Psychologists from The School of Psychology at The University of New South Wales, and The Department of Experimental Psychology, University of Oxford conducted a systematic review of literature based on the symptoms of rumination and PTSD. The conditions are anecdotally linked, but largely unstudied in a formal research setting.

Rumination is a continuous, penetrating thinking pattern which includes repeated, dwelling on a single thought or group of thoughts. It has been studied in the context of clinical and acute depression, but rarely examined in connection with other mental health disorders. Today rumination is known to be intricately linked with post-traumatic stress disorder (PTSD). 

PTSD is a condition created after the brain incorrectly files away new memories when the new experience is so far outside the subject’s understanding that the event is “set aside” to be processed later. Unfortunately, these fragmented thoughts and memories re-emerge at unideal times, causing mental distress, emotional outbursts, unpleasant and realistic memory provocations, and uncontrollable intrusive thoughts. 

Rumination can be a detriment to healthy living in the context of interrupting applicable and relevant thinking, inhibiting healthy sleep patterns, causing appetite disruptions, and interfering with basic life functions. Ruminating over the traumatic event may actually cause PTSD symptoms to become worse and longer lasting. This is especially true when individuals begin to blame themselves.

The connection between rumination and PTSD symptoms are confusing, because they have a vicious-cycle effect. Subjects suffer through obsessive thought patterns that may maintain their mental distress. This complicated relationship between rumination and severity of PTSD was the target of the literature review.

To conduct their review, researchers compiled 809 published journal articles including variants of the phrases, “PTSD” and “rumination.” In the end, 40 studies were included in this literature review for summarization and analysis. Researchers examined the key findings of the studies and specifically addressed six major questions.

What is the correlation in frequency between rumination and PTSD? 

Across studies, researchers found a strong connection between the occurrence of rumination and PTSD diagnoses. One study even found a reported rate of obsessive, intrusive thoughts as high as 82% in war veterans with PTSD. Subjects diagnosed with PTSD had ruminating thoughts which were characterized by an unrelenting focus on their trauma-event, depressive rumination, and rumination before bed at night. They also reported experiencing rumination which included more than verbal thoughts, such as sights, smells, and sensations. 

Another study reported that PTSD sufferers indicated that rumination was an involuntary behavior. Their intrusive thoughts were not purposely being utilized to resolve their past trauma experience. In fact, it had the unfortunate effect of exacerbating their negative memories, emotions, and feelings about themselves.

Are rumination and PTSD related?

In multiple studies, researchers found a relationship between the severity of PTSD symptoms and occurrence of rumination, indicating that these are common features for trauma patients. PTSD sufferers reported thoughts such as intrusive trauma memories, depressive rumination, self-focused rumination, rumination as an emotion regulation strategy, and the general tendency to ruminate. These studies indicate that the way the person processes these ruminations determines how useful or dangerous this behavior is for their PTSD.

Does rumination predict PTSD persistence over time? 

Authors of the review found that obsessive thoughts about a traumatic event shortly after it happened were likely to lead to the development of PTSD. Being predisposed to repetitive, obsessive thoughts is a predictor of post-traumatic stress disorder. This correlation highlights the importance of investigating rumination as a key to treating PTSD.

 Are other processes related to rumination in PTSD? 

Researchers were curious if rumination occurs along with other mental health conditions besides PTSD. After reviewing relevant studies, they found that obsessive thoughts are unsurprisingly linked with poor attention control and depression. Researchers found further indications of a correlation between rumination and poor emotional control, along with difficult memory recollection. 

 Are there shared neurobiological conditions between rumination and PTSD? 

Researchers were curious if there are similar brain mechanisms at work that cause both rumination and PTSD, or if the two processes are coincidentally linked. One study found that the orbitofrontal cortex (OFC) shows increased activity in females with PTSD who indicated that they experience rumination. This part of the brain is responsible for making decisions based on sensory input, such as inhibiting emotions, causing fear-based behaviors, and processing negative information. This heightened activity of the OFC indicates inefficient emotional control in those affected. 

 Does treating PTSD affect prevalence of rumination?

Research is lacking in examining the treatment of rumination to improve PTSD symptoms. In one study, researchers showed that studying participants after traumatic car crashes showed a decrease in PTSD symptoms after writing about the event. At the 3-month mark following the accident, rumination had decreased alongside other trauma symptoms. 

Conclusions

The results of this review pointed towards a positive correlation between post-traumatic stress disorder and rumination thinking patterns, along with other mental health conditions which are implicated in both.Much research needs to be done to better understand the common occurrences of depression, rumination, and PTSD, and the interrelatedness of all three. At this point it is unclear if rumination maintains or establishes PTSD symptoms and depression, or if the relationships are more complicated than simple cause-and-effect. 

As anyone who has suffered from PTSD, rumination, depression, obsession, and other mental health disturbances knows, the relationships between conditions is difficult to understand. PTSD can also seem to make other mental health conditions worse. . Practitioners and clients would benefit from research that untangles the connections between PTSD, depression, and intrusive thoughts.