Rumination OCD: symptoms, co-occurring anxiety, and more

Do you have anxiety, depression, or obsessive-compulsive disorder (OCD) and often find yourself stuck in a repetitive loop of negative, intrusive thoughts? When these thoughts get in the way of daily functioning, they can take away from your quality of life, including work, relationships, and other important matters. 

This phenomenon is called rumination. It’s a co-occurring symptom of several anxiety disorders, depression, and obsessive-compulsive disorder. If you’ve been diagnosed with depression, anxiety, or OCD, there’s a good chance you’ve experienced rumination. 

In this article, we take a deep dive into what rumination is, why it happens, and what you can do to manage intrusive, negative, or repetitive thoughts. 

If intrusive or ruminating thoughts are making it difficult to enjoy your daily life, you could benefit from personalized treatment through Klarity. Klarity connects you with a licensed healthcare provider in your state for affordable, convenient online mental health treatment. They can evaluate your symptoms, offer a professional diagnosis, and develop a tailored treatment plan for you, which could include prescription medication. 

Find relief from your intrusive thoughts today by starting with Klarity’s free two-minute evaluation. Within 48 hours, you’ll be able to meet with a medical professional for your first private telehealth appointment.

This article discusses suicide, suicidal ideation, and self-harm. If you or someone you know is experiencing suicidal thoughts or is in crisis, contact the National Suicide Prevention Lifeline immediately at 800-273-8255.

What is rumination?

Regarding obsessive-compulsive disorder, the repetitive, unending thoughts experienced during rumination are a type of compulsion. Compulsions are traditionally defined as behaviors meant to reduce short-term stress or alleviate fear or anxiety.

Exactly how compulsive behaviors occur is misunderstood. You may imagine a person washing their hands repeatedly, counting to 10 before leaving the house, or needing to circle a car once before entering it. 

However, compulsions aren’t always visible, outward behaviors. They come in the form of thoughts, too. When compulsions are inward, invisible, and thought-based, they can form circular patterns that keep a person trapped in a thought loop — a.k.a. compulsive rumination. 

But how does ruminating reduce short-term stress? It seems like it would cause more stress.

Remember, compulsions are behaviors or thoughts that attempt to temporarily relieve a deeper fear or anxiety. Let’s explore a scenario to better demonstrate what the thought is trying to relieve:

Let’s say you had to present a report to your coworkers two weeks ago. During the report, something really embarrassing happened, and it derailed your entire presentation. You got through the rest of it, but ever since, you haven’t been able to stop replaying it in your head.

Multiple times a day, you catch yourself in a thought loop going over the events and thinking about what you could have done differently and what people must be thinking of you.

The amount of time you spend thinking about that meeting adds up and takes its toll on you, making you less productive and distracting you from present tasks, obligations, and responsibilities. 

This compulsive search for an explanation distracts you from the simple reality that you made a mistake, and mistakes happen. To relieve your embarrassment, you engage in behavior that you believe will provide a reason or explanation for your embarrassment. But instead, it leaves you thinking in circles because there is no solid conclusion to draw.  

You engage in rumination, which is a mental compulsion your mind performs to try to relieve the stress and anxiety surrounding your inability to accept that you made a mistake in front of your peers.

Is it intrusive thoughts, or just a compulsion?

Intrusive thoughts are common in people with OCD, and are characterized as unwanted or negative thoughts that come into your head without warning. It’s possible that you’re experiencing both an intrusive thought and a compulsion at once. 

Ruminating on certain thoughts can become a compulsion when it’s used in an attempt to relieve underlying stress or anxiety. However, being stuck in a repetitive thought loop when trying to accomplish tasks, focus on work, or engage in relationships is certainly intrusive.

Rumination in co-occurring mental health conditions

Rumination is not only a symptom of OCD, but of anxiety and depression, too. However, the way rumination manifests in someone with an anxiety disorder can vary when compared to depression-based rumination. 

