Do you ever get stuck on a particular thought, worry, or fear? It just goes around and around and around in your brain: You can’t stop thinking about it, and you can’t focus on anything else until whatever it is is resolved? That is a rumination and anecdotal evidence suggests they are common in bipolar disorder.

But why is that? Are ruminations a symptom of bipolar disorder? Are ruminations listed in the DSM-5? And if you are ruminating on something, how do you get off of it? How do you move on or at least make it through the rest of the work day? Stay tuned to find out!

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website,

Dr. Nicole Washington
Dr. Nicole Washington

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe Howard: Welcome, everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole Washington: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe Howard: I’ve been thinking, Dr. Nicole. I’ve been thinking about the podcast, and I think about the podcast a lot. And Inside Bipolar is new, so there’s a lot to think about. And I just, I keep going over, like previous recordings, things that you’ve said, things that I’ve said, things that could be better. And I just it just keeps going around and around and around and around in my mind. And I feel like there’s a name for that.

Dr. Nicole Washington: Yeah. That sounds like a rumination.

Gabe Howard: So I’m ruminating on something. Now, is that a diagnosis? Can you diagnose somebody with bipolar ruminations?

Dr. Nicole Washington: You cannot. You cannot. And before everybody gets upset with me, I fully get that you may experience that, but it is not an official thing. It’s not in the DSM. It’s not something that we would put on your diagnosis list that you see when you leave your doctor. It’s not an official diagnosis. We would consider it more of a symptom.

Gabe Howard: A lot of people with bipolar disorder report ruminations. But I mean, you see a lot of patients with bipolar disorder. Are they coming to you and saying that they’re doing this?

Dr. Nicole Washington: Not typically as a single complaint. People don’t normally come in and say everything else is going really great, but I’m having these ruminating thoughts. That’s not usually where it goes. But in the course of asking questions about how they’re doing, these things do happen. So my question usually is when are they happening? What’s your mood state when they’re happening? If they’re happening during a hypomanic or a manic phase maybe this focus is related to your mania, right? Maybe this getting stuck on the topic and not being able to let it go, maybe it’s because of that. If it’s in a what we call a euthymic phase or a normal mood phase, then maybe it’s something else.

Gabe Howard: Now you’re breaking out big words.

Dr. Nicole Washington: Big words.

Gabe Howard: Is euthymic a big word or is this like what I do where I make up words?

Dr. Nicole Washington: What we call euthymic just means a normal mood.

Gabe Howard: Wow. So doctors have special words to mean fine.

Dr. Nicole Washington: Yes, we do.

Gabe Howard: The rest of us are like, I’m fine. Doctors are like, I’m euthymic.

Dr. Nicole Washington: Euthymic. Yeah, it does sound very fancy, but it is an official way for me to put in your note that your mood is normal.

Gabe Howard: Ruminating thoughts for me is when I just get ultra-focused on something that’s already past. That’s when I find that it’s really, really damaging. And it’s not that I never get ultra-focused on things that are in the future, but if it’s happening in the future, at least that focus could be productive. It’s often not productive, but at least it has a small potential to be productive. Ruminating thoughts for me is, let’s say, Dr. Nicole, you and I get in a disagreement,

Dr. Nicole Washington: Okay.

Gabe Howard: Just a run-of-the-mill disagreement. I want this topic. You want that topic, and I send you an email and I’m like, you know, Dr. Nicole, I don’t feel comfortable. The answer is no. I’ve heard all of your thoughts, but for me, I have to set a hard boundary here. Now, that’s, you know, that’s concerning. Nobody wants to do that with a coworker, right? So now I hit send and then it’s all I think about is all of these variations of you getting that email until you answer. All I’m thinking about is should I have sent the email and how will you react? And it manifests itself in me like rereading the email. Like I’ll pull up the email on my phone. I’ll be sitting there watching a television show, a half an hour will go by and I just keep checking my email.

