Are You Ruminating or Obsessing?

People often get confused between rumination and obsession. Both involve repetitive thoughts. However, the way of thinking is different. The American Psychiatric Association says, “Rumination involves repetitive thinking or dwelling on negative feelings and distress and their causes and consequences.” People most often ruminate in a negative way about past personal events or experiences.

In rumination, people turn over in their minds past events and disagreeable emotions in an attempt to focus on understanding their thoughts, emotions, and self-worth. They dwell on past events, often with an element of self-blame. Their goal is to understand what happened. Ruminating is sometimes referred to as overthinking a past event. Sometimes people can stop ruminating when they want to.

Obsessing involves intrusive thoughts beyond one’s control. The American Psychiatric Association defines obsessions as “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress…and are followed by some compensatory strategy to reduce the distress.”

Obsessions can create guilt and fear and lead to questioning one’s morality. They have no relationship to prior life experiences that are mulled over. These thoughts disturb. People fear the outcomes. These thoughts may lead to compulsive behaviors in an effort to neutralize the obsession. This can take the form of “checking” or “constant handwashing” in an effort to cope with and control what is happening to them. Such intrusive thoughts feel beyond the person’s control.

Examples of Rumination and Obsessions

A person may ruminate after a romantic breakup. They question themselves, wondering “What could I have said or done differently to prevent the end of the relationship?” Guilt and regret may increase.

When a person obsesses, he may have an intrusive and unwanted idea that he left his house door open. He will recheck the door and lock many times. He knows it’s locked but feels compelled to do the ritual of rechecking the door. He may be unable to leave home or may be chronically late for appointments. Obsessions are very upsetting because the person has almost no control over them. Compulsive behaviors, like rechecking a door, follow to relieve the stress the person feels from their unwanted thoughts or fears.

The Origins of Rumination

Schweizer et al. conducted a study of the developmental origins of rumination in childhood. They studied both children’s temperament and parents’ behaviors in child-rearing. They examined temperamental factors of negative emotionality and effortful control. Children with negative emotionality were sensitive to stressful events and showed fear, anger, frustration, and sadness. Effortful control is the child’s ability to change his emotions and behaviors and to inhibit his responses with inhibitory control. They discovered rumination risk rises with increased emotional reactivity. Emotionally reactive children have more difficulty controlling attention and shifting their focus away from their negative thoughts and emotions.

Schweizer et al. also found that parents play a role in the genesis and continuance of rumination in children. This is mediated through their style of parenting, expression of positive and negative emotions, and the quality of their relationship with their child.

Supportive parents, who express many positive emotions and who have a good parent-child relationship, augment emotional regulation in the child. Parents who express many negative emotions, who are hostile, and who have poorer parent-child relationships decrease emotional regulation in the child and thereby increase rumination in the child.

Their overall findings were that children who were very angry and who were low in inhibitory control of that anger had more subsequent rumination. Children expressing low anger and low inhibitory control had lower degrees of rumination.

It seems that children’s getting angry may be necessary for children with low internal control to continue ruminating. This was the only emotional state associated with rumination. Neither being sad nor fearful was associated.

Rumination can be common in depression, says the American Psychiatric Association, because people with depressed mood recall more negative events from their past. They also interpret current situations more negatively and they display more hopelessness about their futures.

The Origins of Obsession

OCD, one of the diagnoses with obsessions, commonly starts in teens or young adults, although it may begin in childhood. Not all obsessions come from OCD. Some obsessions come from non-mental health situations—stress, infections, or traumatic brain injuries.

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The causes of OCD are not clearly understood. There are several theories. One is that there are biological underpinnings with alterations in brain functioning. Another points to a genetic component, but specific genes have not yet been identified. In a third theory, obsessions and accompanying compulsive behaviors may be learned in families. Stress or traumatic episodes in life can increase the risk of developing the distress seen in OCD. Having a family member with OCD ups risk.

Diagnoses Associated With Rumination

Abela and Hankin find rumination associated with four main diagnoses––depression, anxiety, PTSD, and OCD. These appear to begin early in childhood and involve rumination at early ages.

Diagnoses Associated With Obsessions

OCD is the primary mental disorder with obsessions. There are other diagnostic variants. Compulsive skin picking is often obsessional, as is body dysmorphic disorder, with obsessions related to how a person looks. Hoarding disorder, which involves problems collecting things and not getting rid of them, is in part obsessional. Hair pulling, or trichotillomania, and being overly concerned about body odor are characterized by obsessions, as is hypochondria. More common associated diagnoses or conditions include depression, anxiety, eating disorders, substance abuse, Asperger’s, and ADHD.

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Treatments

Pollak (2010) recommends distraction by thinking of happier, more positive memories. As well, trying to recall times when things worked well, though the path was difficult, helps. A change in environment to a place that has positive associations can also help. Breaking down large problems into smaller parts can make it easier to tackle problems that seem insurmountable.

Professional treatments encompass rumination-focused CBT (RFCBT) in a format especially useful for rumination. This therapy helps people reframe their views of themselves and make their thoughts healthier (Feldhaus et al., 2020). Nolen-Hoeksema suggests ruminative “why” questions be prompted to be replaced by “how” questions that are more concrete and can be answered more easily.

Another treatment is mindfulness-based intervention (MBI). Perestelo-Perez et al. (2017) describe how ruminative symptoms can be reduced. The process involves several steps: 1) being accepting; 2) defusing thoughts and emotions; and 3) being present in the moment. Using this process, people discover how to encounter emotions without judgment or suppression. They learn how to let ruminative thoughts pass or diminish their focus on them.

Swierkosz-Lenart et al. (2023) review types of treatment modalities in their comprehensive review article on obsessions. The researchers note that obsessions are commonly treated with a type of CBT called Exposure and Response Prevention (ERP). The person is exposed to dreaded situations or thoughts and compulsive behaviors are prevented.

They also note that antidepressant medications like SSRIs; clomipramine, a tricyclic antidepressant; and antipsychotic medications all help with obsessional thoughts. Other treatments include repetitive transcranial magnetic stimulation (rTMS) and deep brain stimulation. Psychotherapy can help by examining underlying causes and developing coping skills. Acceptance and commitment therapy (ACT) can help people discover how to accept rather than eliminate or control obsessions.