Inefficiency of emotion regulation as vulnerability marker for bipolar disorder: Evidence from healthy individuals with hypomanic personality

Center for Doctoral Studies in Social and Behavioral Sciences, Graduate School of Economic and Social Sciences, University of Mannheim, Germany.
Journal of Affective Disorders (Impact Factor: 3.38). 08/2013; 152(1). DOI: 10.1016/j.jad.2013.05.001
Source: PubMed


Emotion regulation deficits are a key characteristic of bipolar disorder (BD). In the present study, we asked if deficits in emotion regulation are also a vulnerability marker for BD. To this end, we investigated a healthy group of participants at high-risk for developing BD, defined on the basis of a hypomanic personality trait. We examined the neural correlates of two emotion regulation strategies, reappraisal and distraction.
Twenty-two individuals with higher risk for BD and twenty-four controls were investigated in a functional magnetic resonance imaging paradigm. Participants were presented with negative, positive and neutral pictures and were either required to passively view the images, to down-regulate the emotional response by reappraising the pictures' content, or to perform a distracting arithmetic task.
High-risk individuals showed increased emotional reactivity to negative stimuli, indicated by heightened amygdala activation during passive viewing. High-risk participants were also less successful in down-regulating amygdala activity using reappraisal of negative stimuli. During distraction from positive stimuli, high-risk individuals showed heightened task-related activity in the inferior parietal cortex, suggesting increased distractibility by task-irrelevant positive background stimuli. There were no differences in habitual emotion regulation as assessed by a self-report questionnaire.
Generalizability of the present results is limited by the age- and education-homogenous sample and the small sample size.
This is the first study to report neural correlates of increased emotional reactivity and deficient emotion regulation in healthy individuals at risk for BD. These findings suggest inefficient emotion regulation through reappraisal and distraction in individuals with high hypomanic personality who are supposed to be at higher risk to develop bipolar disorder.

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    • "Based on prior research, we speculate that the medial prefrontal cortex and amygdala may serve as candidate alternative regions: activity in the medial prefrontal cortex was previously found to be greater in bipolar disorder and at-risk compared to control participants in response to fearful stimuli (Surguladze et al., 2010). In an emotion regulation task, at-risk participants showed increased amygdala reactivity during the presentation of negative stimuli (Heissler et al., 2014). Reduced ventrolateral prefrontal modulation of the amygdala was found during the presentation of emotional distractors in an emotional working memory paradigm (Ladouceur et al., 2013). "
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