Overthinking or excessive worry can be a symptom of several different mental illnesses. The most common conditions associated with obsessive thinking are anxiety disorders like generalized anxiety disorder, obsessive compulsive disorder, and some phobias. Depression can also lead to repetitive negative thoughts. Let’s explore the key signs, causes, and treatments for mental illnesses involving obsessive thoughts or rumination.
What is Overthinking?
Overthinking refers to excessive, repetitive thoughts that are distressing and uncontrollable. These obsessive thoughts often focus on negative scenarios or regrets about the past. Some common thought patterns include:
- Worrying excessively about future events
- Ruminating over past mistakes or choices
- Dwelling on embarrassing or awkward social encounters
- Questioning yourself repeatedly or having low self-esteem
Occasional worry is normal, but overthinking becomes problematic when it is:
- Time-consuming – occupying over an hour a day
- Distressing – causes significant stress, anxiety, or low mood
- Intrusive – thoughts feel outside of your control
- Interfering – impacts daily functioning and relationships
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) involves frequent, exaggerated worry about everyday issues. People with GAD often obsess over minor concerns like health, money, family, or work problems.
Common Symptoms
- Chronic, excessive worry happening more days than not
- Difficulty controlling the worry
- Physical anxiety symptoms like insomnia, fatigue, irritability
- Impaired functioning due to anxiety
GAD affects about 5% of the US population at some point during their lifetime. It often develops in childhood or adolescence and is more common in women. Genetics and childhood trauma may contribute to GAD.
Treatment
GAD is treated with psychotherapy like cognitive behavioral therapy (CBT) and medications like SSRIs. Lifestyle changes like exercise, meditation, and limiting stimulants can also help manage symptoms.
Obsessive Compulsive Disorder
Obsessive compulsive disorder (OCD) causes intrusive, unwanted thoughts as well as compulsive behaviors done to decrease anxiety caused by the obsessions.
Common Symptoms
- Obsessions – intrusive, irrational thoughts or worries
- Compulsions – repetitive behaviors like hand-washing, checking, counting
- Rigid following of routines
- Excessive doubt or fear of making mistakes
About 1-2% of adults have OCD. Onset is often gradual and can start around puberty or after a stressful event. Genetics and brain structure abnormalities play a role.
Treatment
SSRIs like fluoxetine are first-line medications for OCD. CBT with exposure therapy is also highly effective. Treatments help patients resist compulsions and recognize that feared outcomes rarely occur.
Body Dysmorphic Disorder
Body dysmorphic disorder (BDD) is characterized by obsessive focus on one or more perceived flaws in physical appearance that are not observable to others.
Common Symptoms
- Preoccupation with appearance “defects”
- Frequent mirror checking, reassurance seeking, skin-picking
- Avoidance of social situations
- Depression and thoughts of suicide
BDD has an estimated prevalence of about 2% of the population. Onset is typically around adolescence and it affects men and women almost equally. The exact causes are unknown but it may be related to OCD.
Treatment
SSRIs like escitalopram and fluoxetine can reduce BDD symptoms along with CBT. Plastic surgery is generally ineffective as the obsession transfers to a new body part.
Depression
People with major depressive disorder often experience repetitive negative thinking patterns like rumination along with other symptoms like sad mood, fatigue, and changes in sleep and appetite.
Common Thought Patterns
- Self-criticism and blame
- Pessimism about the future
- Dwelling on problems or mistakes
- Downplaying positives
Up to 7% of US adults have major depression each year. Causes involve brain chemistry, hormones, genetics, and environmental factors. Treatments include antidepressant medication and CBT.
Social Anxiety Disorder
Social anxiety disorder is characterized by extreme fear and avoidance of social situations due to irrational worries about being negatively judged or embarrassed.
Common Thought Patterns
- Excessive worry before and after social encounters
- Fears of saying something awkward or stupid
- Intense self-consciousness in public
- Belief that others are highly critical
About 7% of the population has social anxiety disorder at some point. Contributing factors include genetics, trauma, and isolation. Treatments include exposure therapy, social skills training, and medications like SSRIs.
Health Anxiety
Health anxiety, also called illness anxiety disorder, involves obsessively worrying about having or developing serious medical issues. Typical thoughts include fearing diseases like cancer when no symptoms are present.
Common Thought Patterns
- Preoccupation with bodily signs or sensations
- Frequently seeking medical reassurance
- repeatedly checking body for abnormalities
- Avoiding information about illness
About 5% of people experience health anxiety. Contributing factors include genetics, trauma, and having illness in childhood. Treatments include CBT, SSRIs, and limiting reassurance seeking.
Post-traumatic Stress Disorder
PTSD involves re-experiencing a traumatic event through intrusive memories, flashbacks, and nightmares. Avoidance of trauma reminders and hyperarousal are also common.
Common Thought Patterns
- Intrusive memories about the trauma
- Excessive guilt or worry related to trauma
- Difficulty remembering parts of the trauma
- Detachment from others
PTSD has a lifetime prevalence of about 7% in the US. Most common triggers are sexual assault, childhood abuse, combat, and disasters. Treatments include psychotherapy, EMDR, and SSRI medications.
Conclusion
The mental disorders most closely linked to overthinking and worry are generalized anxiety disorder, obsessive compulsive disorder, body dysmorphic disorder, depression, social anxiety, health anxiety, and PTSD. The key is determining when obsessive rumination is interfering with normal functioning and causing significant distress. If obsessive thoughts become uncontrollable, consulting a psychiatrist or therapist can help diagnose any underlying conditions and provide effective treatments. With professional help, peace of mind is possible.