Complex PTSD Symptoms:

Obsessive Thoughts

Sections:

• The Link Between PTSD & OCD
• Rumination
• Ruminating After Narcissistic Abuse

COMPLEX PTSD - SHAME - AVOIDANCE - HYPERVIGILANCE - DYSREGULATION - INTERPERSONAL DIFFICULTIES - DISSOCIATION - IMPULSIVITY - DEPRESSION - TRIGGERS - PHYSICAL - PERSONAL EXAMPLES - TREATMENT

The Link Between PTSD & OCD

Written by Matthew Tull, PhD

Posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD) are anxiety disorders that commonly co-occur in people with a history of trauma. Research shows that the likelihood of a person diagnosed with PTSD developing OCD within a year is about 30%.

Between 19% and 41% of people with PTSD also have a diagnosis of OCD.2 This figure is much higher than the current occurrence of OCD in the general population, which is around 1%.

The treatment for OCD may vary if it occurs with PTSD, so it is important to discuss any trauma with your therapist. Before delving into the link between PTSD and OCD, it's important to understand the basics of these mental health conditions.

Understanding PTSD

PTSD may occur in people who have experienced or witnessed trauma. Trauma is an event that causes physical, emotional, or psychological distress to a person.3 Examples may include:

• Abusive relationship
• Being victimized
• Car accident
• Death of a loved one
• Natural disaster
• Relationship problems (for example, a divorce)
  

A person with PTSD has persistent and disturbing thoughts about the trauma, often relived through flashbacks or nightmares.3

Diagnosing PTSD

In order to be diagnosed with PTSD, a person must be exposed to a traumatic event and have symptoms for one month. These symptoms may include:4

• Avoiding reminders of the trauma
• Experiencing reactive symptoms (for example, being easily startled or having angry outbursts)
• Intense, repetitive memories
• Negative thoughts (for instance, feeling detached from others)

Understanding OCD

While many people have repetitive behaviors or driven thoughts, the thoughts and behaviors of a person with OCD are persistent and disruptive to daily functioning.

Obsessions

Obsessions are recurring and persistent thoughts, impulses, and/or images that are viewed as intrusive and inappropriate. The experience of obsessions causes considerable distress and anxiety for a person.5

It's important to understand that the obsessions in OCD are not just worries about real-life problems.

People will try (often unsuccessfully) to ignore or "push away" these recurrent thoughts, impulses, or images, usually knowing that they are unreasonable and from their own mind. Yet people with OCD cannot suppress or ignore their obsessions.

Compulsions

Compulsions are repetitive behaviors (for example, excessive hand washing, checking, hoarding, or constantly trying to put things around you in order) or mental rituals (for example, frequently praying, counting in your head, or repeating phrases constantly in your mind) that someone feels like they have to do in response to the experience of obsessive thoughts.5

Compulsions are focused on trying to reduce or eliminate anxiety or prevent the likelihood of some kind of dreaded event or situation. Like obsessions, a person with OCD knows that these compulsions are illogical, which causes further distress.

Diagnosing OCD

To be diagnosed with OCD, a person must experience more than one hour per day of intrusive and uncontrollable obsessions and/or compulsions. In addition, these obsessions and/or compulsions must cause considerable distress and impair functioning such as at work, school, or spending time with friends.

Connection Between PTSD and OCD

With both PTSD and OCD, a person has intrusive thoughts and then engages in neutralizing behaviors to reduce their anxiety from these distressing thoughts.

In PTSD, a person often tries to neutralize their thoughts by suppressing them or engaging in other behaviors like isolation and avoidance.1Compulsions are the neutralizing behaviors in OCD.

While compulsive behaviors (like checking, ordering, or hoarding) may make a person feel more in control, safe, and less anxious in the short run, in the long run, these behaviors do not only inadequately address the source of the anxiety, they may even increase the amount of anxiety someone experiences.

Symptoms of Post-Traumatic OCD

People with OCD that develops after trauma show a different pattern of symptoms, including more severe symptoms such as suicidal thoughts, self-mutilation, panic disorder with agoraphobia, hoarding, compulsive spending, and greater anxiety or depression.

