From a neurobiological point of view, there is little
information in the literature on rumination in BD patients;
the findings published thus far cover different mental
disorders, particularly depression. In patients with BD, the
main areas showing functional abnormalities are those
responsible for controlling emotion and executive functions,
namely, areas of the prefrontal cortex (medial,
dorsolateral, anterior cingulate, and orbital regions) and
amygdala.25 All these areas have shown abnormalities in
studies investigating associations between rumination
and neuroimaging findings4,30 in other disorders, in line
with the hypothesis that executive dysfunction may
underlie the tendency to ruminate in patients with
BD.13,16 Moreover, several studies have confirmed that
rumination has negative impacts on cognitive function
in mood disorders, particularly on autobiographical
memories, inhibition, cognitive flexibility, problem solving,
working memory, and attentional bias towards negative