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: Over and over and over again. People will ask me questions and I will answer the question in some form of I sent Dr. Nicole an email telling her No, and I’m afraid that she’s going to receive it wrong.

Dr. Nicole Washington: Right.

Gabe Howard: It never stops.

Dr. Nicole Washington: Right.

Gabe Howard: It never, ever, ever stops until you answer.

Dr. Nicole Washington: Right. So you know what’s really possible? There are people not living with bipolar disorder who deal with these exact same issues. Right? These are not unique to an individual with bipolar disorder. I do think that what happens, though, is when you have an illness that is as consuming as bipolar disorder is to manage, sometimes you think that everything that goes on in your head has to do with the fact that you have bipolar disorder, which may not be the case.

Gabe Howard: I love that you brought that up because people with bipolar disorder experience a large array of emotions just like everybody else.

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: But for some reason, whenever we’re angry, it’s bipolar anger.

Dr. Nicole Washington: Mm-hmm.

Gabe Howard: Right? It’s not just anger. Now, using that bipolar anger, I do feel that there is a level of anger that is really escalated by having bipolar disorder. It just maybe it’s because of mania, maybe it’s because of grandiosity,

Dr. Nicole Washington: Right.

Gabe Howard: Maybe it’s because of psychosis.

Dr. Nicole Washington: In a manic phase, right?

Gabe Howard: Right.

Dr. Nicole Washington: Or in a hypomanic phase. But what about when you’re euthymic? Right? What about when your mood is at that place that’s normal for you? So let me just make it clear. When I say normal mood, I mean happy when something happens that would typically make me happy, angry when it’s appropriate, sad when it’s appropriate. But none of those things, the anger, the sadness, the reacting to the world around you, none of that stuff takes you down. When you’re depressed and something sad happens, it’ll take you down for days. Can’t get out of bed. You’re not eating. When your mood is normal, something sad happens, you can process it better. You can think through it better. You can work through it, sit it on the shelf, go about your day. You might pick it back up every now and then, but you’re dealing with it kind of in a normal mood kind of way. So when your mood is normal for you, whatever that looks like for you, you can get angry and yell at somebody in traffic and give them a fancy hand signal and whatever it is. But to me, that doesn’t necessarily mean that’s part of your bipolar illness. You’re still a person, you still have personality. You still have a temperament about you that is unique to you. I don’t always think those things are related to your bipolar disorder.

Gabe Howard: I do think there’s this tendency to blame everything on bipolar disorder, but everybody ruminates. My wife, who has no mental illness whatsoever, she’s a supervisor, and she recently had to fire somebody. And of course, she got approval from human resources and knew that this was coming on Tuesday. But they fire people on Fridays, Friday afternoon, to be exact. So from Tuesday to Friday, this occupied her mind a lot. She’s a nice person. She doesn’t want to have to do this. It’s difficult to look somebody in the eyes and say, I’m sorry you no longer work here. Here’s your last paycheck, here’s your stuff. So there’s just all of this going through her mind and she’s playing over and over and over again what’s going to happen on Friday? Again, no mental illness whatsoever. But I got to say, I think if it was me, I would have handled it worse. She was still productive at work, right? She still got like the rest of her job done. I would have just sat on the couch for three and a half days.

Dr. Nicole Washington: Some people have more than one disorder, right? Like you can have bipolar disorder and you can have an anxiety disorder. You can have both. And if you’re somebody who has an anxiety disorder in your normal mood state, where you tend to worry about things or overthink things to the point that you’re overthinking that email, going back to the email. And you can’t let it go like you’re thinking about, Should I have said this? Oh, I probably shouldn’t have put that sentence in there. Maybe I should have said it this way. Is she upset? Let me see if she’s responded yet. Like, if you can’t let that go and it’s on a loop, it’s like watching the same YouTube video on repeat in your brain. Then that may be a different issue. Who knows? Who knows?

Gabe Howard: I really like that. You pointed out that it might be a different issue. I think that often people living with bipolar disorder, especially myself. Any time it comes to mood, personality, anything with my brain or mental health, I just assume bipolar disorder has to be the primary culprit. And that’s dangerous.

