Obsessive thinking is a fairly common but rarely discussed symptom of bipolar. We look at ways you can take charge when intrusive thoughts take hold.
By Robin L. Flanigan
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 segues to alarming when intrusive thoughts, worries or even enthusiasms turn obsessive.
For at least a fifth of people who live with bipolar disorder, that scenario happens all too often. And when it does, the consequences can be troublesome. Michelle O. of Florida recalls how one obsessive bout injected a septic ooze into her marriage.
When demonstrating an app called Find My iPhone to her mother-in-law, Michelle decided to use 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 proving her husband was having an affair. She started checking his cell phone when he was in the shower, and his computer and iPad when 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 was 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 to be 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 II 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.”
A HAMSTER WHEEL
Having intrusive thoughts, images and impulses appears to be a nearly universal constant of the human condition. Concordia University and 15 other universities worldwide found that a whopping 94 percent of people experience them in some form at some time, according to research published in the Journal of Obsessive-Compulsive and Related Disorders in 2014.
The problem comes when they do more than intrude—they won’t go away. In the absence of evasive measures, the invaders take control and start to keep you awake at night, disturb your focus during the day, and direct your behavior into counterproductive channels.
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, president of the New York City Cognitive Behavior Therapy Association and a visiting scholar at Columbia University Teacher’s College.
“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,” 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.”
Psychiatry draws a distinction between obsessive thinking—fixating on fears and anxieties in a way that stirs you up—and the type of rumination common in depressions, when the mind tracks around and around some personal problem or past distress in a way that drags you down.
Real life, of course, is not quite so clear-cut. For example, a 2015 review of previous studies by two Brazilian researchers concluded that rumination is present in all bipolar phases and may reflect a hitch in the brain’s executive function (a set of processes relating to planning, organizing, and self-regulation).
Plus, those medical definitions don’t 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.
As an illustration, say you come up with an idea for a new home 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 funneling into finding just the right supplies and designing a website. You may periodically feel ashamed or guilty about being so distracted—but your mind keeps going back to your obsession regardless.
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 psychiatrist Helen Farrell, MD, an instructor at Harvard Medical School and staff psychiatrist at Beth Israel Deaconess Medical Center. “All the stuff they were originally excited about is just not there.”
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, MEd, RP, a registered psychotherapist in Toronto.
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.
“That doesn’t mean the worry has to be with you all the time or drive the bus,” she adds, “but it does mean becoming really expert at recognizing it and learning ways to slow yourself down physically and cognitively and emotionally.”
One way to become an authority is to 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? Was there a trigger? Are there certain times of the day when your thoughts tend to be more intense?
With more self-knowledge in hand, it’s time to deploy distraction and defusion—a label for distancing and disconnecting your mind from whatever idea is consuming you.
If your thoughts tend to be more intense in the morning, for instance, you might plan to go for a regular run before breakfast. The key is to decide in advance on some options for distracting yourself.
“It could be some relaxation exercises, physical exercise like yoga or going for a walk, watching TV, calling a friend, or getting to work on some project you’ve been avoiding,” says Hubbard. “Anything that’s meaningful and valuable and gives you something concrete to shift your attention toward.”
Farrell suggests identifying the obsessive thought, then scheduling a brief block of time later in the day to pay attention to it—allowing you to be more present for the work or people in front of you.
“More often than not, that time never comes because the problem has been defused,” she adds.
MIND & BODY
Another approach is to ground yourself in the physical. Retreat to a space that feels safe and comfortable and engage the body’s senses by cuddling in a cozy blanket, lighting scented candles, drinking ice water, and so on.
It’s also important to check in on how your body is unconsciously reacting. 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).
Mike W. of Michigan feels tension throughout his entire body when he can’t free his mind from the dark thoughts that have plagued him lately, 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. I feel like I could run a thousand miles,” he says.
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 get some perspective and see obsessive thoughts for what they are (temporary sensations) instead of 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.
LEARNING HEALTHY RESPONSES
You may benefit from working with a therapist to learn ways to fend off obsessive thoughts. Psychotherapy is helping Lisa C. get past a devouring inner narrative that makes it difficult for her to trust others.
When she was a girl, her 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,” she 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.”
Olivia H. of Texas obsesses over feeling inadequate at her job. Surrounded by well-educated and more experienced co-workers, 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. “You’d pack your bags, lay out your clothes and shower the night before, make sure you have a ride, and so on to make sure you aren’t late again.
“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.”
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STOPPING REPETITIVE THOUGHT LOOPS
Obsessive thoughts often revolve around irrational or exaggerated worries. The repetitive loops can make it difficult to focus on the tasks at hand, disrupt sleep, and affect daily behavior as you start to avoid certain activities or pursue others to an extreme. Psychologist Bruce Hubbard, PhD, offers these countermeasures:
Switch your focus. In what Hubbard calls “the premier cognitive defusion strategy,” you choose a target of attention (usually the breath) to laser in on when intrusive thoughts take over. With practice, this mindfulness technique exercises your “letting go” muscle, allowing you to release the thoughts that were absorbing you.
Look at the end game. Quiz yourself about the function of your obsessive thoughts. Do they serve some purpose? Are they helpful or harmful? Do they bring you closer to your goals or put you further away?
Label the thoughts. Describe your thoughts in simple, objective, terms. You can say something like, “I just had a thought about X,” or use the one-word shorthand, “Thinking.” Or for more of a sense of distance and passive observation, use phrases like, “A feeling of X is present,” or, “The concern X is present.”
Write it out. Getting the thoughts out of your head and onto a document (paper or electronic) may be helpful since the words then are outside your head.
Use ridicule. Give your thoughts a silly voice. Imagine them narrated by a popular media character such as Donald Duck, Big Bird or Chewbacca, or something non-threatening like a cuddly teddy bear.
YOU’RE NOT ALONE
Statistics dating back to the 1990s suggest that anywhere from 20 percent to 35 percent of people with a primary diagnosis of bipolar disorder have comorbid obsessive-compulsive disorder (OCD). The U.S. National Comorbidity Survey of 2001-02 found rates of 0CD among people with bipolar were 10 times greater than in the general population, the Psychiatric Times reports.
And those figures may not even include individuals whose symptoms ride in with mood episodes of either kind and disperse during periods of stability, or 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 bipolar with OCD represents a specific subtype of bipolar illness.