I can’t stop paying attention to my swallowing. What’s going on?

Our bodies are complex machines conducting numerous functions at any given moment. If we paid attention to all of them, we would never have time for anything else. Indeed, most of us go through our days without giving any thought whatsoever to constant functions like blinking, swallowing, or breathing. 

Most people likely experience occasional moments of awareness and think with awe, Wow, how weird is it that oxygen is constantly coming in and out of my lungs, and I am constantly swallowing my saliva? and then move on with their days. For some, though, thoughts like these don’t go away. If you can’t stop paying attention to your swallowing, it might be hindering your daily functioning. You might struggle to eat and drink, or spend hours a day stuck in obsessive thinking about your swallowing. You might fear choking, worry that you’re not swallowing “correctly”, fear that your throat is closing up (and therefore focus on your swallowing to gauge whether that could be true), or worry that you’ll never be able to stop thinking about your swallowing. 

For me, I became hyper-aware of my swallowing a couple years ago, after I had a mysterious case of hives, and a doctor mentioned offhand, “We should try to get to the root of this because food allergies can worsen the more you’re exposed to them and lead to asphyxiation.” I was told it was likely that stress was what caused my hives in the first place, but that wasn’t certain enough. Since then, the thought still pops into my head from time to time: My throat is closing! I have to swallow to make sure it’s not. 

There’s good news for all of us: it’s been consistently demonstrated that it is possible to free yourself from constantly thinking about your swallowing. It is likely associated with one of the following conditions, both of which are highly treatable. 

What might be going on?

The first possibility is a subtype of obsessive-compulsive disorder (OCD) called sensorimotor/somatic OCD, sometimes referred to hyperawareness OCD. It describes a hyper-attentiveness to bodily processes, sensations, and functions, such as breathing, swallowing, the rate or comfort of eye blinking, posture, or gait. As with all themes of OCD, intrusive thoughts, feelings, sensations, or other triggers spur a high level of distress, and one performs compulsions—mental or physical—to relieve themselves of this distress. With this particular subtype, because bodily functions are happening constantly, sufferers can find themselves constantly triggered.

Signs and symptoms of sensorimotor/somatic OCD (specific to swallowing) include:

Obsessive thinking, followed by excessive distress, surrounding one or more bodily function, process, or sensation. Obsessive thinking can sound like:

• What if I can never stop noticing my swallowing?
• Why is my swallowing so loud?
• What if I forget how to swallow?
• What if I swallow too much or not enough?
• My throat wiggles when I swallow, and I can’t stop noticing it.
• Just to be safe, I can only eat liquids—they’re easier to swallow.
• How will I ever live a normal life if I can’t stop paying attention to my swallowing?
• Will I ever feel present again?
• “Magical thinking” patterns, such as, “If I have the thought that I’ll never stop noticing my swallowing, then it will become true.”

Mental and/or physical compulsions performed to relieve yourself of the distress, such as:

• Seeking reassurance from yourself or others that your fears are not true. This might sound like repeating the thought, “I’ll stop thinking about my swallowing eventually,” or repeatedly asking a loved one, “Do you think I’ll be able to stop thinking about my swallowing?”
• Suppressing your thoughts: trying to force them to go away and not have them in the first place.
• Distracting yourself with movies, books, friends, etc. in order to escape thinking about your swallowing.
• Mental review, meaning looking back through your memories to times where you weren’t paying attention to your swallowing. You might try to figure out what you were doing differently then, and how you can get back to that time.
• Avoiding activities that trigger obsessive thinking, such as eating or drinking (since you would have to swallow).
• Excessive research about healthy or “normal” swallowing, or the potential risks of swallowing “wrong.”

The other condition that might explain why you can’t stop paying attention to your swallowing is called health anxiety, also known as illness anxiety disorder. Health anxiety has similar patterns to those of OCD—according to Louisville OCD Clinic, some researchers argue that health anxiety is a type of OCD. Dr. Nicholas Farrell, licensed clinical psychologist and a Regional Clinical Director at NOCD, describes the difference like this: “The fear associated with sensorimotor/somatic OCD is similar to being in quicksand. People worry they’re never going to get out of it. With health anxiety, people are worried that something is seriously wrong with their health.” 

