In OCD, ruminations are ego-dystonic. The patient perceives them to be as abnormal and puzzling. Eg they know that contamination from the handshake five minutes ago is unlikely to harm them, yet they keep thinking about it and undo it by repetitive hand-washing. The depressed person has mood-congruent ruminations and does not perceives them as abnormal. eg that humiliating moment five years ago really did ruin my life.

Yes generally speaking in severe depression and mild to moderately severe OCD. A good proportion of depressed patients with self downing thoughts, ruminating or not, may still have some insight as to the abnormality of their experience while severe OCD patients may lose that "awareness of irrationality" of their recurrent thoughts. This distinction may significant implication in the treatment of these cases.

This remains a tantalizing question given that we are still struggling to find a fully satisfactory model of aetiology for both disorders and the overlap, despite the above phenomenological comments by colleagues, is large. The frontothalamicstriatal looping occurs in both in the neuroimaging: both disorders in other words have problems with suppression/resolution of looping circuits of cognitive and emotional information. To me, in work with complex trauma patients, where comorbidity is high, the distinctions blur.

However from a treatment point of view, the ruminations of OCD and the Cluster C spectrum seem to be connected to a difficulty with self-other boundary ( including problems with agency and the ownership of thought) and psychotherapeutic interventions that foster a better-boundaried self seem to help these symptoms. The automatic negative cognitions that appear to underly the self-judging ruminations of depression appear to therapeutically respond to address the underlying attachment template through processing what Russell Meares calls the "attacks upon value" in the individual's past experience, with work on the underlying fear and shame.

For both disorders where trauma and unresolved loss are proving to be important aetiological factors in many presentations, the common link to the dissociative processes in a disorganized attachment state of mind, may ultimately help explain the overlap and fluidity and sharpen the neuroimaging and aetiological research and our understanding of the phenomenology.

Long-winded answer but such an interesting and actually complex question!

I have a Masters student just completing a terrific account of treating the obsessional spectrum with the Conversational Model of Psychodynamic Psychotherapy. Please feel free to stay in touch re this as it will be submitted shortly.

IMHO Automatism into OCD is more severe and most times do not refer or have relationship with real facts of the individual.One is dissociation and the other is an attempt to gather facts under a worthlessness situation.

Really interesting question. You could add also anxious ruminations in anxiety disorders such as for instance Generalized Anxiety Disorder to the spectrum.

To my opinion, research on such traits or behaviors over more than one disorder is a neglected field.

I think two points are relevant to this topic. Firstly, the issue of whether the cognitive activity in question is ego-dystonic or ego-syntonic. Secondly, attempting to differentiate between rumination, ‘obsessional rumination’ in OCD and worry in GAD: not so always easy in practice. Classically, obsessions in OCD are described as ego-dystonic. But what about ‘obsessional rumination’? In my clinical experience, often times what might be called obsessional rumination is in fact a compulsion, since its objective is to remove or reduce the anxiety raised by the obsession. In so far as the individual perceives this mental activity to achieve this objective, it will have at least some ego-syntonic component. For example, an individual with an obsession around checking experiences a sudden doubt as to whether they locked their front door on leaving home that morning. Unfortunately, they are now at work and more than one hour’s travel from home, so it is not feasible to check. What they may do instead, is to engage in some type of rumination designed to provide reassurance or decrease anxiety. For example, thinking over and over about what might happen, or trying to convince themselves that they actually did lock the door. This ‘problem solving’ style of rumination is also seen in GAD. I agree with other authors about rumination in depression often having a negative focus, and it may even have a degree of perceived uncontrollability about it. However, there may also be times where it too has a ‘problem-solving’ aim. If we have a treatment focus, perhaps we should not worry too much about trying to classify the mental activity in question into one of these categories, but put some effort into trying to describe attributes of that activity for that individual: what is it trying to achieve? How is it reinforced? How does the individual understand it? Where does it fit in our (the therapist and patient in collaboration) holistic model of the individual’s problems?

