Rumination in OCD: What It Is and How to Manage It

When people think of obsessive-compulsive disorder (OCD), they may picture someone who constantly washes their hands for fear of germs, or a person who checks that their door is locked several times for reassurance before leaving home.However, not all repetitive behaviors associated with OCD are visible. Rumination, a recurrent and often debilitating negative thought process, is common to many people with OCD and happens with almost no outward signs.

The National Institutes of Health (NIH) reports that 1% to 3% of the population is affected by OCD, though there is still much to learn about this disorder and its impact on mental and behavioral health. 

Understanding rumination in OCD is an important step in recognizing and treating obsessive-compulsive behaviors. While also an issue for adults, this is especially true for pre-teens and teenagers, as OCD symptoms such as rumination frequently begin in adolescence. 

Understanding What Rumination Is in OCD 

It’s normal, and very human, to experience recurring thoughts, relive certain moments in the past, and even over-analyze previous mistakes or poor decisions — especially in times of stress, transition, or fatigue.

Rumination, however, is a pattern of negative thoughts that repeats and persists with no endpoint or resolution. It often focuses on past events and is associated with overwhelming feelings of doubt, fear, and self-blame. This causes a pattern of distress that can interfere with daily life. 

Rumination is a behavior related to obsessive-compulsive disorder and a risk factor for other mental health issues, such as anxiety and depression, if unaddressed or untreated.

What Rumination Is Like in OCD 

Ruminating in OCD is not the same as worrying or overthinking. When someone is worried or uncertain about a future event or current situation, they may tend to “overthink” — putting more time and effort into analyzing something than is necessary. 

For example, if you have an upcoming interview, you may excessively analyze what to wear, how to respond to potential questions, or the best route to take to arrive on time. 

Even after the interview, you may overthink the impact of what you said or the interviewer’s perception of your abilities. In most cases, overthinking has an endpoint — you either get the job or you don’t. This doesn’t mean that you won’t overthink again, but it will likely be about something else.

Rumination is similar to overthinking, but without a clear endpoint. People who ruminate are often focused on something that has already happened. They may feel the need to repeatedly go over past moments in their mind, especially negative ones, in hopes of finding a different “answer” or insight.

Instead of resolution, rumination typically leads to guilt, doubt, and even shame or embarrassment. These negative emotions help fuel the compulsion to ruminate even harder or longer to somehow get it “right.” This is like a self-inflicted trap that can keep you from living life in a productive way.

Relationship Between Rumination and Intrusive Thoughts

Everyone experiences an occasional intrusive thought — an unwanted idea or image that comes to mind without warning. Yet for some people, intrusive thoughts occur repeatedly, intensely, and with the power to disrupt daily functioning.

When intrusive thoughts result in persistent distress or impairment, they may be considered obsessions. Obsessions cause anxiety, a state of being that the brain is wired to alleviate.

Rumination is a response to the anxiety caused by obsessive intrusive thoughts. Through rumination, the brain attempts to reduce anxiety by dwelling on negative events or situations. Sadly, the compulsion to ruminate often has the opposite effect of prolonging and increasing anxiety.

Understanding Obsessive-Compulsive Disorder (OCD) 

Obsessive-compulsive disorder (OCD) is a chronic, persistent mental health condition. It is fairly common, with average onset in adolescence or early adulthood. 

Research shows that approximately one in 40 American adults either have OCD or are likely to develop it. OCD can be mild to severe, with different effects among those who have it. 

The primary characteristics of OCD include uncontrollable and repeated thoughts as well as behaviors that people feel compelled to do. These are known as obsessions and compulsions.

• Obsessions: patterns of unwanted thoughts, fears, ideas, or urges that repeat, continue, and result in anxious feelings
• Compulsions: repetitive behaviors or mental actions that are intended to reduce or control anxiety, but are ineffective

Most people with OCD experience a cycle of obsessive and compulsive symptoms. However, obsessions and compulsions can occur independent of each other.

How OCD Affects Adolescents and Teenagers 

According to the National Institute of Mental Health (NIMH), OCD symptoms often start in adolescence. This disorder can have a significant impact on the health and well-being of young people.

