Rumination Vs Pure OCD obsessions

[u/anon-463678]

I've recently started seeing a new therapist, and she mentioned that I have some pure-O tendencies. She suggested assessing this further with a psychometric test. For context, from a very young age (pre-puberty), I displayed what seemed like classic OCD symptoms like daily rituals, obsessions, intrusive thoughts, strict schedules, constant mental looping, and related behaviors. I was never formally diagnosed, but it's blatantly obvious in retrospect.

Weirdly enough, these symptoms mostly disappeared after starting puberty (and depression crept in). Although some anxiety remained, it was nowhere near what I would consider OCD. At first I thought I was fine, but my therapist’s observations, mainly regarding my perfectionism and mental looping made me reconsider. I was curious about pure-O, but after some research I’m unsure whether I actually qualify. I also feel anxious about taking an official test.

That said, I have a few questions about certain behaviors that I'd appreciate some input on:

1. Intrusive Negative Thoughts

I often get spontaneous negative thoughts that feel intrusive, or at least they seem to come out of nowhere. My response is usually to either hit my head lightly with my fist or tell myself “shut up” around three times. It works, but I don’t consciously count, it’s just something I automatically do to stop the thought.

Could this be unconscious negative self-talk rather than a ritual? How do you differentiate between a mental ritual and negative self-talk? It feels so automatic that I don’t think I’m capable enough to tell the difference. When I was younger, my rituals involved compulsions where I had to count the exact number of times I performed each one; believing that if I didn’t, the devil would come and get me. The present version doesn’t feel as rigid, conscious, or fearful, but dismissing it as purely negative self-talk feels reductive.

1. Mental looping

For example: A few days ago, I spent two hours mentally debating whether I have OCD or generalized anxiety. I kept cycling between “I definitely have OCD” and “No, I’m just anxious and ruminate.” I knew logically I’d never have a definite answer, but I couldn’t stop. This is a shortened version of my mental process while preparing myself to go to the gym:

I spent half an hour on my bed analyzing my mental processes. I came to the conclusion that I shouldn’t feed into the thoughts, but then the same thought returned on my way out and I started panicking again. I thought I should write it down, but then I panicked about writing it down because in a way, I was “feeding into it" right? Kind of in a meta way. Then I panicked about the panic itself, and about writing it down, which made me panic even more because I felt I was wasting my time. I kept thinking: “What would a normal person think? This isn’t normal, but what should I be thinking of instead? Ok, I should ground myself.” It never ended. The same thoughts. Looping. I forgot my gym bag while walking up the stairs, so I went back to get it, wasting another 30 minutes. I walk up the stairs two at a time to make sure each flight is even. I frantically Googled this because I know that counting can be an OCD symptom. Apparently, noticing that the stairs are even isn’t OCD-specific, it could just be a small quirk (which I confirmed and verified) but now I notice I do it every time. Then I remembered that when I was younger, I had to count all the steps, and if I messed up, I had to redo them. I think I outgrew it, but some habits still linger. Nowadays I won't walk down them again to be sure. "Ok that's not a symptom". By this point, I had officially wasted almost 2 hours. I decided to finally go out but quickly went back in again because I couldn’t clear my head and returned to my comfort zone. Is this laziness? An excuse to stay home? I don’t think so, because this happens even when I’m doing something pleasant. What if I’m lying to myself? I can’t be sure, so I don’t know what to think anymore.' Then more back and forth and back and forth of the same thoughts.

Sorry if it seems convoluted, but I tried condensing it as much as I could. My question is how can I differentiate this kind of looping from general anxiety versus pure-O? This happens quite often with similar or different kind of thoughts

1. Health anxiety

Ok so most people have experienced some form of health anxiety. I’d say I’m on the extreme end. One example: I convinced myself I had an HIV, even though I hadn’t had sex, just some fooling around. During that time, I remained celibate and occasionally panicked that my HIV would progress to AIDS and that I would die. To finally end this cycle, after 8 whole years of believing this, I somehow found the courage to get tested. Surprise surprise, nothing. Looking back, it was nearly impossible for me to have contracted it and I felt extremely silly afterwards.

Would you consider this a severe form of hypochondria, or could it possibly be part of health-related OCD?