There is an overlap in content (past/future, harm, neg. self-evaluation, symptoms), antecedents/consequencies, function and mediating factors (cognitive control, inhibition) of repetitive and maladaptive negative thoughts in depression and ocd. Depressive mood is an antecedent as well as a consequence of rumination in depression, while anxiety/discomfort has that function in ocd. It is important to distinguish the content and function of ruminations from those of obsessions. With respect to the content of rumination in both disorders I would suggest to pay attention to verbalizations as well as visualizations.

I would take care distinguishing rumination from one and the other states of mind due to main objectives the subject is dealing with; I would not call rumination what happens into depression- in terms of aim. Depressive mood as both, antecedent and consequence?

Depressive mood is one of the facilitators of repetitive negative thoughts that are maladaptive (i.e. rumination) in people with depression, next rumination is a contributor to depression mood (consequence). There is indeed some circularity involved.

Is there a cognitive or functional difference ? It is not only about rumination, but about differences in terms of cognition and functionality. It means: due to depressive mood "negative" thoughts are brought. Depression as facilitator and consequence of itself?

We must establish that rumination is not a repetition of negative thoughts similar to those that may occur or not into depression, due to anxiety that all humans may have sometimes. Obsessional thoughts into OCD may be even not depressive, what , as cognitive and functional approaches put some questions!

It is sometimes difficult to differentiate between depressive ruminations and obsessions. The distinction rests primarily on thought content and the patient’s reported resistance to such thoughts. Unlike obsessions, ruminations are typically pessimistic ideas about the self or the world, and ruminative content frequently shifts. Additionally, depressive ruminators tend to not make repeated attempts to suppress their ruminations the way individuals with OCD try to suppress obsessions. When depression and

OCD co-occur, both phenomena may be present, but only obsessions should be targeted with exposure exercises. I have also found clinically that the generally pessimistic presentation of depressed patients can undermine hopefulness about improvement during EX/ RP; thus, these beliefs may require therapeutic intervention even though they are not obsessional.

Great topic, and many great responses.

I think part of the difficulty here is that we are talking about at least two different phenomena. Rather than debating which diagnosis explains rumination or vice versa, consider instead that rumination is a phenotypic trait independent of diagnosis.

I have worked with many people with OCD and depression who do not have a ruminative trait. One could certainly argue that the compulsive behavior is driven by automatic ruminative thoughts. However, several of the people I've worked with are quite relieved by the compulsive behavior and do not show ruminative behavior in other contexts as well. Many depressed people I work with claim an absence of thought. Indeed, poverty of thought and thought blocking are considered symptoms of severe depression.

Rumination seems a requirement in GAD, paranoia, paranoid schizophrenia, and possibly PTSD. The trait rumination is also an indicator of dangerousness for suicidal and homicidal behavior.

I suspect that trait rumination might be a target for medication. Many people who are depressed and ruminative as well as those who are obsessive in OCD do not receive sufficient symptomatic relief from anti-depressants. Thats not surprising since anti-depressants were not intended to target trait rumination, but depressed mood.

In my experience, people who struggle with rumination in one diagnostic category are at risk for manifestations of the trait in other diagnoses and situations. In my clinical experience, the trait rumination seems related to manifestations of anxiety and depression seen together and increase the risk of dangerousness.

Perfect approach; all data are similar to those I have distinguished during my clinical observations and the remarks are very important, mainly those that refer to rumination as a phenotycpic trait independent of diagnosis and also about the indicator of its dangerousness as suicidal and homicidal behavior important sign of . Congratulations, I have not saw a so very clear statement into RG!

in my clinical experience, The rumination of depressed patients is a sort of "dwelling " on some thought. Thoughts content is mostly obsessive, guilt-ridden, negative, self pity, whereas OCD thoughts are anxious in nature and the outcome is often depression.

I agree with the ego dystonic (OCD)/ ego syntonic (depression) brought by Lisa as being the major and most central distinction. The OCD patient ruminates about situations that are not related to him/her and would often not recognize himself/herself in his ruminations ("it is not me to..."); the depressed patient ruminates about past failures, with him being the central focus of his self-depreciations, feelings of helplessness, etc.

Julian is right, OCD ruminations are primary and ego-dystonic and when tried to control produce anxiety, depression or both. While depressive ruminations are mood congruent and the ruminations are secondary to primary depression evoking stressor (s)

What about rumination in OCPD? How is it different to rumination in OCD?