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Rumination OCD: Symptoms, Co-Occurring Anxiety, and More

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Do you have anxiety, depression, or obsessive-compulsive disorder (OCD) and 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 have been diagnosed with depression, anxiety, or OCD, there is a good chance you’ve experienced rumination. 

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

Klarity has helped 30,000+ Americans find online treatments for anxiety, depression, insomnia, and ADHD, and we can help you access affordable and effective online treatments to help reduce or eliminate rumination.

Discover how Klarity can help you by taking our free, 2-minute mental health evaluation.  

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 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.

It’s often misunderstood exactly how compulsions occur. You may imagine a person washing their hands three times, counting to 10 before leaving the house, or needing to circle a car once before entering it. 

These are compulsions. However, compulsions aren’t always visible, outward behaviors. Compulsions 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. rumination

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

Remember, compulsions are behaviors (or thoughts) that attempt to relieve a deeper fear or anxiety temporarily. Let’s explore a scenario to better demonstrate what the behavior 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 promises a reason or explanation for your embarrassment but always leaves you thinking in circles because there is no solid conclusion to draw.  

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

Is it Intrusive Thoughts? Or just a Compulsion?

It’s possible what you’re experiencing is both intrusive thoughts and compulsion. Rumination acts like a compulsion when the action is taken 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 future uncertainties. The thought loops are often rooted in fears of failure, poor performance, or catastrophe. 

An Example:

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 very 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 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, 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:

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 pretty 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. 

Readers who experience rumination must 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 effectively treat anxiety, depression, and OCD symptoms.

Medication That Can Treat Anxiety, Depression, and OCD Rumination 

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

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

SSRIs, or selective serotonin reuptake inhibitors, 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)

Check out our article comparing SSRIs and SNRIs for more information about side effects, doses, costs, and drug warnings.

Tips To Help Reduce Rumination

Aside from therapy and 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 break free from self-defeating, distracting, and negative thought loops. 

Write Thoughts in a Journal

If you are 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 are trapped in rumination, we often don’t perceive the logical flaws or cognitive distortions that influence our 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 can help us to hear the thoughts from a different perspective. 

It may help you recognize how they are flawed, untrue, or excessively negative. This phenomenon explains the common phrases: “it sounded better in my head” or “now that I hear it out loud, it sounds ridiculous.”  

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, enjoying conversation, 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). 

Meditation is a skill you’ll have to practice, but it is definitely a learnable skill that can help you relax. Meditation releases feel-good endorphins and relieves stress. It can be a mental sanctuary you can access when starting to fall under a ruminative spell.

Reassess Your Life’s Goals and your Sense of Self-Worth

Perfectionists often find themselves 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 are 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, shoot instead for bite-size goals that take you closer and closer to that big goal.

Klarity Can Help You Find Relief From Rumination

If you feel overwhelmed and trapped by intrusive, repetitive thoughts, Klarity can help. Don’t wait months to speak to a medical provider. You need relief from anxiety, depression, and OCD-based rumination as soon as possible.

When you take our free 2-minute online evaluation, within 48 hours, Klarity will book you an appointment with a medical provider who understands the psychology behind rumination. They will assess your mental health, provide a diagnosis, and help you decide on an effective treatment plan.

We’ve already helped 30,000+ Americans receive fast, convenient, and affordable online anxiety, depression, ADHD, and insomnia treatment

We’re ready to help you. 

Sources

Scolan, Dina. “Rumination.” The OCD and Anxiety Center. https://theocdandanxietycenter.com/rumination/

Cirino, Erica. “10 Tips to Help You Stop Ruminating.” Healthline. https://www.healthline.com/health/how-to-stop-ruminating.

Cherry, Kendra. “What is Cognitive Behavioral Therapy (CBT)?” Very Well Mind. https://www.verywellmind.com/what-is-cognitive-behavior-therapy-2795747.

Mayo Clinic Staff. “Depression (Major Depressive Disorder).” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007.

“Overview – Selective Serotonin Reuptake Inhibitors (SSRIs).” NHS. https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/overview/.

“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/.

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