Rumination and Anxiety

With anxiety, rumination is often focused on hypothetical, unanswerable questions or uncertainties about a future event. The thought loops are often rooted in fears of failure, poor performance, or catastrophe. 

An example of OCD rumination

Let’s say you have generalized anxiety and have to give a presentation next week at work. This presentation will determine whether or not you get a promotion, so it feels like a very big deal.

In the week leading up to the presentation, you find yourself obsessing over the thought that you’ll utterly fail during the presentation. You can’t stop playing future scenarios over and over in your head, meticulously going over every variation — each one leading to disaster.  

You find it difficult to stop ruminating about it. All the mental energy and heightened stress from these intrusive mental exercises distract you from preparing for it effectively. It keeps you awake at night, hounds you during your commute, and interferes when people are talking to you. 

This is anxiety-based OCD rumination. It is often accompanied by other symptoms of anxiety, which include:

• Feeling on edge, agitated, restless
• Feeling tired or fatigued
• Being unable to concentrate
• Feeling angry or irritable
• Experiencing headaches, stomachaches, muscle aches, and unexplained pains
• Unable to control or reduce fear, anxiety, and worry
• Sleep issues and insomnia

Rumination and depression

With depression, the rumination is focused on negative thoughts regarding the self — past failures, inadequacies, or feelings of worthlessness. These thought loops keep a person stuck in a negative state of mind and erode a person’s feelings of self-worth over time. 

An example of rumination in depression

Let’s say you have a depression diagnosis, and you went on a particularly bad date a few months ago. Though the person probably didn’t intend to hurt you, they said a few things that triggered your own insecurities. You really liked them, and this experience was painful.

For the past few weeks, you’ve replayed that date repeatedly, focusing on what you perceive to be terrible flaws in how you look or your personality. You ruminate on how you might have said things differently and beat yourself up for not being “good enough,” “interesting enough,” “funny enough,” or “cool enough.”

You spend much of your downtime stuck in these negative, self-defeating thoughts, and you start to internalize these thoughts as inherent truths. The next time someone asks you out, you turn them down in an act of self-preservation because you feel that these negative, intrusive thoughts must be true.

Depression-based rumination can make depression symptoms worse, creating a negative echo chamber in your own mind. Symptoms of depression include:

• Feeling sad, empty, or hopeless
• Feeling angry, irritable, and frustrated
• Being uninterested in activities that once brought joy and fulfillment
• Sleeping too much or too little
• Weight loss or weight gain from eating too much or too little
• Feeling extremely fatigued and “weighed down”
• Moving, thinking, and speaking more slowly
• Feeling worthlessness, guilt, or shame
• Ruminating on past failures
• Trouble concentrating or thinking clearly
• Thoughts of suicide or death
• Unexplained physical pains, headaches

Whether you have OCD, anxiety, depression, or a combination of all three, rumination can lead to worsening symptoms and emotional (and sometimes physical) pain. However, rumination, like any mental process, can be treated. 

If you experience rumination or mental compulsions, understand that there are ways to escape negative, intrusive thought loops.  

Medical treatment for OCD, anxiety, and depression-based rumination

Mental health providers will likely suggest medication, psychotherapy, or a combination of both to address rumination. Therapy and FDA-approved antidepressant medications can effectively treat anxiety, depression, and OCD symptoms.

Medication that can treat anxiety, depression, and OCD rumination 

The FDA approves the following selective serotonin reuptake inhibitors (SSRIs) to treat OCD (in addition to treating anxiety and depression).

• Sertraline (Zoloft)
• Fluoxetine (Prozac)
• Fluvoxamine (Luvox)
• Paroxetine (Paxil)

SSRIs elevate serotonin levels in the brain by inhibiting its absorption back into brain cells, keeping it where it is most useful — in the spaces between brain cells.

Serotonin is an essential neurotransmitter (chemical messenger) for regulating mood, emotion, and sleep. SSRIs increase serotonin levels, improving the functioning of these vital processes.

Certain SSRIs and SNRIs (selective norepinephrine reuptake inhibitors) are not FDA-approved to treat OCD, but are sometimes prescribed as off-label treatments.

