Treatment for body-focused OCD is paradoxical and involves intentionally leaning into your symptoms rather than away from them.
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.
…or continue the discussion on Facebook, Twitter, or Google+.
Related posts:
- OCD Core Fears Related to Body-Focused Obsessions & Compulsions (e.g., Swallowing, Breathing, Blinking)
- Sensorimotor OCD Body-Focused Obsessions & Compulsions (Swallowing, Breathing)
- Sensorimotor OCD & Social Anxiety Differential Diagnosis: “Obsessive Swallowing”
Home
About
Contact
Curriculum Vitae
Links
Past Research
Del.icio.us
Digg
Technorati
Magnolia
Newsvine
Reddit
34 Responses
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.
Thanks.
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 (ocfoundation.org) 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.
Happy I could help!
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.
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.
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.
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.
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.
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 ocfoundation.org, 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, ocfoundation.org lists sliding scale providers as well).
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. http://ocfoundation.org/find_a_support_group.aspx
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!!
Jenev
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
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
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.
Mehdi
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?
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
Hi Mehdi,
Thanks for reading. I’m in the process of editing a new blog post which addresses this issue. It will be posted within the next week. In the meantime, have you read the post below?
http://www.steveseay.com/sensorimotor-ocd-social-anxiety/
Wishing you the best!
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.
I added some additional information in my reply to the person who commented after you. Take a look.
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.
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.
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!
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,
Rossie
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 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!
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.