Dr. Nicole Washington: It is dangerous.

Gabe Howard: If I assume that everything is the fault of bipolar disorder, I’m never going to improve as a human.

Dr. Nicole Washington: Right.

Gabe Howard: Let’s go back to my wife having to terminate an employee. Right. There’s an art to it. There’s training, there’s learning. Right. It was the first time that she ever had to do it. She’s a new supervisor. Fast forward five years. She’s got it down.

Dr. Nicole Washington: Right.

Gabe Howard: She’s not as worried. But what if she decided that the reason that she was bad at or ruminated on terminating somebody was because she was a woman? And women have a hard time firing people because they’re just so kind. And this is a true thing, by the way. Somebody said this to her, well, you know, women, they don’t like to fire people. And she’s like, what do you? What does this have to do with my genitals? I don’t, I don’t understand.

Dr. Nicole Washington: Not a doggone thing, but go ahead.

Gabe Howard: Exactly. But if she would have believed them, this would have prevented her from gaining the experience and getting better. So you replace Oh well you’re just struggling with this because you’re a woman with Oh yeah, you have ruminations because you’re bipolar. I think you end up in the same place.

Dr. Nicole Washington: And you’re doing to yourself what you get mad at other people for doing, right? So whenever you get upset, you get mad and your loved one says, Did you take your meds? Are you manic? Are you okay? And you get ticked off every time they assume all of your behaviors that aren’t Kumbaya as your bipolar disorder. You just did the same thing.

Gabe Howard: Dr. Nicole with the real talk. Oh, I just. But this is the resting point for many of us. We would never tolerate anybody treating our friends the way that we treat ourselves.

Dr. Nicole Washington: Oh, absolutely.

Gabe Howard: Bringing this back to the ruminations question, though, we didn’t just make this up. You and I didn’t sit around and say, Hey, let’s pretend that ruminations and bipolar disorder go hand in hand. This is a search term on Psych Central. I sit in many a support group and people are like, I just can’t get it out of my head. I just ruminate over and over again. I believe you indicated that people even talk to you about it in your practice. So on one hand, I want to be like, Hey, ruminations is just part of the human experience, but I do feel like there’s something more when it comes to ruminations for people with bipolar disorder. And you indicated that it might have to do with hypomania or mania.

Dr. Nicole Washington: Well, it depends on what you’re ruminating about, right? When you think about mania and one of the key kind of symptoms of that mood episode being an increase in activity, an increase in goal-directed activity, the racing thoughts. A lot of times those racing thoughts are surrounding whatever it is that you’re wanting to do. So if you decide that during your manic episode that you all of a sudden want to start a business and you want a particular type of business, you will constantly think about that type of business and your research, and you’ll think about all the ways you can run that business and competition and where could you get a location and getting the loan and paperwork and your thoughts could be consumed with everything related to that business, which could feel like ruminating. Definitely talk to your psychiatrist or whoever it is that’s managing your medication. Definitely let them know that you’re experiencing that because they’ll then ask you questions to make sure is this just ruminating on a one thing or is this related to mania or hypomania? Because let’s face it, you are not always the best at knowing when you’re hitting a mood episode. And I can’t tell you how many people I’ve seen who were misdiagnosed because they said, Oh, I have these moments where my anxiety is just really high, like I’m so anxious. And what we find out later is that was a hypomanic episode or that was a mild manic episode. That wasn’t they were anxious. They just didn’t have the right words to use. And to them, subjectively, it just felt like anxiety.

Gabe Howard: I’m wondering, though, what’s the difference between rumination and obsession? Obsession in bipolar disorder is more clear. People become obsessed with these things and it’s dangerous. And one of the things in bipolar disorder that people become obsessed with is suicidality. They become obsessed with this idea that they don’t need to be here anymore, that that’s like a, I don’t know, ruminations on steroids. And I’m, I’m using such incredibly lay terms. Can you medical this up for me?

