation if any). None has found anything.

    My biggest fear is when I am in a silent environment and I feel isolated to my thoughts. As for the tic, I know I cannot prolong the time without swallowing in more than 1 minute. Only when I ‘m actively thinking/speaking or doing sports or talking with a girl I like I retrospectively find I was not often swallowing thus feeling more relaxed and blithesome. But, then I know I cannot seek always external ways to ‘gain’ some time without throat concern.

    Generally, I know I ‘ll have a bad time when I am about to sit/lie down/stand in stances where if I try to swallow, it ‘ll be more difficult. So, I am always try to have my chin closer to the chest or my neck to be tilted on the left or my neck rotated to the right. All in combinations that I feel I ‘ll have a better more clear and fast swallowing.

    As an evading technique, I ‘ve found myself playing with my fingers, beard and nose mainly. Mostly, when I touch my mouth and beard I feel more relaxed. Generally, I feel the urge to swallow, building saliva slowly in the middle of my throat and feeling/knowing that I will swallow involuntarily, otherwise I ‘ll have a “spasm?” like we do when anxious at the dentist.

    As for the thinking part, many times I feel very depressed not wanting to do anything but relax. And this goes up and down every day. When I do not feel the urge to swallow, I immediately remind myself that the problem is not solved and this is temporary. Mainly, I believe because I have not solved the physiological part, that will leave me only with the thinking problems to manage.

    To finish all these, I want to say also that I overcame a breathing OCD that I had for 2 years (2 years after I started my swallowing OCD). I suddenly thought I ‘ll focus on every single breath without skipping one. This made me having breathing tic, like having shorter pulses of breathing. I am not sure how I deleted this as a condition, but because my breathing has not any physiological problems throughout my last 20 years, I maybe managed to “skip” some breaths for a much longer time than usually and then feeling more comfortable and confident I “skipped” them more often, finally understanding there is no fear around this. I am not sure though how this works. When being aware of my breathing now, i don’t feel anything bad. Also, I can understand that I am breathing but I am categorizing it subconsiously as non-focusing. It is very strange when I think about this (This does not happen with my swallowing). So now I am trying to test myself on this and there is no recursion. Only, when my breathing is felt more difficult because of my body stance, I can rarely feel like focusing is maybe again an issue, but this goes away fast.

    Could you possibly identify any application of the ERP on my swallowing compulsions? If not for ERP, what could I try?
    Thank you so much!

  161. I have OCD throughout my life. It all started when I was doing my 6th grade. I always had this urge to use toilet throughout the school time. Felt so much anxiety in class and always concentrated in how my stomach or bladder felt. It continued for a very long time and led me to use anti diarrhea medications on daily basis. One day after 3 years, all of the sudden I got hyperaware of my breathing and can’t able to focus on anything. It lasted for a day and next morning it was gone. After a few years, I got this sudden sensation on my left chest one day. I can feel my left chest through out the day for atleast 3 days. Some how after that, I never had anything like that. It’s like magic it was gone. Soon after some time, I frequently get aware of saliva stuck in my throat. I have to clear my throat multiple times especially during night. Over the time, it also got disappeared. In between I also have intrusive sexual and violent thoughts. Most of these thoughts and bodily sensations have not brought much anxiety except my frequent urge to pee during class. Over time i have consulted three different psychiatrist and found only one doctor helpful. Many psychiatrist are judgemental. I took the drugs he prescribed and my symptoms got reduced and I have managed to complete my bachelor’s degree. When I was doing my master’s, I started feeling my heartbeat and can’t able to get focused on anything. It made me very anxious, especially at night. I again consulted the same doctor who I felt comfortable. He prescribed some drugs. After changing a number of drugs, I found one having very little side effects. I never felt such anxiety in my life before. My doctor said I was suffering from anxiety disorder. I don’t know anything about it. I searched through online and came across this somatic ocd. Which matched my symptoms. I read about cbt. I asked my doctor about it, he said such therapies are not required for me. So I tried to confront my problem and tried to feel my heart beat as much as possible as i can. Over the period of time my anxiety reduced and i can concentrate on other thing. In two months, I became normal but continued with prescription drugs for over a years. I graduated my masters and got a job. Now, after two years, I again got stuck with my ocd obsession over my breathing. Currently I am seeing the same doctor. Again started taking drugs. Now after three weeks, I feel better but I am constantly worried about my breathing and I feel like at any time I may get stuck to my breathing. How to do erp for this as it is not possible for to get a good therapist trained to treat this type of ocd. I feel like I will never lose my concentration on breathing.

  162. hey,
    I suffer from breathing ocd.
    Its all start when I try to breath from my nose in breathing exercise to be more relax. its been very difficult, I start to get obsess about it.
    after one month I found that I have allergy and start to take pills for my allergy. but my ocd stay and get bigger.
    I try to do erp and acceptence but I think I do this wrong.
    I dont know what is my compulsion.
    when I do ERP I know I need to pay attention to my breath, but should I need to avoid from breathing from the nose? because thats what trigger me. but from the other side I dont want to avoid from something. so my main issue is how to breath.
    my anxiety very high because I switch from mouth breathing to nose breathing and all the time I confuse If its compulsion or if its avoidance.
    thank you.

  163. Hey,
    I’m suffer from breathing ocd 4 month .
    It’s start when I found that I can’t breath through my nose. And after that I found it was allergic. I start to take medication for the allergy but the ocd stay and become bigger .I don’t know How I should breath , I try to force breathing from my nose. It’s became obsessions. Now I try to do the erp but I don’t sure. I know I need to accept the breath . But how should I breath . Should I need to avoid from breathing in certain way .
    I feel like it’s cause hyperventilation if i not breath from my nose .
    I start to breath consciously. It’s very hard. Please help me .how my erp should look like.
    I don’t have therapy that know about this theme in my country .

  164. I have what i believe is sensorimotor ocd with breathing. I feel i have to inhale at the end of each breath or i will not take a breath naturally. I have tried to not think about the inhale but i naturally wont take breath and the feels like you are suffocating. Im also aware of the inhale exhale 24/7. Had this for 8 months and fear i’ll have this for the rest of my life. How should i approach this. Nobody here has heard of sensorimotor ocd.

  165. How can I stop constant rubbing of tongue against teeth, feeling of crowded edges makes me anxious. As soon as I wake up I start and it doesnt go away until sleep. I have Mianserin for anxiety – no help really 🙁

  166. Thanks for the advises. I have breathing OCD and I feel much better now

  167. This article was so insightful for me.
    I always thought I just had anxiety but then started noticing that my anxiety was not the same as everyone else. My somatic obsession is related to being afraid of the somatic symptoms from fear and anxiety so I try to block the sensations and fight them. Only creating more of the sensations and its a horrible cycle. I feel the urge to block and tense up when the sensations come to try to push them down but I get to the point that I tense up so much and it is not even suppressing the emotion but the urge is still whole body gets tense sometimes and its painful. Its like an internal flinching. Not sure how else to describe it. Any advice or tips would help.

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