Psychotherapy is often used to treat both OCD and PTSD. Some types that may be used include:

• Exposure therapy: OCD is classically treated with exposure therapy, in which a person is exposed to the stimuli that cause them anxiety and then prevented from engaging in their normal compulsion.7 But with trauma-related OCD or OCD that is co-occurring with PTSD, you may need a different type of therapy.
• Cognitive-behavioral therapy (CBT): Some experts use cognitive-behavioral therapy (CBT) for trauma-related OCD.1 In this type of therapy, a person is taught how to redirect intrusive thoughts about the traumatic event.
• Other therapies: Other forms of trauma-focused therapy, including eye movement desensitization and reprocessing (EMDR) therapy and trauma-focused CBT, may also be useful.8

There is a blurred boundary between OCD and PTSD. If you have PTSD and/or OCD, it's very important to seek treatment from a mental health professional. Be sure to mention any history of trauma to your psychologist or therapist, as this may affect your treatment plan. 

Rumination

Rumination involves repetitive and passive thoughts focused on the causes and effects of a person's distress. However, these thoughts do not lead to the person engaging in active coping mechanisms or problem-solving strategies that would relieve distress and improve mood.

While people are prone to rumination from time to time, it can magnify stress to the point that it creates additional problems. Rumination is associated with many negative effects on the mind and body.

Unfortunately, these repetitious thoughts are an easy mode to slip into when people are stressed. This pattern often begins with the simple desire to solve the problems that people are experiencing.

While it seems like solving the problem with resolve the stress, rumination does not lead to any solutions. Examining memories, situations, and feelings can be an important part of processing our experiences, but processing and ruminating are different things and learning how to distinguish between the two can be important for your mental well-being.

Causes of Rumination

It is normal to ruminate on things from time to time, particularly if you are thinking about a stressful or upsetting experience. People may ruminate because they believe they can solve a problem or gain insight by thinking about it repeatedly. Having a history of trauma or dealing with stressful situations in the present can also contribute to rumination.3

Some factors that might cause rumination:

• Certain personality traits such as perfectionism or neuroticism
• Stressful events such as job loss or a relationship break up
  
• Poor self-esteem
• Stressing about something you fear
  
• Traumatic events
  
• Worrying about upcoming events like a work presentation or exam
• Worrying about a health condition

Rumination is also associated with several different mental health conditions. These conditions can contribute to rumination, but experiencing these repetitive thoughts can also contribute to or worsen the symptoms of these conditions.

Mental conditions that can cause rumination or be worsened by it include:

• Anxiety is often marked by worrying or ruminating over specific fears or anticipated situations. Research has shown that rumination is a risk factor for anxiety.
• Depression can cause people to ruminate over negative thoughts. Numerous studies have linked rumination as a significant risk factor for the onset of depression. Research suggests that rumination can be a maladaptive way of responding to a depressed mood, leading to more feelings of depression.4
• Eating disorders can cause people to ruminate about food, dieting, and exercising. Research has found that people who exhibit eating disorder psychopathology are more likely to experience ruminating thoughts, and such thoughts tend to decrease mood and cause more negative body-related thoughts.5
• Obsessive-compulsive disorder (OCD) causes intrusive, obsessive thoughts that may lead to compulsive behaviors to relieve distress. One study found that rumination plays a role in maintaining OCD symptoms that can also contribute to depressed mood.6
• Post-traumatic stress disorder (PTSD) often involves ruminating about traumatic memories. Researchers believe that rumination may be an intentional way to understand and process the trauma, although the results are ultimately ineffective.

Signs of Rumination

What does rumination look like, and how is it different from productive emotional processing? Rumination and emotional processing both focus on problems and usually on emotions surrounding these problems.

Rumination, however, tends to have a more negative bent, often including thought patterns that involve pessimism and cognitive distortions and focusing mainly on the negative aspects of a situation. Emotional processing, by contrast, may start out this way, but leads to acceptance and release of negative emotions, while rumination keeps you "stuck."

As a general rule, the following can be indicators that you may have fallen into the trap of rumination:

• Focusing on a problem for more than a few idle minutes
• Feeling worse than you started out feeling
• No movement toward accepting and moving on
• No closer to a viable solution

Likewise, with a conversation with a friend, if you both end up feeling worse afterward, you've likely just engaged in co-rumination.

How Rumination Works

Most people don't set out to ruminate over their problems. Most of us want to be happy and want to focus on thoughts that make us happy. The problem occurs when something frustrating, threatening, or insulting happens to us—something that is difficult to accept—and we can't let it go.

We may be trying to make sense of it in our mind, attempting to learn from it, or we may just be seeking validation that this should not have happened. Whatever the reason, though, we can't stop thinking about it, and when we think about it, we become upset.

The unproductively negative focus it takes is the defining aspect of rumination that differentiates it from regular problem-solving. Rumination may involve going over the details of a situation in one's head or talking to friends about it.