Dr. Nicole Washington: Yeah. These are terms that, of course, patients are going to use them interchangeably at times. It’s a rumination. It’s an obsession. It’s. And we are typically when we’re thinking about, oh, my gosh, what is this? We are really, really trying to conceptualize it in our brain to figure out where is this coming from? Is it part of this disorder or that disorder? Because we just want to make sure that treatment is right. And I will tell you, this may be an area where it’s not always crystal clear when you first bring it up. This is going to be one of those times when you get mad at me because I might say, oh, I’m not really sure exactly what this is coming from. Let’s make sure your mood is really stable first. Let’s make sure that we aren’t misinterpreting some hypomanic symptoms as, you know, a rumination that we might consider with an anxiety disorder or an obsession. We may want to make sure that your mood is really stable and you get mad at me, like, not you personally, but, you know.

Gabe Howard: Now you’re blaming me. All of your patients are Gabe’s fault.

Dr. Nicole Washington: You get mad at me, right? Because you say I came to you because I’m anxious or I’m having these ruminating thoughts. Why are you worried about my mood? My mood is fine. Sometimes we just want to make sure your mood is great before we start mucking around with other stuff. At the end of the day, I don’t know that it matters as much that we agree on what we’re going to call it, as long as we both have a good idea of what the symptoms are and we can monitor them and we can have open conversation about them, but be open to the fact that I might not respond in the way that you think I should respond in the beginning.

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Gabe Howard: And we’re back discussing ruminations with bipolar disorder. Doing research for this show, Dr. Nicole, everybody agreed that it’s a common symptom, but a rarely discussed symptom, and they also describe it. It’s in the abstract. Like nobody can really decide exactly what it is, but people who experience it are positive that it’s exist. They’re really, really worried about it and they want help.

Dr. Nicole Washington: Yes.

Gabe Howard: And I understand whether it’s ruminations, obsessions, if you get ultra-focused on a single idea, it impacts your life,

Dr. Nicole Washington: Yeah.

Gabe Howard: Right? You’re not present in the moment because you’re thinking about some other thing that happened and you just ruminate and ruminate. So we’ve spoken about this in mania, but ruminations also occur in depression and

Dr. Nicole Washington: Yeah.

Gabe Howard: A lot of depressive thoughts aren’t starting a business, aren’t running a 20K. I’ve decided it’s a 20K. Right? When you’re ruminating about suicidality, when you become obsessed with death, when you ruminate about this idea about whether or not you should be alive, they’re dangerous to yourself.

Dr. Nicole Washington: Yeah.

Gabe Howard: What do you do when you as a provider, as a professional, realize that somebody is just ruminating about something that is dangerous to themselves or others?

Dr. Nicole Washington: I mean, again, it’s all about what phase is your mood in? It’s all about what are your meds looking like? I mean, the important thing is that you tell us, regardless of whether you feel like we have the right answer or you don’t want to tell us because you’re embarrassed, because sometimes the thoughts that people have that they obsess over or they ruminate over, sometimes they’re embarrassing. Just knowing that we have heard it all and knowing that you are not going to say anything that is going to surprise me or shock me, but bringing it up because I can’t do anything about it if you never tell me that you’re experiencing it. And there are things that we can do with medication to help with those thoughts, even if they are the depressive ruminating thoughts.

Gabe Howard: What are some coping skills that people can use to manage ruminations?

