"Over the Shoulder" has been described as early example of electro-industrial, as well as synth-pop and synthrock. On Twitch, it is the fifth track with a length of five minutes and thirteen seconds; the single version is six minutes and fourty four seconds long. Musically, the song contains multiple layers of looped synthesizer parts along with distinctive heavy drum machine pattern and Jourgensen's weak vocal appoarch; Billboard editors compared this approach with music of Scritti Politti and Bee Gees, while Miami New Times' Jean Carey wrote that the song "sounds like a giant mosquito" In the same magazine's “Dance Trax” column, writer Brian Chin described it as "a satire." In the later review for the March 1986 issue of Spin Magazine, columnist John Leland praised Sherwood's work with Ministry's “typically banal ideas.”
The single version of "Over the Shoulder" and "Isle of Man" were included as additional tracks on compact disc edition of Twitch in 1990;:32 the song was also to be featured on a 2001 compilation album Greatest Fits, but was left off due to medium limitations.