Bipolar disorder patients hold contradictory self-associations

By Eleanor McDermid, Senior medwireNews Reporter

Symptomatic bipolar disorder patients have a marked discrepancy between their automatic and “thought-out” views of themselves, research suggests.

The findings are in line with the concept of “damaged self-esteem,” say lead study author Nienke Jabben (VU University Medical Center, Amsterdam, the Netherlands) and colleagues.

They found that patients with unipolar depression, and even mentally healthy people, had stronger implicit than explicit depressive self-association. But the discrepancy was significantly larger in patients with bipolar disorder.

The team suggests that implicit self-esteem could be directly targeted in bipolar disorder patients, citing examples of conditioning tasks that have helped to increase patients’ implicit self-esteem and counteract negative self-associations.

After accounting for age, gender, and education the study participants’ results on the Implicit Association Test showed a clear association with their depressive state. The strength of the automatic associations between the words “me” and “depressed” (relative to “elated”) was strongest in 32 patients with current bipolar depression, and similar to that in 270 patients with current unipolar depression.

The strength of the association was significantly weaker in 55 remitted bipolar disorder patients and 966 remitted unipolar depression patients, but was still significantly stronger than that in 387 controls.

“The persistence of depressive self-associations in euthymic [bipolar disorder] patients suggests that the underlying dysfunctional self-schemata in memory may act as a cognitive vulnerability for the development of future illness episodes,” the researchers write in Psychiatry Research.

However, they note that persistent depressive self-associations during remission could also represent a “scar” of previous episodes.

There was a similar pattern for explicit depressive self-associations, measured with a questionnaire. Explicit depressive self-associations were significantly stronger in symptomatic bipolar than unipolar depression patients, but this difference disappeared after accounting for current depressive symptoms, which were more severe in patients with bipolar than unipolar depression.

Implicit and explicit depressive self-association closely correlated in controls and patients with unipolar, but not in patients with bipolar disorder. All three groups tended to have stronger implicit than explicit depressive self-associations, but the discrepancy was significantly larger in symptomatic bipolar disorder patients than in controls and remitted patients, and tended to be larger than in symptomatic unipolar depression patients.

“This might suggest that individuals suffering from [bipolar disorder] rely less than individuals with [unipolar disorder] or healthy controls on the automatically elicited self-association when explicitly considering and rating their self-associations,” say Jabben et al.

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