Anxious-depressive attack-A clinical state with intrusive rumination

The present study aimed to examine anxious-depressive attack (ADA) regarding its characteristics and the circumstances of onset, thereby clarifying why ADA has remained underrecognized.

In this cross-sectional study, 286 psychiatric outpatients were assessed using structured clinical interviews. ADA was diagnosed according to predefined criteria, characterized by sudden and recurrent episodes beginning with intense anxious-depressive distress, followed by prolonged intrusive rumination involving negative memories or future worries and prominent negative emotions. Data on prevalence, onset, temporal patterns, phenomenology, and coping behaviors were systematically collected.

The lifetime prevalence of ADA was 21.7%, with onset typically during adolescence or early adulthood. Episodes most commonly occurred during periods of mental disengagement, particularly in the evening or at night, and typically lasted 2-3 h. Detailed intrusive thoughts were predominantly autobiographical, emotionally intense, and often related to temporally distant experiences. While most patients could recall the onset, offset, and content of their episodes, 43.5% regarded ADA as a mental state that anyone might experience and 29.0% had never disclosed their experiences. Maladaptive coping behaviors, including suicidal behavior or sexual derailment, were observed in 40.3% of cases.

ADA represents a distinctive mental state preserving consciousness and memory coexist with reduced self-reflective awareness of the pathological nature of the episode. Its ego-syntonic, covert nature, prolonged duration, and relative lack of prominent somatic symptoms may contribute to underrecognition of ADA. Recognizing ADA in clinical practice should facilitate more accurate clinical assessment suggesting an appropriate treatment strategy.