Rates of suicidal ideation and behavior are extremely high in Bipolar Spectrum Disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every four months for an average of three years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk for suicide.

Non-suicidal self-injury (NSSI) is highly prevalent among late adolescents and predicts the onset of suicidal ideation and behavior. Although research has established an association between the behavioral approach system (BAS) and NSSI, less research has explored mechanisms underlying this relationship. The authors examined negative and positive emotion regulation patterns, as well as the BAS-relevant cognitive style of self-criticism, as potential mechanisms through which a hypersensitive BAS might be related to NSSI frequency. Late adolescents (N=177) with high and moderate BAS levels completed measures of self-criticism, positive emotion regulation, brooding, and both lifetime and last year frequency of NSSI. Results indicated that self-criticism and positive emotion dampening independently mediated the relationship between BAS and last year frequency of NSSI. Self-criticism also mediated the relationship between BAS and lifetime frequency of NSSI. Results suggest that cognitive and emotion-regulatory styles may help to explain why high BAS individuals are likely to engage in NSSI.

BackgroundReward and punishment sensitivities have been identified as potential contributors to binge eating and compensatory behaviors, though few studies have examined gender differences in these behaviors.MethodA college-aged sample (N = 1,022) completed both the Eating Disorders Diagnostic Scale (EDDS) and Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ).ResultsRates of binge eating were similar in males and females. Among those reporting compensatory behaviors, women reported engaging in compensatory behaviors more frequently than men. Sensitivity to reward and sensitivity to punishment were both positively associated with binge eating frequency in both genders. In contrast, women with high reward sensitivity reported engaging in compensatory behaviors more frequently.ConclusionsRates of binge eating and compensatory weight control behaviors were similar between college-aged males and females, though females who engaged in compensatory behaviors did so more frequently than males. Sensitivity to punishment was greater in females, whereas sensitivity to reward was greater in males. Reward and punishment sensitivity were each positively associated with binge eating in both males and females, while only reward sensitivity was positively associated with compensatory behaviors in females.

Background Bipolar spectrum disorders (BSDs) are highly comorbid with anxiety, which is associated with an extended duration and exacerbation of depressive symptoms. Unfortunately, the underlying mechanisms are not known. This study examined the role of maladaptive cognitive styles in the co-occurrence of BSDs and anxiety disorders and prediction of depressive symptoms. Methods Participants included 141 young adults (69.6% female, mean age= 20.24, SD= 2.11), in one of three groups: a BSD group (bipolar II, cyclothymia, n=48), a comorbid BSD/Anxiety group (n=50), and a demographically-matched healthy control group (n=43), who were followed prospectively. Participants completed the Cognitive Style Questionnaire (CSQ), Depressive Experiences Questionnaire (DEQ), Dysfunctional Attitudes Scale (DAS), Sociotropy Autonomy Scale (SAS), Halberstadt Mania Inventory (HMI) and Beck Depression Inventory (BDI) at the initial assessment. One year later, participants completed the BDI and HMI again to assess severity of depressive and hypomanic/manic symptoms. Results A Multivariate Analysis of Co-Variance (MANCOVA) revealed significant differences between the three groups on their DAS Perfectionism, DEQ Dependency, DEQ Self-Criticism, CSQ Negative, SAS Autonomy, and Time 2 BDI scores, with the BSD/Anxiety group scoring higher than the BSD only group on all measures except the CSQ. Preacher and Hayes' (2008) bootstrapping method was used to test for mediational effects of the significant cognitive style measures on depressive symptoms at follow-up. The 95% confidence intervals for the indirect effect of group on follow-up depressive symptoms through DAS Perfectionism did not include zero, indicating the presence of a significant mediating relationship for perfectionism. Limitations This study only used two waves of data; three waves of data would allow one to investigate the full causal effect of one variable on another. Further, a comorbid anxiety diagnosis consisted of any anxiety disorder. Further research should separate groups by their specific anxiety diagnoses; this could afford a more complete understanding of the effect of types of anxiety on prospective depressive symptoms. Conclusions After taking into account initial levels of depressive and hypomanic/manic symptoms, we found that those with BSD/anxiety comorbidity experienced more severe depressive symptoms, but not more severe hypomanic/manic symptoms. Further, their more severe prospective depressive symptoms are explained by a perfectionistic cognitive style.

Bipolar spectrum disorders (BSDs) are often characterized by cognitive inflexibility and affective extremities, including “extreme” or polarized thoughts and beliefs, which have been shown to predict a more severe course of illness. However, little research has evaluated factors that may be associated with extreme cognitions, such as personality disorders, which are often characterized by extreme, inflexible beliefs and also are associated with poor illness course in BSDs. The present study evaluated associations between BSDs, personality disorder characteristics, and extreme cognitions (polarized responses made on measures of attributional style and dysfunctional attitudes), as well as links between extreme cognitions and the occurrence of mood episodes, among euthymic young adults with BSDs (n = 83) and demographically-matched healthy controls (n = 89) followed prospectively for three years. The relationship between personality disorder characteristics and negative and positive extreme cognitions was stronger among BSD participants than among healthy controls, even after statistically accounting for general cognitive styles. Furthermore, extreme negative cognitions predicted the prospective onset of major depressive and hypomanic episodes. These results suggest that extreme cognitive styles are most common in individuals with BSDs and personality disorder characteristics, and they provide further evidence that extreme negative cognitions may confer risk for mood dysregulation.