Emotion regulation deficits characterize bipolar and MDD patients

By Lucy Piper, Senior medwireNews Reporter

Patients with bipolar disorder and major depressive disorder (MDD) have increased use of maladaptive and decreased use of adaptive emotion regulation (ER) strategies, researchers report.

Moreover, this pattern was evident even during times of remission, which the researchers say may make it a likely “risk factor for the development of further affective episodes.”

The team, led by Larissa Wolkenstein (University of Tübingen, Germany), used the Cognitive Emotion Regulation Questionnaire (CERQ) to assess ER in 42 euthymic patients with bipolar disorder, 43 with a history of MDD, and 39 mentally healthy individuals.

Bipolar disorder and MDD patients were more likely than mentally healthy individuals to report significantly increased use of rumination, catastrophizing, and self-blame in response to negative events.

The average CERQ scores for rumination were 11.36 for bipolar disorder patients and 12.16 for MDD patients versus 7.21 for controls, while the corresponding scores for catastrophizing were 8.14 and 7.63 versus 5.24, and for self-blame were 10.81 and 10.93 versus 7.53.

The bipolar disorder and MDD patients were also significantly less likely than controls to use positive reappraisal (11.36 and 11.77 versus 13.74, respectively) and put things into perspective (10.36 and 11.14 versus 14.42).

The researchers note in the Journal of Affective Disorders that patients with bipolar disorder and MDD did not differ significantly in their habitual use of ER strategies.

“[T]his is the first study to demonstrate that neither increased use of rumination and catastrophizing nor decreased use of putting into perspective are specific to [bipolar disorder] or MDD, but rather seem to reflect a general marker of vulnerability to affective disorders,” they add.

Correlation analyses also showed that in patients with bipolar disorder, depressive residual symptoms were positively associated with blaming others and negatively associated with acceptance, whereas residual manic symptoms were positively associated with self-blame.

Wolkenstein and co-workers say their results demonstrate “that it is vital to examine which ER strategies [bipolar disorder] patients use while in a stable euthymic mood state as compared to their strategy selection in view of first affective symptoms of either polarity.”

The researchers call for further studies to clarify which processes underlie the observed deficits in ER and for the development of appropriate interventions.

They add: “Furthermore, we need to examine whether ER deficits are specifically characteristic for remitted affective disorders or whether they characterize individuals with any lifetime psychiatric diagnosis.”

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