When Ruminating Becomes a Problem
Everyone ruminates. We especially ruminate when we’re stressed out. Maybe you’re ruminating about an upcoming test—you have to score an A to keep your scholarship. Maybe you’re ruminating about an upcoming presentation because you want to impress your boss. Maybe you’re ruminating about an upcoming date and the many ways it could go. Maybe you’re ruminating about a bad performance review. Maybe you’re ruminating about an injury that’s really been bothering you.
“We are evolutionarily wired to obsess,” according to psychiatrist Britton Arey, M.D. We are wired to sense threats and dangers in our environment—like lions who are waiting around the corner to consume us. “The people who didn’t ruminate about the lion were more likely to get eaten by it, and therefore, much less likely to pass along their genes, from an evolutionary standpoint.”
Today, with less lions and other predators and less looming threats, ruminating isn’t particularly helpful. But, again, it is normal—to an extent. As Arey said, normal ruminating passes after a period of time after the stress is over; is susceptible to distraction by someone or something that pulls away our attention; and doesn’t interfere with our ability to function.
And that’s the key. Because ruminating becomes problematic when it impairs our ability to function healthfully. It becomes problematic when we’re unable to maintain an optimistic mood, to connect with others, to sleep or to attain inner peace, Arey said.
Most of the patients Arey sees at South Coast Psychiatry, her private practice in Costa Mesa, Calif., struggle with ruminating. They obsess about things they can’t control and traits they despise. They fixate on fears that they’re not good enough. They ruminate about their regrets and their future. They seek help because their ruminating has affected their mood, their quality of life and their daily functioning, she said.
In fact, rumination is one of the most common symptoms of almost every disorder, Arey said. It might be part of depression, the ruminations revolving around hopelessness and negativity about yourself, your future and your world. She described it as “self-bullying” because the criticism is that intense.
It is like looking through “gray-colored glasses,” Arey said. “Everything looks dark, gray and dismal.”
The rumination might be part of post-traumatic stress disorder, focusing on past traumatic experiences. It might be part of an eating disorder, the obsessions focused on food and weight. It might be part of obsessive compulsive disorder (OCD), the ruminations fixated on specific numbers, diseases or fears about loved ones’ health and safety.
In fact, rumination is common to all anxiety. And it can become a self-fulfilling prophecy. In other words, according to Arey, “those who tend to obsess and ruminate, believing the worst possible scenario is likely to occur, will often act in ways that will make these scenarios more likely to occur.”
Ruminating can stem from childhood. Individuals may internalize the critical voices of others. We “play out their fears and insecurities in ways that seem outside our conscious control,” Arey said.
Ruminating also is subconsciously seen as an effective armor, as a successful shield. “[T[here is an illusion that obsessing, worrying or ruminating about something gives us some kind of power or control over its outcome, which is a rampant misconception.”
Telling someone to stop ruminating, to simply let it go, to snap out of it doesn’t work. That’s akin to advising against thinking about an elephant—and we all know how effective that is. (In fact, you’ve probably pictured several elephants already.)
Instead, a holistic approach is helpful. Arey takes a “biopsychosocialspiritual” approach with her patients. This includes: addressing any biological issues; delving into how a person’s upbringing has shaped the way they see themselves; exploring their social interactions and ability to be authentic; ensuring adequate support; and connecting to something outside of themselves, which “can help anchor our thoughts outside of a loop inside our heads that may be consuming our thinking.” (After all, “so much of ruminative thinking occurs when people get ‘stuck inside their heads.’”)
The key is to first identify the underlying condition because treatment will vary depending on the disorder. Is it anxiety? Depression? An eating disorder? Something else altogether?
Once there’s a proper diagnosis, treatment can start. For instance, according to Arey, if it’s OCD, treatment might include: taking antidepressants, which “can help patients get out of obsessive thought loops and more easily turn their thoughts to other things”; attending cognitive behavioral therapy; joining a support group; practicing mindfulness to refocus on the present; and engaging in healthy, nourishing habits, such as getting regular exercise and restful sleep and cultivating authentic connections with others.
When you’re stuck in ruminative thinking, it can feel like there’s no relief. You’re drowning in your own distressing thoughts, sinking in negative thought loops that seem like they’re never going away. Which can feel incredibly lonely and demoralizing.
Thankfully, there is effective treatment. If you’re struggling with stressful thoughts that play on repeat, don’t hesitate to see a mental health professional. Doing so is a courageous act. It might not feel like it. It might feel like the opposite. But it is this century’s version of outsmarting a predator and saving your skin. Facing your struggles is the ultimate in strength and bravery, is it not?
Tags: Archive, Clinicians on the Couch