Stability of self‐esteem in bipolar disorder: comparisons among remitted bipolar patients, remitted unipolar patients and healthy controls¹

Abstract

Instability of self-esteem and affect is present in bipolar patients, even when their symptoms are in remission, and has previously been found in people at genetic risk of the disorder. It may be a marker of vulnerability to the disorder.

Are Social Comparisons Detrimental for the Mood and Self-Esteem of Individuals with an Affective Disorder?

“…However, because of prior work showing instability and even daily fluctuations in self-esteem in bipolar disorder (e.g. Knowles et al 2007) we had expected here as well a differential pattern for patients in reaction to the social comparison condition. The latter negative result can probably be explained by the nature of the measure which asks for general self-esteem.…”

“…Based on the manic defence hypothesis and related research (Knowles et al 2007;Lyon et al 1999), we predicted that contrary to UD patients with euthymic BD will not report a change in explicit selfesteem after the upward social comparison but-similar to UD-show a decrease in implicit self-esteem. However, this specific hypothesis was not supported.…”

“…Buhrmester et al 2011;Leary and MacDonald 2003). Especially with respect to BD, instability of self-esteem has been described which was not restricted to being in clinically relevant mood episodes (Bentall et al 2011;Knowles et al 2007).…”

“…Patients with bipolar disorder (BD) show stronger fluctuations in their self-esteem even during remission compared to healthy controls (Knowles et al 2007). There is accumulating evidence that vulnerability to BD is related to an increased sensitivity to cues of potential reward and reinforcement which is hypothesized to be linked to a dysregulation in the behavioural approach system (BAS; see therefore Alloy and Abramson 2010;Alloy et al 2009Alloy et al , 2012Johnson 2005).…”

“…Additionally, remitted patients with BD often only show depression-like cognitions when compared to controls in the implicit assessment of self-esteem (e.g. in the Pragmatic Inference Task), but not in the explicit ones (Knowles et al 2007;Pardoen et al 1993). This discrepancy in results where the cognitive vulnerability of patients with BD looks similar to depressed patients when implicit measures are used but resembles healthy controls in explicit measures, has been discussed in the context of the reformulation of the manic defence hypothesis.…”