Let’s start by defining our terms:
‘Obsessions’ are intrusive thoughts/feelings/images that trigger a fear of making a mistake you can’t take back that has permanent consequences (for further explanation, see A Simple Explanation of OCD).
‘Compulsions’ are things a person does to make sure that doesn’t happen.
‘Rumination’ means thinking about the same thing over and over again. Rumination does not mean repeating the same thought over and over again; it means getting stuck trying to figure something out.
People sometimes think that ‘rumination’ is a stream of obsessions because the person is thinking a lot and finds the thinking distressing. However, as explained in Understanding Pure O: You Are Not Having Intrusive Thoughts All Day, You Are Ruminating, rumination is actually a compulsion, because it’s being done to protect the person from making a mistake they can’t take back that has permanent consequences.
Now, you might think that the question of whether rumination is an obsession or a compulsion is just a matter of semantics, but actually it has crucial, practical implications for treatment:
- First, in Exposure with Response Prevention (ERP, the treatment for OCD), we ask the patient to let the obsession be there, while refraining from doing any compulsions. Thus, when people mistakenly identify rumination as an obsession, they think that they are supposed to allow it to persist. This means they are actually doing a compulsion on purpose, and doing compulsions is what maintains OCD, so they don’t get better.
- Second, compulsions don’t go away on their own: It’s the patient’s responsibility to eliminate them. Thus, since rumination is a compulsion, it’s the patient’s responsibility to eliminate it, in order to get better. This might sound obvious, but many people think that some other part of treatment is supposed to make them stop ruminating, when in fact they themselves have to stop ruminating.
For both of the above reasons, it is essential that both therapists and patients understand that rumination is a compulsion, which means it has to be eliminated as part of treatment. To learn how I teach patients to stop ruminating, check out How to Stop Ruminating.
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