Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: emotional dysregulation or rumination?

Emotional dysregulation

Emotional dysregulation is a transdiagnostic formulation mechanism that can amplify impulsivity, interpersonal rupture, avoidance, and risk.

AffectBehaviourInterpersonal+1

Rumination

Rumination may feel like problem-solving but often maintains low mood, shame, threat, and cognitive inflexibility.

CognitionAffectBehaviour

Definition

ADifficulty modulating the intensity, duration, expression, or behavioural consequences of emotional states.

BRepetitive, passive, negatively toned thinking about distress, causes, meanings, or consequences.

Core process

AHigh emotional sensitivity, intense arousal, limited regulation strategies, and rapid action urges interact under stress.

BAttention becomes repeatedly captured by unresolved negative meanings without moving into effective action or new learning.

Look for

ARapid affect shifts · Impulsive coping

BLong repetitive analysis · Difficulty shifting attention

Patient language

A“It goes from zero to one hundred”

B“I keep going over it”

Maintaining cycle

ATrigger -> intense emotion -> urgent behaviour -> consequences -> shame or threat -> further dysregulation

BNegative event -> repetitive analysis -> mood worsens -> more negative material becomes salient

Treatment leverage

AIncrease pause, labelling, and tolerable regulation options before action urges dominate.

BMove from repetitive analysis to values-based action or specific problem-solving.

Check before using

AMood shifts are better explained by episodic mania, delirium, intoxication, or seizure activity.

BThe person is doing concrete planning that leads to action.

Formulation language

Emotional dysregulation appears to intensify threat cues into urgent action, creating consequences that then feed further distress.

Open full guide

Formulation language

Rumination appears to keep the patient caught in repeated negative meaning-making, worsening mood and reducing behavioural movement.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: emotional dysregulation or rumination?

Emotional dysregulation

Emotional dysregulation is a transdiagnostic formulation mechanism that can amplify impulsivity, interpersonal rupture, avoidance, and risk.

AffectBehaviourInterpersonal+1

Rumination

Rumination may feel like problem-solving but often maintains low mood, shame, threat, and cognitive inflexibility.

CognitionAffectBehaviour

Definition

ADifficulty modulating the intensity, duration, expression, or behavioural consequences of emotional states.

BRepetitive, passive, negatively toned thinking about distress, causes, meanings, or consequences.

Core process

AHigh emotional sensitivity, intense arousal, limited regulation strategies, and rapid action urges interact under stress.

BAttention becomes repeatedly captured by unresolved negative meanings without moving into effective action or new learning.

Look for

ARapid affect shifts · Impulsive coping

BLong repetitive analysis · Difficulty shifting attention

Patient language

A“It goes from zero to one hundred”

B“I keep going over it”

Maintaining cycle

ATrigger -> intense emotion -> urgent behaviour -> consequences -> shame or threat -> further dysregulation

BNegative event -> repetitive analysis -> mood worsens -> more negative material becomes salient

Treatment leverage

AIncrease pause, labelling, and tolerable regulation options before action urges dominate.

BMove from repetitive analysis to values-based action or specific problem-solving.

Check before using

AMood shifts are better explained by episodic mania, delirium, intoxication, or seizure activity.

BThe person is doing concrete planning that leads to action.

Formulation language

Emotional dysregulation appears to intensify threat cues into urgent action, creating consequences that then feed further distress.

Open full guide

Formulation language

Rumination appears to keep the patient caught in repeated negative meaning-making, worsening mood and reducing behavioural movement.

Open full guide

Browse the map Use both hypotheses