In other words, those with sensorimotor/somatic OCD are distressed by their awareness of the sensation, worried they’ll never be able to stop noticing it. Those with health anxiety, on the other hand, are specifically worried that the function they’re fixated on, such as swallowing, is emblematic of a serious illness, and they might even induce swallowing so that they can “check” its normalcy. Despite these key differences, the two conditions are similar in that both are typically accompanied by compulsive behavior. 

Signs and symptoms of health anxiety include:

• Excessive worry or rumination on what could be wrong with your swallowing and the body parts associated with it. For example, you might spend much of your day thinking about your esophagus and whether or not it’s wide enough for your saliva to go down.
• You may ask yourself a plethora of “what-ifs”, such as “what if my throat is closing up?” or “what if I’m producing too much saliva and that means I have a serious illness?”
• Hyper-awareness of bodily sensations/functions. You may find yourself assessing your swallowing multiple times per day to decide whether it’s “normal”/healthy.
• Inducing a bodily sensation or function in order to “check” it. 
• Frequent visits to the doctor or hospital, convinced that something is seriously wrong with you.
• Frequent research about what the “symptom” could mean and/or feared diseases/conditions.
• Taking actions you perceive to preserve your health, such as only eating certain foods that you feel like you can swallow “normally,” excessive hand-washing to prevent disease, or seeking excessive healthcare services.

It can be exhausting enough simply having a body. At a given moment, we experience any number of stressors: getting through the day after a poor night’s sleep, taking care of our children while working full-time, dealing with a chronic illness, and infinite other circumstances that can cause stress and influence our energy levels. To feel as if you’re locked into constant awareness of your body and its functioning adds another layer of exhaustion. 

Luckily, both sensorimotor/somatic OCD and health anxiety are highly treatable. You don’t have to live indefinitely with the fatigue and distress that all types of OCD and anxiety come with. Speak with a mental health professional to help you determine what the underlying cause of your hyper-attentiveness to swallowing is. In either case, the gold-standard treatment for your struggles is a type of therapy called exposure and response prevention therapy (ERP). 

How can I get help?

Both health anxiety and sensorimotor/somatic OCD are treated with exposure and response prevention therapy (ERP). The first component of ERP, exposure, involves being exposed to your triggers incrementally, meaning you’ll start by facing triggers that bring a low amount of distress and work your way up to more distressing ones. The second key component of ERP is response prevention, in which you practice resisting the urge to spiral into compulsive mental or physical behaviors, such as distraction, checking, reassurance-seeking, or rumination. You and your ERP-trained therapist will work together to devise a plan for your exposures and discuss tools for response prevention. 

Examples of exposure exercises designed to treat an inability to stop paying attention to your swallowing include:

• Reading a story or watching a movie about someone with a health condition related to their swallowing or the body parts necessary for it. 
• Resisting the urge to make yourself swallow so you can “check” for normalcy.
• Swallowing without ruminating on whether or not it’s normal or healthy.
• Going to dinner with friends, where you won’t be able to only eat your “safe” foods or spend too much time ruminating on your swallowing.

Maybe just reading those examples gives you anxiety. If so, don’t beat yourself up—you’re in the right place. It will take time for your triggers not to trigger you anymore. Neither sensorimotor/somatic OCD or health anxiety will be “fixed” overnight—in fact, ERP is not about “fixing” you, but about building up tolerance to your triggers—but if you put in the work, you can find lasting relief, as many people learn they also habituate to those triggers, meaning they aren’t as scary as they once were. The day can come where you simply notice your swallowing and move on. 

Dr. Farrell describes ERP as helping someone “do the opposite of what they’ve been doing.” Your OCD or health anxiety has convinced you that you need them in order to be safe. Therefore, doing the opposite of what you’ve been doing might sound terrifying. Dr. Farrell reminds us, “In the moment, it might not feel like ERP will reduce awareness of swallowing, but it does.” He says it might feel like a “blind leap of faith”—but it’s a worthwhile one. 

If you think you may be struggling with Sensorimotor/Somatic OCD and would like to learn more about doing ERP therapy with a licensed specialist, I encourage you to learn more about NOCD’s accessible approach to treatment—every therapist in the NOCD Therapy network has received specialized training in treating all subtypes of OCD with ERP.