by: Cassandra M. Faraci, Psy.D.
Most people think anxiety shows up as panic attacks or visible fear. In reality, it’s often far quieter. Many individuals carry intense internal distress while outwardly appearing composed, productive, and “fine.” To the outside world, nothing seems wrong—because high functioning can hide significant suffering.
Do any of these resonate with you?
- “I just can’t stop thinking about it.”
- “I replay conversations in my head.”
- “I go over every possible worst-case scenario.”
- “I know I’m overthinking… but I can’t stop.”
When constant mental looping becomes your norm, it’s easy to label it as “just stress” because you’re used to it; maybe you’ve experienced this your whole life, and you know nothing else. And, if the associated distress is mild and doesn’t interfere with your life, it could be “normal.” But sometimes, it’s something more.
Let’s talk about two common (and often confused) patterns: rumination and obsessions.
They’re related. But they’re not the same.
Anxiety-Driven Rumination: The Mental Replay Loop Won’t Stop
Rumination is repetitive, unproductive thinking about something distressing.
It can often focus on past situations:
- Previous conversations
- Mistakes you think you made
- “Why did I say that?”
- “What if they’re upset with me?”
- “Did I handle that wrong?”
It can also focus on future scenarios:
- What if I mess this up?
- What if something bad happens?
- What if I’m not prepared?
Rumination feels like you’re trying to solve something you may or may not have control of, searching for certainty when it may not be possible, or mentally preparing for things until you think it “feels right.” For those struggling with clinical anxiety, rumination rarely brings relief. Instead, it can bring self-doubt, irritability, sleep disruption, emotional exhaustion, muscle tightness, and other symptoms.
Rumination is common in generalized anxiety and high-functioning perfectionism. It masquerades as problem-solving, but it’s actually the brain stuck in threat detection mode.
Anxiety-Based OCD: When Thoughts Feel Intrusive and Unwanted
Obsessions in OCD are often confused with rumination. While they have some overlap, they’re quite different.
Obsessions are:
- Intrusive
- Repetitive
- Unwanted
- Often distressing or disturbing
Common examples include:
- Fear of harming someone accidentally
- Fear of contamination
- Doubts about safety (Did I lock the door? Did I turn off the stove?)
- Intrusive taboo thoughts
- Persistent moral or religious doubts
Unlike rumination, obsessions don’t feel like “I’m thinking too much.”
They feel like:
- “Why is this thought even in my head?”
- “What if this means something about me?”
- “I need to be 100% sure.”
- “I need to get rid of these thoughts so that a bad future event doesn’t occur.”
Obsessions often lead to compulsions, which can be:
- Physical behaviors (checking, washing, seeking reassurance)
- Mental rituals (replaying, neutralizing, repeating phrases, reviewing memories)
The goal of compulsions is to reduce anxiety, but they reinforce the cycle long-term.
So What? Why This Distinction Matters
Both rumination and obsessions are exhausting. Both create mental loops. But they may require different therapeutic approaches.
- Rumination often responds well to cognitive restructuring, mindfulness, and behavioral activation associated with Cognitive Behavior Therapy (CBT) and Acceptance and Commitment Therapy (ACT)
- OCD often requires specialized treatment such as Exposure and Response Prevention (ERP).
Mislabeling OCD as “just anxiety” can delay the right support.
And minimizing rumination as “overthinking” can prolong unnecessary distress.
Is it Stress or Something More?
Consider seeking professional support if:
- You can’t stop thinking about the same issue, even when you want to.
- You feel mentally “stuck” most days.
- You avoid situations to prevent anxiety.
- You rely on reassurance to calm down.
- Your thinking patterns interfere with sleep, focus, academics, occupational functioning, or relationships.
- You feel trapped in your own head.
If any of this resonates, we’re here to help.
Call or us at (908) 883-4173 or visit www.AnxietyAndBehaviorNJ.com to schedule an appointment or consultation.
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