Dr. Nicole Washington: Beyond talking to whoever is prescribing your medication, there are things that you can do, because they can get quite uncomfortable. You don’t want to have these thoughts. Some of the biggest recommendations that people have out there are distraction, things like how can you distract yourself from these things? What does that look like for you? Is that calling somebody? Is that exercising? Is that dancing? Is that adult coloring book? What does that look like for you? What’s that thing that’s going to distract you from your thoughts and literally get you out of your head for a second? And then some people honestly, I have some people who they kind of give themselves a little bit of room for those obsessions or ruminations. So back to your email example, they set very firm boundaries with that level of worry that they’re going to allow themselves to engage in. They may say, okay, I’m going to check this email once an hour and that’s it, or once every other hour until I get a response, and that’s it. So they allow themselves the room to check it a little bit, but then they don’t allow themselves to continue to check it. So they set parameters and that for them kind of gives them a little bit of comfort to do that. And then I always think your circle is important. I really do. Like beyond your therapist, the people around you, that when things like that are going on, that you have people in your life that you can say, Oh my God, I’m so stressed. I sent Dr. Nicole this email and she hasn’t responded. I think probably she’s going to quit the podcast and she’s like, sending Healthline her resignation right now. You need somebody who’s going to say, Gabe, seriously, it’s an email, chill out. Like you need somebody to kind of reality test against, see if you’re along the right path or if you’re veering off the rails.

Gabe Howard: I could not agree more that having a strong support system is helpful in managing ruminations, because I cannot agree more that having a strong support system is helpful in managing bipolar disorder and well, frankly, just managing life. Several of the techniques that I use and I do have a few, is one, I try not to send emails like that. It’s just too much. Going back to our example, that would just be a bad email to say, I would send you a message. I’d be like, Hey, let’s hop on a Zoom call. Let’s just hash this out.

Dr. Nicole Washington: Right? Yeah. Because there’s no context with emails. Right.

Gabe Howard: Right. Sometimes you do have to send the email and I understand that you don’t have the opportunity to jump on the call. And that’s where, of course, this system breaks down, but

Dr. Nicole Washington: Yes.

Gabe Howard: Whenever possible, whenever a conflict breaks out or something that I feel might be. I don’t know, when I get that feeling in the pit of my stomach, texts and email is not the way to handle that,

Dr. Nicole Washington: Yeah.

Gabe Howard: Just handling it in person because it’s over when it’s over. Right.

Dr. Nicole Washington: Yeah.

Gabe Howard: And I know that’s hard. That brings up all kinds of other things that people with bipolar disorder contend with, confrontation, maybe you’re depressed and you don’t want to leave the house. You haven’t showered in three days. Who knows?

Dr. Nicole Washington: Yeah.

Gabe Howard: We get so many emails that are like, Well, I can’t Zoom. That’s why email is better. I completely understand. But if possible, try. Because it’ll save you that time.

Dr. Nicole Washington: Agreed.

Gabe Howard: The next thing I want to say is just be aware of catastrophizing, which I think is a real word. I got a real word, right? Catastrophizing?

Dr. Nicole Washington: You did. You did.

Gabe Howard: Yay.

Dr. Nicole Washington: Yeah. It’s a real word.

Gabe Howard: Listen, it’s okay to think about the worst-case scenario. We’re human. The worst-case scenario is Dr. Nicole could quit. So one, think about that and then think about, hey, a plan moving forward. I consider that to be prepared. Okay, if Dr. Nicole quits over this, what is my plan moving forward? Can I host the show alone? Who could be a backup person that I could talk about. That is acceptable, but I would also say maybe think of a few other outcomes. The worst-case scenario is that Dr. Nicole quits. All right, so you’ve done that. Why don’t we go with the best-case scenario where Dr. is like, Cool, I didn’t care. You know, we were in a brainstorming session and this didn’t mean that much to me. I don’t, you sound really worried for no reason or where Dr. Nicole says, Hey, I understand, but you realize the next time you want to do a topic and I don’t I’m not going to compromise with you because you didn’t compromise with me. Okay.

Dr. Nicole Washington: It is on.

Gabe Howard: Right, right. So that’s fair. Think about that just to balance it out. Dr. Nicole, I love your distraction idea. You used exercise, though, and work. I’m going to say try some fun. Get distracted by going to a concert. Go to a movie.

Dr. Nicole Washington: You can’t just, just impulsively decide to go to a concert.

