Fears or Worries about Breathing

What is breathing related OCD?

Somatic OCD often involves intrusive thoughts, urges, and fears concerning automatic bodily functions, including blinking, heart rate/beat, swallowing, and others. In some, the focus of their fears or concerns is on breathing. This hyper-awareness of breathing could cause someone to experience intrusive thoughts such as “What if I randomly stop breathing?” “Would I stop breathing if I don’t focus on my breathing?”  “Could I forget how to breathe?” “Am I breathing correctly?” or “What if I can never stop focusing on my breathing?”

Such intrusive thoughts begin to cause a great amount of distress, fear, and anxiety and tend to make it difficult for the individual to focus on anything other than breathing. These types of obsessions are often followed up by compulsions or safety-seeking behaviors done in an attempt to feel some relief from the thoughts or fears.

In Somatic OCD, these compulsions may involve continuously monitoring and measuring breathing, counting breaths to ensure the right amount and frequency of breathing, excessively researching the act of breathing, seeking reassurance from others, and even substance use. These compulsions are a way to cope with and neutralize the anxiety created by these intrusive thoughts and sensations.  

This hyper-awareness and focus on one’s breath can interfere with a person’s quality of life. It can be difficult to be present when spending time with family and/or friends, focus on tasks at work or school, or even sleep. 

By identifying triggers, accepting unpleasant thoughts, and resisting the urge to engage in compulsions, people with any theme of OCD can get on the path to recovery. This is the basis of Exposure and Response Prevention (ERP) therapy, the gold standard treatment for OCD.  Individuals engaging in ERP treatment and practicing interoceptive exposures (i.e., exercises that help people induce and better tolerate uncomfortable physical sensations/feelings) learn they can sit in uncertainty, discomfort, and doubt while going through their daily life.  This can free up a lot of time and energy, and improve their overall quality of life.  

Breathing related OCD – Common obsessions

• What if I suddenly stop breathing?
• Is my breathing too deep, too shallow, etc.?
• Am I breathing the right amount of breaths?
• Is my breathing normal like other people?
• Will I always be focused on my breathing?
• What if I never stop paying attention to my breathing?
• Urges to breathe in a particular manner

Common triggers

When engaging in treatment for OCD, a specialist will help identify triggers that increase anxiety and that normally lead to experiencing intrusive thoughts. These triggers are helpful in determining effective exposures to practice throughout ERP therapy.  

Triggers for breathing related OCD may include:

• The act of breathing itself
• Breathing increasing due to walking, running, exercise
• Hearing self or someone else breathing, panting, coughing, etc.
• Getting sick in a way that might influence breathing (stuffy nose, coughing, etc.)
• Hearing about respiratory issues in general or with someone they know
• Feeling something in the back of the throat
• Going to sleep
• Distractions that take attention away from being able to focus on breathing
• Tightness or discomfort in the chest
• Changes in temperature that impact how air feels entering lungs (cold, hot, humid, dry, etc.)
• Speaking/laughing/crying or any act that might cause temporary shortness of breath
• Reading/hearing about conditions that can impact breathing (asthma, COVID, etc.

How do I know this is OCD fear of breathing and not another disorder or condition? 

OCD follows a particular pattern, and involves several distinct aspects. In the DSM-V, OCD is characterized in the following way:

• The presence of obsessions, compulsions, or both.
• Obsessions are current and unwanted thoughts, urges, feelings, or images that are intrusive and cause distress or anxiety.
• Compulsions are repetitive behaviors or mental acts that a person does in an attempt to relieve the anxiety caused by obsessions, or to prevent a feared outcome.
• The individual attempts to avoid triggers or suppress discomfort from obsessions, or neutralize it with some other thought or action.
• These obsessions or compulsions are time-consuming (taking up more than one hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

It can be difficult for a person to determine whether they have OCD for themselves. An ERP specialist will utilize assessment tools to rule in or out any other potential disorders during the intake process and help to distinguish OCD from other potential conditions.

Common compulsions

Compulsions are often referred to as safety behaviors.  These behaviors, whether mental or physical, are performed in order to find relief from the distress caused by obsessions.

Some common compulsions done by people with breathing themes in Somatic OCD are:

• Online Researching anything related to breathing
• Counting frequency of breaths within a time frame
• Breathing in set, specific manner
• Trying to breathe in different ways to “test out” which way is “best”
• Frequently consulting doctors for tests or reassurance
• Scanning one’s body
• Avoidance of sleeping 
• Avoidance of activities that increase heart rate, breathing, etc. 
• Avoidance of travel, social situations, any environments where they could become more aware of their breathing and/or contract illness related to lungs
• Seeking reassurance from others
• Rumination
• Mental review

Some of the above compulsions mentioned often lead to decrease in sleep, decrease in energy, low mood, difficulties in interpersonal relationships, difficulties with functioning at work and/or social situations. Due to these challenges, OCD can become quite debilitating.

How to treat fear of breathing

Exposure and Response Prevention (ERP) therapy is the most effective way to treat OCD and maintain recovery. In ERP, interoceptive exposures are often the most beneficial exposures for the treatment of Somatic OCD.  

To break it down, ERP involves intentionally exposing oneself to one’s triggers in a controlled environment, while resisting the urge to engage in compulsive responses. For Somatic OCD treatment, interoceptive exposures can be the most effective and beneficial. This type of exposure involves triggering feared sensations for example doing an exercise that increases breathing (something that may be avoided when the obsession is focused on breathing and/or heart rate) and sitting with the discomfort to let it pass on its own. This ultimately teaches the brain that the feared response isn’t something to be feared; it can be managed.  

Interoceptive exposures are organized in a hierarchy: the first exposure will be something that creates a mild amount of fear/anxiety i.e. taking a brisk walk, and as treatment develops, more anxiety or discomfort will be triggered.

ERP is considered the gold standard of treatment for OCD.  It has been shown to decrease OCD symptoms in up to 80% of cases. It can be anxiety provoking, but the goal is not to eliminate anxiety altogether; rather, it is to learn to manage and control symptoms even when anxiety and fear is present. In time, by managing this anxiety and fear without engaging in compulsions, one is able to habituate to the distress, bringing less and less distress over time.

Typically, ERP treatment takes 12-20 weeks on average before one sees significant improvement in the management of their symptoms. Overall quality of life often increases, including relationships at home and work, improvements in social functioning, and increased energy and contentment.  

If you’re struggling with OCD, As an OCD specialist, I’ve used ERP to help many people regain their lives from OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment with the NOCD care team to learn how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.