thicc np

[thicc np @nuggetspawn]

Lindsay Clancy after having constant access to psychiatrists/therapists/other resources and then killing her kids

[thicc np @nuggetspawn]

@bade1hp Your mom wants a community college?

[thomas @nnepenthes]

she really chopped it up with everyone

[thicc np @nuggetspawn]

@j_mee949 Mental breakdown so had to take a break from socials. But I’m back lmao and stronger girl!!!

[Snoopy @snoopyb047]

Dolly parton 💔🤲

[fūnké @funkefly]

i try to do this with my cat once a day

[Kaleb @DDSKaleb2]

Just clocked in to work

[micheal @godsb0y]

attitude was so bad at work today that i thought they might fire me on the spot

[ponyboy @ponyboooooy]

gays in their 30s hating on addison rae:

[MULCH LOVER @SUVIzt4y]

My birthday is no longer a source of joy or excitement 😀

[Dr Sanil Rege FRANZCP | MRCPsych @sanilrege]

Coin flips work when the problem is indecision. They are less likely to work when the problem is Rumination.🚨
The Phenomenology of Thoughts ��

A 50/50 decision can often be solved by action.
Choose the restaurant.
Send the email.
Pick the option.
Move on …

But rumination is a distinct entity. 🚨

“Rumination may generally be construed as a process of repetitive thoughts.”

“Rumination was described as “fixed ideas” (French: idees fixes) and the “compulsion to repeat” (German: Wiederholungszwang)”

That older language matters because it captures something we still see clinically.

The thought does not simply appear.
It returns.
It intrudes.
It repeats.
It perseverates.

So the construct has at least two clinically relevant components:

1. Intrusion and repetition : the thought keeps forcing itself back into awareness because it has high salience.

2. Perseveration: the person struggles to shift set, disengage, or move flexibly to another mental frame.

That is why rumination is not the same as ordinary worry or indecision.

Worry is often future-oriented:
“What if this happens?”

Indecision is often choice-oriented:
“Which option should I pick?”

Rumination is often self-referential and affect-laden:

“What does this say about me?”
“What have I done?”
“Why do I feel like this?”
“How damaged am I?”

And in depression, especially melancholic depression, this can take very specific forms:

1. obsessional guilt
2. financial ruin
3. nihilistic 
4. somatic

This is where phenomenology becomes crucial .

In clinical practice a significant proportion of resistant anxiety / OCD / somatisation is rumination misclassified
- also leading to missing melancholic depression

Hence the definition :

“Rumination, a phenomenon that is subserved (i.e., a result of) by brain processes relevant to cognition, is characterized as a cognitive-emotional process whereby individuals repetitively and passively engage in excessive malicious self-referencing and focus on the negative feelings, reasons, consequences and symptoms of their distress instead of engaging in proactive problem-solving (Tang et al., 2021).”

That is the key point.

This is not simply a patient refusing to decide.

It is an all consuming ( almost ) thought (s) .

The psychic equivalent of a repetitive movement.

And if someone has a repetitive motor phenomenon, we do not say:

“Here are two options. Pick one.”

Because the issue is not choice.

The issue is the system being unable to disengage from the loop.

Neurobiologically it is a ‘loss’ of top down control with heightened salience .

That is also why rumination is clinically serious.🚨

It is associated with depressive severity, hopelessness, impaired problem-solving and suicidality.
It’s also transdiagnostic

The question for clinicians in treating ruminations is

“What has made this thought so salient that the mind cannot leave it alone”

*image of thought hierarchy ( conceptual as thought quality may overlap ; obsessions may move to ruminations and have a ruminative quality ( obsessional guilt )

[Tyler Black, MD @tylerblack32]

I have been told that there are many NPs and GPs who are forced to prescribe antipsychotics because there aren't enough psychiatrists.

I hear that, and my opinion would not change if we were talking about surgeries or reading MRIs.

if you must, do ALL:
https://t.co/rmABUruIcV

[ana @anaisaddicted]

me after binging

[dior ✞ @deeore5]

"listen to your body"

my body: go get a cinnamon roll the size of a tire

[‏ً @BALUCIAGA]

you didn’t just make me cum—you made me arrive—and honestly? that’s growth. 🌱

[𝒵𝒾𝓀✯ @_Gottalovezik]

me at any social event observing instead of interacting with people

[Meg @heirmeg]

did ya see that tiktok of the girl tryna take a pic cus she got rear ended n the bitch that hit her start folding up the license plate LMAAOOOOOO