Those of us with bipolar disorder tend to get stuck in our own minds on a fairly frequent basis. Whatever is going on around you becomes hazy and out-of-focus. The focus instead has shifted to whatever you’re ruminating on at the time. A gorilla could saunter by and not even be a blip on your radar. Rumination can be a good thing, but constant, inward reflection can be incredibly stressful and counter-productive. When you get to the point of focusing only on yourself and all of the wrong things you’ve done and your negative opinions of yourself, it’s going to have a negative effect overall.
Rumination has a fairly specific definition in mental illness research. It’s not just getting lost in your thoughts, whether positive or negative. Érico de M. Silveira Jr. and Marcia Kauer-Sant’Anna define rumination as a ”process of perseverating thinking about one’s own feelings and problems, instead of thinking in terms of the specific content of one’s thoughts.” Everyone does this. Screw something up at work? Lose a family heirloom? You’re probably going to get a little obsessed over that for a while, but can refocus without a tremendous amount of difficulty relatively soon afterward. The thing with bipolar disorder is that it’s a self-perpetuating process that becomes nonvolitional. It’s incredibly difficult to control. This is not exclusive to depressive states either. It can happen in manic states and when we aren’t symptomatic at all.
Depression is often associated with a slow, brooding affect. Think Eeyore. The body slows down. Response time is lengthened. Emotion can even seem stunted. It would make sense that slowed thinking would be a part of this set of symptoms, but there hasn’t really been any conclusive evidence to that. So we’re left with negative thoughts running around in our heads while the rest of us is feeling sluggish and despondent. Also, similar to neuroticism, the these thoughts are not pulled out of left field. They’re not necessarily rational, but are generally based in some sort of truth, similar to the thoughts mentioned previously. Only, when you lose something, you keep going through the same, initial thought process of how bad the situation is instead of moving on to more productive reasoning. Depressive patients tend to engage in catastrophizing and self-blame. “Everything is horrible, and it’s all my fault.” Unsurprisingly, this kind of thought process can lead to an increase in suicidal ideation.
Rumination is not exclusive to depression in bipolar disorder. It happens in mania as well. Mania is characterized by racing thoughts and grandiosity. This doesn’t seem like it would mesh well with rumination, but it does. However, instead of concentrating on bad things that happened, with purely manic rumination, you focus on the good. It’s not grandiose when you’re not inflating what actually happened. If you accomplished something and did it well, you praise yourself. With bipolar disorder, you just keep focusing on that one thing that you did really well and forget to move on. While this might seem more positive than ruminating on the negative, there’s an increased chance of risk-taking with this thought process. You felt really good when you accomplished something, so you want to keep making sure you get that same reaction.
Hypomania does not escape rumination either. In hypomania, rumination can be used as a coping mechanism. That doesn’t mean it’s necessarily a good coping mechanism, but a coping mechanism just the same. Thoughts aren’t likely to be racing as much as in mania, so they can be more focused and organized. If this is the case, the rumination cycle may be easier to escape. If those thoughts are positive, it can even be productive and provide healthy introspection. This is typically only the case in positive affect hypomania, not dysphoric hypomania, which ends up looking a lot like neuroticism.
There are considerable overlaps between neuroticism and rumination. There’s a reason for that. Both are thought to be part of the same distinct circuitry and structure that goes along with bipolar disorder and other mood disorders. The prefrontal cortex is the part of the brain responsible for executive functions- memory, inhibition, focus, problem-solving and social cues. In mood disorders this part of the brain is atrophied, and those functions are therefore affected negatively. The amygdala is another brain structure affected by bipolar disorder. It’s responsible for emotional responses, including the fear response. With rumination in bipolar disorder, the negative stimuli (whatever is causing the negative thought) actually gets stuck in a cycle within the amygdala, so the patient is stuck with those negative emotions and has a harder time escaping them than those with more normal brain structure.
Despite this negative cycle and the general negativity associated with rumination, there are a couple of positive aspects. Again we run into neuroticism because the positive aspects of the two are pretty much the same- problem solving and creativity. This does not occur in the self-focused form of rumination. It has to be more outwardly-focused, like working on a project. The ability to continue to focus on one problem gives you more time to come up with multiple possibilities. You just have to get your brain to change its focus.
This post is partnered with a previous post: Neuroticism: An Anxious and Creative Mind
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