For some people overthinking is not a brief or isolated event. For some people overthinking is actually a symptom of OCD. For some, thinking about something that’s bothering them can last for weeks, or even months. It may cause insomnia, substance abuse, panic attacks, frustration, losing hours and hours of time a day, and the inability to focus on anything else. This is a painful and often overlooked symptom of OCD. For some, thinking IS the compulsion.
We often think of a compulsion as an action: washing of hands, checking the stove, tapping the lights, etc. Most of us view thinking as the obsession part of Obsessive Compulsive Disorder. But in actuality, most people with OCD also have what is called a “figuring it out” compulsion, also called Rumination. Even those who do perform observable actions as compulsions will also have figuring it out compulsions.
For example, someone with a fear of bugs, and the obsession that bugs are infesting their bedsheets may check their bed for bugs for one hour in the morning, two hours in the evening, and two hours before going to sleep. However, that’s not the only time they are performing compulsions. In between checking their sheets they are thinking about whether they checked them well enough, whether they left the window open, figuring out which bugs might be entering the house, figuring out how they can prevent bugs from entering their house. It is easy to treat a compulsion that you can see happening, but the ruminations are harder to treat because they are going on most of the day and not observable.
It is important to address rumination or figuring it out compulsions while treating OCD. I teach my clients to identify rumination throughout the day, and then give themselves a choice of whether they want to engage with the ruminations or not. Clients become very good at separating ruminations from other thoughts, and disengaging from them. I have often found that addressing the ruminations as well as the observable compulsions leads to better treatment outcomes for all types of OCD.
Ruminations are not exclusive to OCD. They can happen in other anxiety disorders such as Panic Disorder, Phobias, PTSD and GAD. They have a different quality than other types of thoughts. They tend to be:
- Circular: they seem to lead to no conclusion.
- Reassurance oriented: they seek comfort that everything is fine. Sometimes this comfort is found, and this reinforces the ruminations and makes them stronger. For this reason they come back over and over again.
- Consuming: it might feel extremely hard to focus on anything else. this could cause the person to become dissociated from their lives. Details might become hard to remember, tasks may be left unfinished, and functioning is often impaired at work and at home.
There may be a physical tell that someone is ruminating. They might pace, pick at their skin, have a distant and concerned look on their face, bite their nails, twirl their hair, or shake their leg.
In conclusion, ruminating is an important symptom of OCD that must be addressed in treatment if the treatment is to be successful. OCD tends to change shape throughout someone’s lifetime. It can start as OCD about germs, and turn into OCD about harming someone, or OCD about relationships. Teaching clients about rumination will empower them to catch an OCD that is developing and address it without having to do exposure on every single fear that OCD attaches itself to.