Rumination vs. Emotional Processing

As you look at the difference between rumination and emotional processing, you might have several concerns:

• If we don't think about our problems, how can we hope to solve them or learn from the process?
• Should we just focus only on the positive?
• Don't we sacrifice growth and solutions if we don't focus on unpleasant situations from time to time?

These are important questions because knowing the happy midpoint between ignoring problems and engaging in rumination can save us a lot of stress.

Rumination

• Often leads to self-blame, guilt, or shame

• Does not produce solutions or insights

• Can lead to blaming others

• Focuses on the negative

Emotional Processing

• Leads to feelings of acceptance

• Produces solutions and insights

• Allows people to put situations in perspective

• Helps people look for the positive

Rumination involves negative thought patterns that are immersive or repetitive. Many people slip into rumination when trying to process their emotions, but they become "stuck" in negative patterns of replaying past hurts without moving toward solutions or feelings of resolution.

What distinguishes rumination or "dwelling on problems" from productive emotional processing or searching for solutions is that rumination doesn't generate new ways of thinking, new behaviors, or new possibilities. Ruminative thinkers repeatedly go over the same information without change and stay in a negative mindset.

Rumination can even be "contagious" in a way. Two people can engage in "co-rumination" and keep a negative situation alive between them with little movement toward the positive.

How to Overcome Rumination

Rumination can be difficult to give up, especially if you don't recognize it as rumination or don't know how to stop. Letting go of stress and anger can help with ruminative thinking. Properly dealing with negative emotions can also help with rumination and the feelings of stress that come with it.

Some strategies that might help you learn to let go of repetitive thoughts include:

• Try meditation: Meditation can help relieve feelings of stress and redirect thoughts toward less negative patterns.
• Distract yourself: When you ruminate on negative thoughts, break out of the pattern by doing something to distract yourself from your thoughts. Try doing a puzzle, reading a book, calling a friend, or watching a movie.
• Challenge your thoughts: Remind yourself that thoughts are not facts. Instead of accepting a negative thought as reality, actively challenge it and look for alternative explanations.
• Engage in exercise: Physical activity can be a great way to distract from negative thoughts, but research has also found that it can significantly reduce rumination in people with a mental health diagnosis.8
• Go outside: Research has also found that spending time in nature can significantly reduce rumination.9 Try combining exercise and nature exposure by walking in a park or natural setting.
• Cull your social media feeds: It is also important to avoid or minimize contact with things that trigger rumination. For example, if scrolling through your social media feeds leaves you with negative thoughts about your life, relationships, or appearance, consider unfollowing accounts that lead to these negative thoughts and feelings.
• Cultivate social support: Having people you can lean on is important in times of stress. Your social connections can be an important source of support and help distract you from negative thoughts.

If self-help strategies are not providing enough relief, consider talking to a mental health professional. Therapy approaches such as cognitive-behavioral therapy (CBT) can help you change the negative thought patterns associated with rumination and develop new ways of coping.

Understanding Rumination After Narcissistic Abuse

The most significant hindrance to healing from narcissistic abuse is rumination. Survivors often find themselves replaying the abuse in their minds, analyzing situations and questioning themselves.

Rumination presents one of the most substantial challenges in overcoming narcissistic abuse – even after leaving the abuser, these thoughts can haunt you for days or even years.

You relive every conversation and experience repeatedly, affecting your productivity. These thoughts can be distracting, taking your focus away, even when the narcissist is not present.

The voices in your head can keep you feeling small, and they seem to continue the work of the narcissist even in their absence.

Managing the anger and grief stemming from these thoughts can be incredibly challenging.

Examples of Rumination:

Imagine people have repeatedly told you that you're not consistent, or not good enough.

Now, every time you're about to embark on something new, this thought lingers in your mind: 'Are they right? Am I wrong to believe in myself?'

It's a relentless loop, even though deep down, you know that these individuals aren't genuinely looking out for your well-being.

Think about the final episode of the series 'The Bear.' It's that moment when all those negative thoughts converge, typically when you're stepping out of your comfort zone or standing on the brink of success.

Even though you've made progress and achieved so much, deep down, you might still listen to those nagging voices.

Interestingly, I've personally found that watching that scene repeatedly can be incredibly therapeutic.

Another common example of rumination is dwelling on the life you could have had if the narcissists were not in your life.

You find yourself fixating on all the missed opportunities and times when you downplayed yourself due to their influence.

It's like a mental reel that plays out the 'what-ifs' and 'could-have-beens,' often leading to feelings of regret and self-doubt.