Gabe Howard: You don’t know. Send the email right before the concert and then while I’m at the concert you will reply. I’m really glad that I stumbled upon this because I did this once where I sent the email right before I left for a concert. Right,

Dr. Nicole Washington: Okay.

Gabe Howard: Because, you know, it was like near the end of the day. I sent the email and I went to the concert and you can ask my wife. She is still to this day furious. I spent the entire concert checking my phone, waiting for the response.

Dr. Nicole Washington: You did not.

Gabe Howard: I did. I absolutely did. I just ruminated over and over and the person never responded until the next morning. I ruined date night. I ruined a

Dr. Nicole Washington: Yeah.

Gabe Howard: Concert tickets that cost hundreds of dollars. It was a complete waste of time. What I learned and I will pass this on to all of you, is I should have sent that email in the morning. If I had to send an email, I should have waited until the morning to send that email because then I wouldn’t have been worried about what Dr. Nicole was thinking.

Dr. Nicole Washington: Is that true or would you just have had all day to ruminate about whether I sent it to you and it just wouldn’t have ruined date night?

Gabe Howard: Obviously, it’s tough and you’ve got to decide that. The thing that triggers it for me, it was giving you the bad news. Knowing that I’m giving you the bad news wasn’t wasn’t as big of a deal. I think, Dr. Nicole, many of us get in these rumination situations because we move too fast. An email comes in and we have to answer quickly, like I have to answer you within 5 minutes of receiving that email. I think it’s okay to just say, you know what, I’m not sure what I’m going to do here. I’m pretty sure I’m going to tell her no. I’m pretty sure I’m going to set a hard boundary. But why don’t I wait till tomorrow? Why don’t I hang out with my wife? Why don’t I go to the concert? Especially when you’ve got, like, an event coming up, right?

Dr. Nicole Washington: Yeah.

Gabe Howard: Why

Dr. Nicole Washington: Yeah,

Gabe Howard: Don’t

Dr. Nicole Washington: Yeah.

Gabe Howard: I just go to the event and live in the moment for that

Dr. Nicole Washington: Mm

Gabe Howard: And

Dr. Nicole Washington: Hmm.

Gabe Howard: Then pick this up tomorrow, and then that way you’ve got some time. I think that’s just good advice. Forget about ruminations for a moment. I think that’s just good advice, period.

Dr. Nicole Washington: Yeah.

Gabe Howard: But you are right, there is the possibility that I would just ruminate over and over and over again about sending you the email.

Dr. Nicole Washington: Yeah. All day long about it. I do believe,

Gabe Howard: Yeah.

Dr. Nicole Washington: Too, though, when a person, whether it’s anxious about something or can’t stop thinking about that one thing or that one conversation having a set of questions. Sometimes I work with people on developing their set of questions. One is, how urgent is this and how important is it? Right? It may be important, but if it’s not urgent, can it wait another day? Do I have to respond now? Do I have to deal with this at this moment? Where do you want to prioritize it? Right. So giving it a priority stamp, is it urgent, is it important? Is it neither of those things? Sometimes we ruminate about things that aren’t urgent or important neither. They’re just things. Realistically, if I go to bed tonight and don’t have this answer, is my life going to change one way or the other? Once you have your set of questions, because a lot of times it’s the same questions that you can put to any situation and then it can help you kind of. Okay, you’re right. I don’t have to deal with this today. This is for another day. I can deal with this tomorrow. I can follow up tomorrow. I can do whatever I need to do. But that’s not more important than date night. So I want to set it aside. And your wife is a saint, by the way.

Gabe Howard: My wife is a saint. There is absolutely no doubt in my mind that my wife is a saint. But listen, I’m a saint, too. Do you know how much I tolerate from this woman?

Dr. Nicole Washington: No.

Gabe Howard: Literally.

Dr. Nicole Washington: No, I don’t. I don’t.

Gabe Howard: I’m telling you, I do all the cooking. I do all the cleaning, I manage the entire house. My wife is the most spoiled wife in the history of wives. Except for the part where she’s married to me like that, that part is hard.