Some effects of OCD on adolescents and teenagers include:

• Reduced self-esteem and self-worth
• Poor academic performance
• Development of “ritualistic” behaviors
• Feelings of loneliness or isolation
• Difficulty maintaining family and friend relationships
• Higher risk of drug or alcohol use to cope
• Increased risk of despair and potential suicidal ideation

The American Academy of Child & Adolescent Psychiatry (AACAP) emphasizes that young people with OCD, just like adults, may feel shame or embarrassment, increasing their reluctance to talk about it.

Parents and families can better understand and develop support through healthy communication.

How Rumination Relates to OCD

Since rumination is based in thought, some may associate it as an obsessive symptom of OCD. In fact, rumination is a mental compulsion. 

The compulsion to ruminate is a behavior that may feel like positive problem-solving to the brain. It may seem as if thinking about and replaying an interaction or situation over and over is productive and will lead to a solution.

Unfortunately, this behavior just reinforces the cycle of OCD — the more rumination, the stronger the obsessive-compulsive disorder grows.

Here’s how the cycle works:

• Intrusive thought or doubt occurs, resulting in anxiety
• Rumination begins as repetitive, overanalyzing thought process
• Temporary relief happens until next intrusive thought or doubt renews and worsens cycle

People feel temporary relief when they ruminate because there is an illusion of control — that the mind is actively processing something. Being stuck in a thought loop can also bring relief in some cases because it allows the person to avoid dealing with uncomfortable emotions and feelings in a productive way.

However, this relief is short-lived and no actual progress is made through rumination. This behavior only serves to increase anxiety, doubt, and the OCD cycle.

Causes of Rumination in OCD

In most cases, intrusive or obsessive thoughts are what lead to rumination in OCD. This negative thinking can trigger the compulsion to review, dissect, and process the event, idea, or situation that was the source of the initial negative thoughts.

It can be very difficult to break this internal, consuming cycle. Any anxiety relief that rumination may provide is short-lived with diminishing returns. This can increase the compulsion to ruminate in response to obsessive thoughts.

Symptoms of Rumination OCD

Since rumination is a behavior centered in thought, there may not be outward symptoms when it happens. However, if you or a loved one are frequently preoccupied with moments in the past and feel pressured to repeatedly “figure out” or evaluate what happened, rumination is likely.

There is a difference between reasonable worry and rumination behavior. Rumination in OCD generally results in compromised daily functioning as well as difficulty participating in healthy relationships and activities.

Rumination Is a Brain Loop, Not a Choice

Rumination OCD isn’t about a lack of willpower — it’s a misfiring of the brain’s error-detection system and cognitive control center. The thought loop feels urgent and unresolved. This is why the brain keeps returning to it, even when the person desperately wants to stop.

In addition, people with rumination OCD aren’t lacking motivation or insight. In fact, many know their compulsive thoughts aren’t rational — but that doesn’t stop the anxiety or pressure to ruminate. This can add to feelings of embarrassment, wrongdoing, or shame, worsening the cycle.

Examples of Rumination in OCD and How it Feels

Everyone revisits difficult moments, wondering what may have happened if they’d made an opposite choice or wishing they’d behaved differently. For most, these thoughts occur occasionally and don’t interfere with everyday life.

With OCD, ruminating thoughts are persistent and repetitive — sometimes occurring daily and for hours at a time. Here are some examples:

• Ethical or moral worries: Frequently wondering if you are a “bad” person or have done something wrong

• Replaying conversations: Consistently worrying that you’ve said the wrong thing or been misunderstood

• Reliving past situations: Mentally repeating past mistakes, decisions, or actions

• Overactive concerns about the future: Obsessive mental rehearsing of upcoming events or researching of potential health issues

Rumination in OCD results in difficult consequences such as mental exhaustion and reduced problem-solving skills. Sadly, it can affect the person’s relationships, work, overall well-being, and ability to function.

This can be especially worrisome and heartbreaking for pre-teens and teenagers whose coping and cognitive abilities are not fully developed. They may be unaware that negative thought cycles can be harmful or unsure how to express the experience.

