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Why can’t I stop focusing on my breathing? Understanding Somatic OCD

4 min read
Keara Valentine
By Keara Valentine
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety.

“Why am I breathing so much?” 

“Do I always breathe like this?”

“Can anyone else hear my breathing?”

“What if I’m not breathing enough?”

“What if I forget to breathe?”

Have you ever found yourself asking these questions? 

Occasionally, we have all become acutely aware of bodily sensations that run in the background. While breathing normally happens without thinking about what your body is doing, it can be very easy to tune into your breathing patterns and suddenly become fixated on each and every breath you take. 

Heightened awareness of bodily functions, such as blinking or breathing, isn’t uncommon among the general population—and it’s especially common when someone is experiencing anxiety or panic. However, if this awareness starts to feel intrusive and long-lasting, or if it leads you to enact certain behaviors to ease your discomfort, you may be experiencing a subtype of OCD called somatic OCD.

What is OCD? What is the OCD cycle?  

Obsessive-compulsive disorder (OCD) is a commonly diagnosed mental health disorder. Its key feature is a cycle of intrusive, unwanted thoughts (obsessions) and urgent-feeling behaviors to try to stop the thoughts (compulsions) or prevent feared outcomes from occurring. 

The cycle begins with an intrusive thought. Virtually everyone experiences intrusive thoughts, but most people shrug them off and move on. People with OCD, on the other hand, attribute meaning to that thought and develop an obsession with it. 

For someone with OCD, the obsessions can center on or be triggered by many things. Typically, these obsessions are broken down into different OCD subtypes. A few of these subtypes include:

Let’s say that random thought is about hurting a child. People with OCD might ask: “What does this thought appearing in my head say about me?”

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The most likely answer to this question is nothing. We are not our thoughts. They arrive and leave like trains in a station. But if you have OCD, distinguishing the thought from you becomes challenging—even impossible. This can create feelings of extreme anxiety. 

In an attempt to reduce these uncomfortable, anxious feelings, people with OCD will engage in compulsions. These can include things like physical behaviors in order to feel relief or avoidance of anything that will trigger their obsessions—such as excessive hand washing in the case of contamination OCD. 

People with OCD enact these compulsions to reduce their discomfort, and they can be temporarily effective. But compulsions’ effectiveness in reducing anxiety means people will turn to them whenever they obsess over a thought. 

No matter the subtype, almost everyone with OCD will feel the need to complete compulsions to deal with the discomfort their obsessions create. Often, someone with OCD feels certain that something terrible will happen if they don’t engage in their compulsions, further perpetuating the cycle. 

What is somatic OCD?

To dive further into why you may feel like you can’t stop focusing on your breathing, let’s look at somatic OCD. Somatic OCD is a subtype of OCD with obsessions around being extremely conscious of the sensations happening in your body. 

 If you think you may have somatic OCD, you might find yourself unable to stop noticing or thinking about “normal” everyday functions like swallowing, blinking, breathing, etc. Since these functions typically occur without thought, having obsessive thoughts about them can be extremely overwhelming and frustrating. 

Think back to the questions at the beginning of this article: How often have you caught yourself asking them (or some variation)? When you begin questioning the normalcy of your breathing or fixating on some aspect of your breathing, it can feel impossible that you will ever stop noticing it. However, somatic OCD is a highly treatable disorder; you can learn to manage your symptoms.

Treating somatic OCD

The good news is that somatic OCD is very responsive to a particular type of treatment called Exposure and Response Prevention Therapy (ERP)

ERP therapy is considered the gold standard of treatment for any subtype of OCD, including somatic OCD. If you begin ERP therapy, you can expect to work with your therapist to find out what triggers your cycle of obsessions and compulsions.  

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From there, you and your therapist will work to expose you to these triggers to allow you to experience the obsessions about your breathing and face your fears in a safe and controlled environment. The goal is to help you experience the trigger and, over time, feel less urgency to complete your compulsions. 

NOCD has a nationwide network of therapists who all specialize in OCD treatment and have received ERP-specific training. The NOCD clinical team can match you with a therapist that’s right for you, and you can quickly begin treatment from the comfort of your home through teletherapy appointments. You can also join our Somatic OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

Keara Valentine

Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.

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Taylor Newendorp

Taylor Newendorp

Licensed Therapist, MA

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Licensed Therapist, LCMHC

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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