II. Recognizing the Signs of Rumination

Common signs and symptoms of rumination include:

• Overwhelming preoccupation with distressing thoughts and memories related to narcissistic abuse.
• Replaying past events and conversations in your mind, often in search of answers or validation.
• Heightened anxiety.
• Persistent sadness.
• Emotional exhaustion.
• Physical symptoms such as insomnia, loss of appetite, tiredness, and fluctuations in body weight.
• Difficulty maintaining focus.
• Reduced efficiency in work or study.

III. Breaking the Cycle of Rumination

1. The first step is recognizing that you're ruminating over your life due to these individuals who aren't worth your time.

Self-awareness is where change begins.

2. When you notice the first negative thought creeping in, it's time to take immediate action with a 10-15 minute break.

The goal is to halt those thoughts before they gain more ground. Here are some ideas to try during your break:

• Go for a walk.
• Do a quick 10-minute workout.
• Take a refreshing shower.
• Spend some time on skincare.
• Make a grocery list.
• Tackle some cleaning.
• Create a list of pending tasks.
• Enjoy quality time with your pet.
• Engage in some online window shopping (a personal favorite).
• Update your wishlist.
• Plan for a dream vacation in the future, even if money is tight.

3. If you're struggling to stop rumination, try to approach the particular incident or situation from multiple angles.

Journaling can be a helpful tool for this, even though it may not be a pleasant experience. Sometimes, delving deep into feelings of shame or guilt can provide you with a new perspective.

4. Practice self-compassion.

If rumination is triggering feelings of shame, remember to forgive yourself.

You did the best you could with the knowledge and resources you had at that time.

Most of the negative opinions likely stem from the narcissist's perspective, not from someone with a healthy mindset. It's often a projection of their own insecurities.

5. If rumination fuels anger towards someone, understand that you're still dedicating your time and energy to narcissists.

Instead, focus on moving forward, and remember that your success and happiness are the best forms of revenge.

Seek out support groups, therapy, or safe spaces to vent and heal.

6. Engage with movies, series, or music that revolve around themes of revenge or overcoming abuse.

For example, Taylor Swift's "Look What You Made Me Do" is a favorite of mine for shifting my mindset from victim to survivor. I also rewatch "Promising Young Woman" quite often.

IN PROGRESS. 

. 

SOURCES:

CPTSD Workbook, Arielle Schwartz PhD/ CPTSD Treatment Manual__CPTSD: From Surviving to Thriving, Pete Walker__www.verywellmind.com/what-is-complex-ptsd__psychcentral.com/ptsd/complex-posttraumatic-stress-disorder-symptoms#common-triggers__goodtherapy.org/dissociation-c-ptsd-role-of-detachment-in-complex-trauma___crappychilhoodfairy.com/cptsd-behaviors-like-narcissism__Crittenden, P. M., Heller, M. B. (2017). The roots of chronic posttraumatic stress disorder: Childhood trauma, information processing, and self-protective strategies. Chronic Stress, 1, 1-13 https://journals.sagepub.com/doi/10.1177/2470547016682965__Kessler, R. C., & Bromet, E. J. (2013). The epidemiology of depression across cultures. Annual Review of Public Health, 34, 119–138. https://www.annualreviews.org/doi/10.1146/annurev-publhealth-031912-114409__Lawson, D. M. Treating adults with complex trauma: An evidence-based case study. Journal of Counseling and Development, https://onlinelibrary.wiley.com/doi/abs/10.1002/jcad.12143 Sar, V. (2011, March 7)__Developmental trauma, complex PTSD, and the current proposal of DSM-5__European Journal of Psychotraumatology, https://www.tandfonline.com/doi/full/10.3402/ejpt.v2i0.5622__Tarocchi, A., Aschieri, F., Fantini, F., & Smith, J. D. Therapeutic assessment of complex trauma: A single-case time-series study. Clinical Case Studies, 12, 228–245. https://journals.sagepub.com/doi/10.1177/1534650113479442__https://www.verywellmind.com/agoraphobia-101-2584235__Avoidance Behavior, Written by Silvi Saxena MBA, MSW, LSW, CCTP, OSW-C/Reviewed by Raiy Abulhosn MD__ https://psychcentral.com/pro/complex-ptsd-and-the-realm-of-dissociation__https://www.verywellmind.com/trauma-ptsd-and-ocd-2797516

COMPLEX PTSD - SHAME - AVOIDANCE - HYPERVIGILANCE - DYSREGULATION - INTERPERSONAL DIFFICULTIES - DISSOCIATION - IMPULSIVITY - DEPRESSION - TRIGGERS - PHYSICAL - PERSONAL EXAMPLES - TREATMENT