The following information and resources have been provided courtesy of The Lurie Center for Autism, a program of Massachusetts General Hospital and Mass General for Children.

The Lurie Center for Autism is committed to advancing treatments for and knowledge about Autism Spectrum Disorder (ASD) and other developmental disorders, and translating these discoveries into exceptional clinical care. A program of Massachusetts General Hospital and Mass General for Children, The Lurie Center is a multidisciplinary treatment, research, training, and advocacy organization dedicated to supporting individuals and their families across the lifespan.

This resource is intended to provide information so that you can be better informed. It is not a substitute for medical advice and should not be used to treat any medical conditions.

Repetitive thoughts

Persistent patterns of repetitive thinking which cause significant distress or functional impairment are core symptoms of virtually every diagnostic category within the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including Autism spectrum disorder and other neurodevelopmental disorders, as well as anxiety, mood and psychotic disorders. Subtypes of repetitive thoughts include preoccupations, ruminations, obsessions, over-valued ideas and delusions.

Preoccupations

Preoccupations are pleasurable repetitive thoughts. While they are generally enjoyable for the individual, they can become problematic when they become excessive or overly time-consuming. A highly intense, enjoyable interest in a specific topic which an individual spends a lot of time thinking about is an example of a preoccupation.

Ruminations

Ruminations are similar to preoccupations in that they are also repetitive thoughts that are congruent with mood state. The key characteristic which differentiates ruminations from preoccupations is that ruminations are non-pleasurable. They are typically negative and nihilistic in content. The individual may have limited insight with regards to the irrational nature of the thoughts. A repetitive, negative thought such as “I have not done anything worthwhile in my life” is an example of a rumination.

Obsessions

The DSM-5 defines obsessions as recurrent and persistent thoughts, urges or images which the individual attempts to ignore, suppress or neutralize with some other thought or action. Obsessions are experienced as intrusive and unwanted, causing high levels of anxiety or distress. Importantly, insight about the irrational nature of the thought is usually retained. However, obsessions can also be accompanied by poor insight, where the individual thinks the thoughts are probably true, or absent insight, where the individual is completely convinced that the thoughts are true. Recurrent, intrusive thoughts of fear of harming others because of not being careful enough is an example of an obsession.

Over-valued ideas

Over-valued ideas are isolated, abnormal beliefs which are associated with strong affect and are experienced as unwanted and distressing. In contrast to obsessions, over-valued ideas are associated with fluctuating insight. The individual is generally convinced about the veracity of the thought but can often be temporarily persuaded otherwise when presented with evidence to the contrary or significant reassurance. The thought, “My nose is larger than it should be, I think” is an example of an over-valued idea.

Delusions

Delusions are fixed, false beliefs which are held with strong conviction despite compelling counterarguments. Delusions can be either pleasurable or distressing, depending on the content of the delusion. The thought “I am sure the government is spying on me” is an example of a delusion.

Revised 12/2022. Mass General for Children and Massachusetts General Hospital do not endorse any of the brands listed on this handout.