If unaddressed, rumination can lead to feelings of helplessness and distress in all age groups, potentially increasing risks of mental and behavioral health issues. Yet since this is an internal and self-focused behavior, it may be difficult to recognize.

How Parents Can Detect Signs of Rumination OCD in Adolescence

OCD symptoms, including ruminating thoughts, can begin in pre-adolescence. They often manifest in different ways during adolescence and early adulthood, as school, relationships, and other aspects of life grow more complicated and stressful.

Kids may not notice rumination behaviors, understand the OCD cycle, or know how to express what they are thinking and feeling. This can lead to increased anxiety as well as other mental health challenges, such as depression.

Here are some signs of potential rumination in OCD for parents to look for:

• Excessive thinking or talking about past situations or negative scenarios
• Issues with concentration
• Persistent worry, dwelling, or need for reassurance
• Reluctance to participate in enjoyable activities
• Withdrawal from relationships

Since rumination is an internal, self-focused behavior, it may be difficult for parents to recognize in their teenagers. In fact, any significant or negative change in an adolescent’s behavior can cause worry or concern.

That’s why it’s helpful for parents to actively listen to, communicate with, and be supportive of their kids. If your pre-teen or teenager seems to be “stuck,” focused on mistakes, or reliving the past, they may be experiencing rumination in OCD.

How to Alleviate the Rumination Cycle 

Though there is no specific “cure” for rumination, there are ways to interrupt and change negative thought patterns associated with this behavior. Finding ways to alleviate the rumination cycle can improve mental health and quality of life.

Strategies to Stop Ruminating

Since stress can bring on and intensify ruminating behaviors, many stress-relieving strategies can also help with this compulsion. The goal is to recognize and interrupt the cycle of negative thinking to become focused on the present moment.

Lack of sleep, poor hydration and nutrition, and low activity levels can make rumination OCD symptoms worse. Quality rest, healthy eating habits, and daily exercise can strengthen the mind and body and ease the OCD rumination compulsion cycle.

 Applying these methods takes commitment and effort, but the results can be positive across time. Knowing that you or a loved one can use strategies to reduce rumination offers a sense of empowerment, greater self-worth, and more optimistic outcomes.

Here are some ways to alleviate the compulsion to ruminate:

• Breathing exercises: Regulated, relaxation, and mindful breathing techniques can bring focus to the present moment.
• Going outside: Getting a change of scenery, being in nature, and walking outdoors helps reduce stress and gain perspective.
• Self-care: Proper rest, nutrition, and activity can keep the mind focused on health and improve your well-being.
• Positive journaling or list-making: Keeping a record of strengths, achievements, meaningful moments and people can invoke positive memories of hope, love, and happy times.
• Two-minute rule: Allow ruminating thoughts for exactly two minutes. Then actively consider if any progress was made or insight obtained. Assess whether ruminating resulted in positive or negative feelings. Use results to reinforce that rumination is unhelpful.
• Limiting internet activity:  The American Psychological Association estimates that young adults and teenagers spend more time online than any other group. Social media platforms and internet use can reinforce negative thought patterns, lower self-esteem, and feelings of isolation

Treatment Options

Many individuals with rumination OCD are helped through therapy or a behavioral health treatment plan. These forms of treatment can provide coping mechanisms to decrease rumination and stop intrusive thoughts to improve daily function and quality of life.

Though it may seem like a potentially awkward or difficult conversation, talking about mental and behavioral health is beneficial for overall well-being — especially when it comes to pre-teens and teenagers. Their experience of emotional pain can lead to unhealthy habits and even more isolation if untreated.

Open communication can lead to awareness, effective intervention, and better support. If you or your child experience symptoms of rumination OCD, it’s important to seek professional help as soon as possible.

Get Help for OCD Compulsions and Rumination 

Understanding and dealing with rumination, OCD, and other behavioral health issues can put you on a path to a productive and fulfilling life.

Sevita’s companies can help support those who need it with specialized services and programs — including behaviors related to obsessive-compulsive disorder.

Explore available behavioral health services to learn more about getting you or a loved one the care you need.