Dr. Nicole Washington: Have you been talking to my husband? Because I feel like. I feel like he would say the exact same things and has said the exact same things about me on multiple occasions. So there you go.

Gabe Howard: Dr. Nicole I always enjoy hanging out with you. It’s interesting that many of the things that that really impact people with bipolar disorder aren’t talked about. I mean, mania and depression gets talked about all the time. But ruminations is one of these things that I really hear a lot of, and I’m just not seeing a lot of people actually admitting that it’s a real thing. And this is my final medical question for you. Is bipolar rumination a real thing? I understand it’s not in the DSM five, but with a yes or no answer. Is it real or is it something that just exists in the heads of people with bipolar disorder?

Dr. Nicole Washington: I think we still don’t know where we fall on that on that answer. I mean, if you have bipolar disorder and you find that you ruminate. I still don’t know that I can call it officially a bipolar rumination or something that’s unique to bipolar disorder. So I’m going to say no, bring on the negative emails. Bring it. I got it. I’m ready for you. But I’m going to have to land on the no side.

Gabe Howard: That’s interesting. I just want to make sure to to clarify, you’re not saying that ruminations don’t hurt. People are impactful.

Dr. Nicole Washington: Yeah.

Gabe Howard: You’re just saying that attaching it to bipolar disorder is nonsense. We should just be discussing ruminations.

Dr. Nicole Washington: Gabe, I did not say nonsense. I said.

Gabe Howard: I feel feel like you said nonsense.

Dr. Nicole Washington: I didn’t, I said.

Gabe Howard: I feel like you said fake.

Dr. Nicole Washington: I didn’t say nonsense.

Gabe Howard: Like you said fake. I feel like you said fakery.

Dr. Nicole Washington: I said if your mood is in a normal state and you’re having these ruminations, it doesn’t necessarily mean that it’s related to your bipolar illness. That’s all I said. Quit putting words in my mouth.

Gabe Howard: I apologize. I apologize. Let me ask you the question differently.

Dr. Nicole Washington: Okay.

Gabe Howard: Are ruminations real and can they be impactful to someone?

Dr. Nicole Washington: Absolutely. Absolutely.

Gabe Howard: So it’s just the bipolar rumination part that is sketchy.

Dr. Nicole Washington: I just really struggle with saying that it’s always related to the bipolar illness. Yes. I don’t know if sketchy is the word that I would use, but we’ll roll with it for now.

Gabe Howard: Hey, I use the word sketchy. You didn’t. Dr. Cole, I appreciate you being honest about it. Right. Because if you Google bipolar rumination, there’s hundreds of thousands of articles on it. So the Internet has decided it’s a real thing. But but I hope that everybody hears that if you are having ruminations, if you are obsessing on a thought, if you are ultra focused on something and you can’t get out of it, if your life is impacted, the name of it is irrelevant. Seek help. Talk to a friend, an online support group, an in-person support group, a therapist. Talk to your doctor. Nobody is saying that it’s not real. We seem to just be having a semantics argument.

Dr. Nicole Washington: All the time. If I could get us to just focus on the symptoms and try to treat those and what we’re dealing with and less about, it has to be this diagnosis or I have this thing like let’s let’s just sometimes take a step back and figure out what’s uncomfortable and approach it that way. I agree with that. I hate having these name game battles with people because they want me to put something in their chart that doesn’t exist.

Gabe Howard: I completely agree. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also a public speaker who travels nationally. You can get my book on Amazon, but of course you can head over to my website and get a signed copy with free swag. That website is

Dr. Nicole Washington: In. My name is Dr. Nicole Washington, and you can find me on all social media platforms @DrNicolePsych to see all the things I have my hand in at any given moment.

Gabe Howard: And hey, can you do us a favor? Wherever you downloaded this episode, please subscribe or follow. It is absolutely free and we need another favor. Share the show. Sharing the show is how we grow. Tell everybody you know. We will see you next Monday on Inside Bipolar.

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