Obsessive Thoughts in Bipolar: Rumination, Fixation, and Relief

Whether it’s anxiety, rumination, or intense fixations, these strategies — used by real people — can help you find relief.

Getting something stuck in your head — the catchy chorus of a song, a gruesome image from the news — can be annoying for anyone. But annoying can become alarming when intrusive thoughts, worries, or even enthusiasms turn obsessive.

For at least 20 percent of people who live with bipolar disorder, that scenario happens all too often. And when it does, the consequences can be troublesome. 

What Are Obsessive Thoughts in Bipolar Disorder?

Michelle, of Florida, recalls how one obsessive bout affected her marriage. When demonstrating an app called Find My iPhone to her mother-in-law, Michelle used her husband’s cell number to show that his phone was with him at the grocery store where he works. Instead, the app pinpointed a location five miles away from where she thought her husband would be.

Already off-balance because of mood symptoms, Michelle became obsessed with the idea that her husband was having an affair — and proving it. She started checking his cell phone while he was in the shower and his computer while he was at work. If he came home tired, she took it as a sign he had spent his energy on another woman. If he were on his phone, she would want to know why.

One day, after seeing a number on his screen that she didn’t recognize, she grabbed her wallet and left the house, unsure whether she would return home. She drove around for a while before calling the suspicious number.

“It was a Walmart,” Michelle reports. “I was like, ‘You’ve got to be kidding me.’”

That was the moment Michelle realized she needed help. She called her psychiatrist and asked to be seen right away. She had her medication adjusted and began cognitive behavioral therapy, which has helped her learn how to shift back to more realistic thinking when she’s getting obsessive.

“There’s a lot of repeating the rational thought just to get me to hear it sometimes,” says Michelle, who has a bipolar 2 diagnosis and co-existing anxiety disorders. “It’s almost as though I have a person on each shoulder — one funneling in the bad stuff and one fighting to funnel in the rational thoughts.”

Bipolar Rumination vs. Intrusive Thoughts

Intrusive thoughts, images, and impulses appear to be a nearly universal part of the human condition. The problem comes when they do more than intrude — when they won’t go away. They can keep you awake at night, disrupt your focus during the day, and steer your behavior toward counterproductive channels.

Psychiatry draws a distinction between these two experiences based on their emotional focus:

• Rumination focuses on the past. This is a passive, repetitive dwelling on past personal events, negative feelings, or self-blame, usually occurring during depressive episodes.
• Intrusive thoughts focus on fear. These are unwanted, distressing ideas or images that feel beyond your control and often trigger anxiety or a need for “checking” behaviors, common in mania or mixed states.

Obsessive thinking is like a hamster wheel in the brain, with different animals parading in and out over time, according to psychologist Bruce Hubbard, PhD, a visiting scholar at Columbia University Teachers College in New York City.

“People with bipolar disorder often report that there’s an obsession of the day or the week, and as one problem gets resolved, it can easily be replaced by another problem,” Dr. Hubbard says. “There’s something in the brain that needs to ruminate and worry and obsess about different topics. It could be a real problem or a completely irrational problem — it almost doesn’t matter what the topic is.”

Real life, of course, is not quite so clear-cut. For example, in one study, researchers at Harvard Medical School found that for people with bipolar disorder, rumination might signal executive dysfunction, or challenges in the brain’s ability to manage and control thoughts and actions.

How Obsessive Thinking Changes During Mania and Depression

Those medical definitions don’t always take into account the kind of obsessive thoughts and behaviors that can sweep in with mania or hypomania, when some particular enthusiasm gets taken to extremes.

For example, say you come up with an idea for a new home-based business. It feels good to have a project you’re passionate about, and you spend more and more time thinking about how to get it off the ground. Pretty soon, it’s all you’re thinking about.

You neglect current commitments because of the inordinate amount of time and money you’re spending on finding the right supplies and designing a website. You may periodically feel ashamed or guilty about being so distracted — but regardless, your mind keeps going back to your obsession.

Then the enthusiasm wanes, and you’re left with a load of debt and a life in disarray.

“It’s almost like people … grab the shovel and start digging and can’t wait to see what they find, but they wind up getting entrenched in their thoughts, and before they know it, they’re deep in a pit of nothing,” says Helen Farrell, MD, a psychiatrist in private practice in Boston. “All the stuff they were originally excited about is just not there.”

How to Manage Obsessive Thoughts

A big part of learning how to deal with this tiring parade is accepting that this is how your brain is wired, says Felisa Shizgal, a registered psychotherapist in private practice in Toronto, Ontario.

Shizgal suggests reminding yourself that obsessive thoughts “are a part of me, not all of me,” as a healthy way to recognize their presence in your life without getting overwhelmed.

Cognitive Techniques to Break Thought Patterns

• Self-awareness is key. Track patterns in a log and be curious about them. What are you feeling insecure or upset about? Would it be a sensible concern to a neutral observer?
• Identify triggers. Are there certain times of the day when your thoughts tend to be more intense?
• Scheduled worry time. Dr. Farrell suggests identifying the obsessive thought, then scheduling a brief block of time later in the day to pay attention to it.

