Consistent with the BAS hypersensitivity model of bipolar disorder, a highly responsive BAS provides vulnerability to onsets of (hypo)manic episodes. In addition, a highly sensitive BIS increases risk for major depressive episodes.

In recent years, a call for increased research on bipolar disorder has been answered with methodologically diverse studies exploring goal striving, life events, cognitive style, decision-making, and neurobiological abnormalities in bipolar disorder. In order to further this spurt of research and to systematize our understanding of bipolar disorder, an integrative perspective is warranted. The behavioral approach system (BAS) dysregulation theory, proposed by Richard Depue and colleagues, provides such an integrated model for understanding psychosocial and biological aspects of bipolar disorder. In this paper, we review studies on life events, cognitive style and other psychosocial and neurobiological factors to examine whether the BAS dysregulation theory is supported by existing data. Then, we draw on recent advances in the study of emotion and motivation, and propose an expansion of the BAS dysregulation model of bipolar spectrum disorders to foster further biopsychosocial investigations of bipolar disorder. This expanded model provides greater specificity in predictions, especially about the nature of BAS dysregulation, environmental factors and psychological processes (e.g., appraisal processes) featured in a causal chain culminating in bipolar symptoms. Finally, we discuss the implications of the expanded BAS model for the course of bipolar spectrum disorders.

Little longitudinal research has examined progression to more severe bipolar disorders in individuals with “soft” bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a non-patient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of “soft” bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts.

Adolescence is a period of radical normative changes and increased risk for substance use, mood disorders, and physical injury. Researchers have proposed that increases in reward sensitivity, i.e., sensitivity of the behavioral approach system (BAS), and/or increases in reactivity to all emotional stimuli (i.e., reward and threat sensitivities) lead to these phenomena. The present study is the first longitudinal investigation of changes in reward (i.e., BAS) sensitivity in 9 to 23-year-olds across a two-year follow-up. We found support for increased reward sensitivity from early to late adolescence and evidence for decline in the early twenties. This decline is combined with a decrease in left nucleus accumbens (Nacc) volume, a key structure for reward processing, from the late teens into the early twenties. Furthermore, we found longitudinal increases in sensitivity to reward to be predicted by individual differences in the Nacc and medial OFC volumes at baseline in this developmental sample. Similarly, increases in sensitivity to threat (i.e., BIS sensitivity) were qualified by sex, with only females experiencing this increase, and predicted by individual differences in lateral OFC volumes at baseline.

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We examined concurrent and prospective associations of Behavioral Approach System (BAS)-relevant and non-BAS-relevant cognitive styles with bipolar spectrum disorders. Controlling for depressive and hypomanic/manic symptoms, 195 individuals with bipolar spectrum disorders scored higher than 194 demographically matched normal controls on BAS sensitivity and BAS-relevant cognitive dimensions of performance concerns, autonomy, and self-criticism, but not on BIS sensitivity and non-BAS-relevant dimensions of approval-seeking, sociotropy, and dependency. Moreover, group differences on autonomy fully mediated the association between higher BAS sensitivity and bipolar status. In addition, only BAS-related cognitive dimensions predicted the likelihood of onset of depressive and hypomanic/manic episodes among the bipolar individuals over a 3.2-year follow-up, controlling for initial symptoms and past history of mood episodes. Higher autonomy and self-criticism predicted a greater likelihood of hypomanic/manic episodes and higher autonomy predicted a lower likelihood of major depressive episodes. In addition, autonomy mediated Corresponding author: Lauren B. Alloy, Ph.D., Department of Psychology, Temple University, 1701 N. 13 th Street, Philadelphia, PA 19122. Phone: 215-204-7326, Fax: 215-204-5539, lalloy@temple.edu. NIH Public AccessAuthor Manuscript J Abnorm Psychol. Author manuscript; available in PMC 2010 August 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript the associations between BAS sensitivity and prospective hypomanic/manic episodes. These findings suggest that individuals with bipolar spectrum disorders may exhibit a unique profile of BAS-relevant cognitive styles that influence the course of their mood episodes. KeywordsBipolar Spectrum Disorder; Behavioral Approach System (BAS); Cognitive Styles Bipolar spectrum disorders are prevalent (4.4% of a nationally representative U.S. sample; Merikangas et al., 2007) and often produce significant impairment such as poorer academic achievement, erratic work history, divorce, suicide, and substance abuse (e.g., Angst, Stassen, Clayton, & Angst, 2002;Conway, Compton, Stinson, & Grant, 2006;Goodwin & Jamison, 1990;Grant et al., 2004;Nusslock, Alloy, Abramson, Harmon-Jones, & Hogan, 2008;Quackenbush, Kutcher, Robertson, Boulos, & Chaban, 1996;Strakowski, DelBello, Fleck, & Arndt, 2000). These disorders appear to form a spectrum of severity from the milder subsyndromal cyclothymia, to bipolar II disorder, to full-blown bipolar I disorder (e.g., Akiskal, Djenderedijian, Rosenthal, & Khani, 1977;Akiskal, Khani, & Scott-Strauss, 1979;Cassano et al., 1999;Depue et al., 1981;Goodwin & Jamison, 1990). Moreover, milder forms of bipolar disorder often progress to the more severe forms (e.g., Akiskal et al., 1977;Shen, Alloy, Abramson, & Grandin, 2008), providing support for the spectrum concept.Recently, there has been increasing interest in psychosocial processes in the onset, course, and treatment of bipolar spectrum disorders (see A...

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We review longitudinal predictors, primarily psychosocial, of the onset, course, and expression of bipolar spectrum disorders. We organize our review along a proximal -distal continuum, discussing the most proximal (i.e., prodromes) predictors of bipolar episodes first, then recent environmental (i.e., life events) predictors of bipolar symptoms and episodes next, followed by more distal psychological (i.e., cognitive styles) predictors, and ending with the most distal temperament (i.e., Behavioral Approach System sensitivity) predictors. We then present a theoretical model, the Behavioral Approach System (BAS) dysregulation model, for understanding and integrating the role of these predictors of bipolar spectrum disorders. Finally, we consider the implications of the reviewed longitudinal predictors for future research and psychosocial treatments of bipolar disorders.