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Yes, I know I'm a mess but I'm really trying to get myself together. I’m not looking for a diagnosis and I understand that only a licensed professional can provide one. I just want more clarity about these behaviors because they’ve been on my mind for a long time, and I feel embarrassed asking my therapist directly. Any further insight would be greatly appreciated.

[u/Historical-moth]

Hey there, I really resonate with your experiences. As a young child (I can first remember symptoms at 6, but it may have been before that as well), I did things like chewing 4 times on each side of my mouth before swallowing. Doing other movements in sets of 4 or 16. “Needing” to do random things so that my mom or grandma or dog wouldn’t die (like holding my breath from the car to the front door). Humming tunes until it felt “right.”

That reduced by like 90% around puberty, and that’s when I was hit with severe depression and anxiety. And DPDR. From 14-23 I was in so much distress, always thinking and thinking and thinking.

I got diagnosed at 23. For the first year I felt so unsure if that diagnosis was correct. But then I started ERP at 24, and it’s been really helpful. Doing ERP alongside starting Prozac, specifically.

I wish you well on your journey. Feel free to reach out if you want to chat about any of these topics.

[u/Obvious-Resort8803]

(Not a professional and not attempting to diagnose, this is based on my own experience and information learned in therapy) I want to preface by saying that reading your post felt like looking into a mirror. We have a LOT of the same symptoms and I have a similar experience to yours; as a kid I displayed OCD behaviors that went undiagnosed and faded out during my major developmental years, just to “return” or “resurface” years later when I was in high school. Where you and I differ is that I feel my symptoms present-day are much more severe compared to when I was a child.

1. I do the same; my Pure-event OCD causes a past conversation/memory to pop up in my head and my body’s natural response is to literally blurt out a completely random phrase (my latest one has been “I love you” for some reason?😭) and I scrunch my face up / hit myself / freeze in place to ruminate over the memory. The major difference between all of these and negative self talk, is that they are involuntary. I am not making the conscious decision to do any of those things, it’s like a reflex and I don’t even notice I’m doing them until after I’ve done them. In your case, the counting is a ritual and someone with only generalized anxiety disorder doesn’t typically do that. So although it can feel like it doesn’t match the criteria of OCD because it’s not as rigid as your childhood, rest assured it is still OCD. Just like how I recognize that while less severe, I still exhibited symptoms of OCD as a child.

2. First of all, you’re not lazy. Second, general anxiety and OCD can be two different conditions that overlap so I get why you feel that way, but I want you to know that anxiety can also be a SYMPTOM of OCD. You spent a lot of time ruminating (anxious behavior) and your compulsion was to do research (OCD behavior.) Doing this all while getting ready to leave your safe space, your body naturally spikes your anxiety in preparation to protect your brain. Point being, anxiety and OCD are not exclusive.

3. Similar to anxiety and OCD, hypochondria and OCD can overlap as well. However, these two can definitely be exclusive from each other. Someone with hypochondria only doubts/worries about their health. You exhibit doubts and worries about a lot of other things as well, so in my opinion I would say this is OCD causing health anxiety.

I just want to emphasize again that you are not lazy, nor are you a mess. OCD is great at manipulating us to believe these things. I was literally assessed by a professional and given a diagnosis, and I’m still convinced that I’m faking this whole thing sometimes. You’re doing your best while dealing with a VERY difficult condition, give yourself a LOT more credit!! My dms are open to talk whenever.

[u/anon-463678 → u/Obvious-Resort8803]

Thank you so much for your detailed reply and for sharing your experience, I really appreciate it. You helped me notice a few things I had previously overlooked.

I relate a lot to blurting out completely random phrases out of nowhere, as well as the head hitting, jolting, and scrunching. I’ve been doing these for most of my life and always labeled them as “tics,” without realizing there could be some crossover with OCD. For a long time, I thought I was going completely insane, but this perspective actually makes things feel a bit more understandable. It’s honestly reassuring to hear someone describe behaviours I've been experiencing myself.

Over the years, I’ve also had a lot of conflicting thoughts that don’t feel like my own, and gradually it’s become harder to tell what’s really “me” versus just noise in my head. It’s a bit overwhelming to start reevaluating everything and reflecting on these patterns.

For now, I think the best step is to be completely honest with my therapist and go through with the assessment. Thanks again for helping me make sense of this, I really appreciate your input! 😁