You are halfway through a work meeting when you suddenly notice your own breathing, and now you cannot stop noticing it. Or it is 2am and you are replaying a party from last weekend, convinced you said something awful that you cannot quite remember. Neither looks like the OCD you have seen on television, so you might never guess that is what is happening.
Obsessive-compulsive disorder works as a cycle. Unwanted thoughts make you anxious, and you then do things to make the anxiety go away; those things are compulsions. About 2.3% of US adults have had OCD at some point, according to figures from the National Institute of Mental Health.
Most people only picture the handwashing kind, yet obsessions can attach to almost anything, from doubts about a loving relationship to the values you hold most dearly. Below are three forms that rarely get talked about, and what helps with each.
When you cannot stop noticing your own body
Somatic OCD is when you become stuck on something your body does by itself, such as breathing, blinking, or swallowing. You might feel it in meetings, at dinner, or lying in bed at night, and much of the fear is that the awareness will never stop.
The checking is easy to miss because most of it happens in your head. You might:
- Keep checking whether the sensation is still there
- Breathe or swallow on purpose to see if it feels normal
- Ask someone whether your breathing sounds OK
- Search online to see if anyone else has this
Each check settles you for a minute before the feeling returns. This is more common than you might think. In a 2015 study of 106 adults with OCD, 67% said uncomfortable feelings, including physical ones, came before or during their compulsions.
The fear that you did something you cannot remember
False memory OCD is the fear that you did something bad in the past without remembering it. A thought arrives out of nowhere: did I hit someone on the drive home, or did I cheat on my partner at that party? You cannot prove it happened and you cannot prove it did not, so you start digging by:
- Replaying the night again and again
- Scrolling back through texts and photos
- Checking the news for car accidents
- Asking friends what happened
In my practice, clients often arrive for a first session after weeks of playing detective. They have gone through receipts, messages, and maps, and they still do not have the answer they want.
People with OCD may also trust their memory less than it deserves. A 2022 review of 19 studies found that people with OCD scored only slightly lower on memory tests, but their confidence in their memory was much lower. That gap makes it easier for a frightening “what if” to feel like a real recollection.
When being a good person turns into a ritual
Scrupulosity is OCD that centres on right and wrong, or on religion. It can look like:
- Repeating a prayer until it feels right
- Confessing the same small thing to several people
- Going back over a conversation to search for anything dishonest or unkind
From the outside this can look like being very devout or very kind, which is partly why it can stay hidden for years. Some of my clients had gone to a faith leader for comfort many times before anyone mentioned OCD.
You do not have to be religious to have it. In a 2011 study of scrupulosity, nearly one in five people with this form of OCD did not belong to any religion. If being a good person matters a great deal to you, OCD can latch onto that.
What the three have in common
All three work in the same way. A doubt appears and feels like an emergency, so you do something to make it go away. You feel better for a while, and that relief tells your brain the doubt was a real problem, so it comes back, usually louder than before.
In my view, the hardest part is accepting that you may never know for sure, because every search for proof makes the doubt a little stronger. With no visible handwashing or stove checking, you might decide you are simply anxious, oversensitive, or a bad person, and if the thoughts feel embarrassing, shame can stop you telling anyone at all.
What helps with all three
The main psychological treatment for OCD is exposure and response prevention, or ERP, a form of cognitive behavioural therapy that looks at how thoughts and actions affect each other. In ERP you deliberately face the thoughts that frighten you and then hold back from whatever you would normally do to feel better. As the NHS explains in its guide to OCD treatment, you start with what feels least frightening and build up from there.
In practice that might look like this:
- Somatic OCD: Paying attention to your breathing on purpose for a few minutes, then letting your mind drift without checking whether the feeling has gone
- False memory OCD: Letting a doubt about last weekend sit for a whole evening without texting anyone to ask
- Scrupulosity: Leaving a prayer as it is, even when it does not feel finished
Your therapist plans these steps with you, and you set the pace. If therapy alone is not enough, or the OCD is more severe, the NHS notes that a type of antidepressant called an SSRI may also help.
If any of this sounds like you, you do not need to work out which type you have before reaching out. Telling a therapist what the doubt feels like and what you do to calm it is enough to begin. At Anchor Therapy, my practice in Hoboken, our therapists use ERP and CBT for OCD, seeing clients in person and online across New Jersey, New York, and Florida.