Off-label SSRIs for OCD

• Citalopram (Celexa)
• Escitalopram (Lexapro)

Off-label SNRIs for OCD

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)

If you have OCD, generalized anxiety disorder (GAD), or major depressive disorder (MDD), SSRIs or SNRIs can be incredibly helpful in managing or alleviating intrusive thoughts, compulsions, or ruminations. If you’re interested in finding a safe and effective medication for your mental health symptoms, find a provider on Klarity today.

Tips to help reduce rumination

Aside from medication, you can try several activities and strategies to reduce the severity and frequency of ruminations. When combined with advice from an anxiety, depression, and OCD-trained medical provider, these coping strategies can help you find temporary relief from self-defeating, distracting, and negative thought loops. 

Write thoughts in a journal

If you’re overwhelmed by rumination, try writing your thoughts down in a journal and revisiting them later. Sometimes getting ruminative thoughts out into the physical world can help us see them differently. 

When we’re trapped in rumination, we often can’t perceive the logical flaws in our compulsive thoughts. Putting them down on paper can help correct these cognitive distortions.

Say your thoughts out loud

After writing your thoughts down, try reading them out loud. When we hear negative or intrusive thoughts out loud, the auditory processing part of our brains handles the information. This lets you hear the thoughts from a different perspective, and may help you recognize how they’re flawed, untrue, or excessively negative. 

Find healthy distractions

Keeping yourself busy and distracted is a great way to avoid ruminative behaviors. Identify when you start having ruminative thoughts and replace that time with a particular hobby or activity you enjoy. 

The activity doesn’t matter as long as it’s healthy — exercising, playing a sport, reading, drawing, talking with friends, or enjoying some simple family time. Don’t replace ruminative thoughts with unhealthy distractions like drugs and alcohol.

(Learn to) meditate

If you feel overwhelmed and trapped by looping thoughts, you should consider learning how to meditate properly. One of the main goals of meditation is to clear your mind. However, going from an emotionally agitated state to a calm and clear one isn’t particularly easy (at first). 

Try finding some guided meditation videos or podcasts to offer a healthy distraction from ruminative thoughts. Try to focus on your breath and the words being spoken, and do your best to redirect your thoughts if they begin to wander. It takes practice, but with time meditation can become a much-needed sanctuary from intrusive thoughts and ruminations. 

Reassess your life’s goals and your sense of self-worth

People with OCD or anxiety often have perfectionist tendencies. With perfectionism, you often find yourself ruminating over every past mistake and obsessing over getting everything right in an effort to reach unrealistic goals. This expends a lot of energy. If you’re constantly ruminating over the unrealistic expectations you have set for yourself, you might need to reassess your life goals. 

When we fail to live up to our own self-expectations, it harms our self-esteem. Instead of obsessing over accomplishing big goals, aim instead to accomplish smaller tasks that bring you closer and closer to that big goal. Work with a therapist or trusted friend to help you break down your long-term dreams into more realistic objectives.

Find a therapist to help you find relief from rumination

If you feel overwhelmed or trapped by intrusive, repetitive thoughts, it can be incredibly difficult to break free of the cycle on your own. Even if you try to follow the tips we listed, mental health conditions like anxiety, depression, or OCD make it hard to ignore ruminating thoughts without the help of a medical professional. 

When you need fast, affordable, and convenient relief from anxiety, depression, and OCD-based rumination, Klarity can help. Klarity connects patients with licensed healthcare providers to help them overcome their symptoms through comprehensive online mental health treatment. Your provider can evaluate your symptoms and develop a personalized treatment plan, including prescription medication, if they prescribe it. 

Get started with Klarity today by taking our free short assessment.

“The Gateway Institute – Treatment Methods” 

https://www.gatewayocd.com,https://www.gatewayocd.com/treatment-programs/treatment-methods/.

“What is Exposure and Response Prevention?” International OCD Foundation. https://iocdf.org/about-ocd/ocd-treatment/erp/.