Repetitive Intrusive Thinking Process: A Transdiagnostic Perspective Framework for Rumination, Obsession and Delusion

The transdiagnostic approach has potentials to address the problems of comorbidity of diagnostic entities and heterogeneity in psychopathology. This approach may unveil the underlying mechanisms across different diagnostic entities. It is also important to study the potential risk factors for aggravating trajectories to develop specific psychiatric conditions. By extending the current theoretical models, we propose the repetitive-intrusive-thinking process (RITP) as a transdiagnostic framework to link rumination, obsession and delusion together as a continuum. Attention-control-deficit, cognitive-inflexibility, and impaired-reality-monitoring are core features of the self-referential RITP framework, associated with hyperactivation of the default-mode-network, and dysregulation of the salience network and the fronto-parietal network. Clarifying the shared mechanisms between rumination, obsession and delusion using the transdiagnostic perspective will benefit clinical care and facilitate personalized, domain-specific assessments and interventions across symptoms in psychiatric patients.