Behavioral Strategies and Distraction

With more self-knowledge in hand, it’s time to deploy distraction and defusion — in other words, distancing and disconnecting your mind from whatever idea is consuming you.

• Physical Activity If thoughts are intense in the morning, plan a workout, or stretching before breakfast.
• Engagement Relaxation exercises, yoga, watching TV, or calling a friend can help shift your focus, suggests Hubbard.
• Grounding Retreat to a safe space and engage the senses with a cozy blanket, scented candles, or a healthy meal.
• Body Check-In Breathing can become shallow (so take a deep breath). Shoulders can migrate toward the ears (drop them back into place). Muscles can tighten (consciously relax them).

When Obsessive Thoughts Become Severe

Mike, of Michigan, feels tension throughout his entire body when he can’t free his mind from dark thoughts, making it difficult to focus on everyday tasks long enough to complete them. He doesn’t eat well or get much sleep.

“It’s like every muscle in my body wants to go somewhere,” he says. “I feel like I could run a thousand miles.” 

The things that keep him most centered are solo walks in nature and listening to loud music while wearing headphones. Even so, there are times when his mind latches onto a notion so strongly that he can’t access the strategies he has learned in therapy.

“It’s like none of that stuff ever existed,” he says. “I can think of them at other times when somebody asks me, but in those moments, it’s not something I can grab out of my brain.”

The ultimate aim of cognitive defusion techniques is to gain perspective and see obsessive thoughts for what they are (temporary sensations) rather than what your mind insists they are (permanent facts).

What you don’t want to do is try to control or suppress the obsessive thoughts, because they tend to intensify when resisted.

How Past Trauma Can Fuel Obsessive Thought Loops

You may benefit from working with a therapist to learn ways to fend off obsessive thoughts. Psychotherapy is helping Lisa get past a negative inner narrative that makes it difficult for her to trust others.

When she was a girl, Lisa’s father ridiculed her freckles and poked fun at her for being heavy-chested. She was teased about her weight by her brother and bullied by a classmate.

As a result, she has thoughts “every single day, all day long, about the past, about things that have happened to me, how people looked at me,” says Lisa, who lives in Ontario, Canada. “I’m always afraid somebody’s going to hurt me emotionally in some way.”

She can also feel consumed by unwarranted guilt because three of her four children also have bipolar disorder. Or she will get into a repetitive loop after she accepts some demand on her time that she’d rather refuse, second-guessing her decision. (Setting boundaries is another topic for her and her therapist.)

“It’s very difficult to separate the logical thought and the feeling,” Lisa explains. “It takes a long time to be honest with yourself about it. But I need to be patient with myself, no matter what anybody says. I need to do this on my time, not on their time.”

Planning Ahead: Strategies to Sidestep Intrusive Thoughts

Olivia, of Texas, obsesses over feeling inadequate at her job. Surrounded by well-educated and more experienced coworkers, she feels like an imposter. She tries to keep those kinds of thoughts at bay by watching Netflix or talking to friends, along with techniques she’s learned from her psychiatrist and therapist.

“It gets really exhausting to talk back to and correct irrational thoughts, but you have to try,” Olivia says. “I give myself positive affirmations to remind myself who I am and hopefully prevent those thoughts from happening in the first place.”

She uses the analogy of being chronically late to class when encouraging herself to stick with it.

“If you knew the teacher was going to lock the door and mark you absent, you would do whatever is necessary to be on time, right?” she says. “If I don’t want obsessive thoughts to take over, I have to use my coping skills like planning out my day, making checklists, and making sure I’m surrounded by people to keep my mind focused and occupied.”

Bipolar Disorder and OCD Overlap

Research suggests that up to 24 percent of people with a primary diagnosis of bipolar disorder have comorbid obsessive-compulsive disorder (OCD). And according to one small study, researchers looked at people experiencing bipolar depression and found that 1 in 4 individuals also have OCD. 

Those figures may not even include people whose obsessions don’t take the classic forms found in OCD. In any event, the crossover is seen so often that some scientists are arguing that bipolar disorder with OCD represents a specific subtype of bipolar illness.

Editorial Sources and Fact-Checking 

• Braverman L et al. Rate of OCD and Sub-Threshold OCD in Bipolar Disorder Patients With First Depressive Episode. Psychiatry Research. August 2021.
• Chou T et al. Rumination in Bipolar Disorder Associated With Brain Network and Behavioural Measures of Inhibitory Executive Control. Acta Neuropsychiatrica. August 2023. 
• Khalkhali M et al. Obsessive Compulsive Disorder and Bipolar Disorder Comorbidity: A Comparative Study. Iranian Journal of Psychiatry. April 2022. 

UPDATED: Originally printed as “Mind Control,” Fall 2017