A prospective, behavioral high-risk design provided a theoretically guided examination of vulnerability to first onset of bipolar spectrum disorder based on the Behavioral Approach System (BAS) model. Adolescents (ages 14–19) at an “age of risk” for bipolar disorder onset were screened on BAS sensitivity by interviewers blind to current symptoms, lifetime history, and family history of psychopathology. Participants were selected with high versus moderate levels of BAS sensitivity and administered a lifetime diagnostic interview. Those with a bipolar spectrum disorder, psychosis, or hypomanic episode with onset prior to the BAS sensitivity assessment were excluded. High BAS (n = 171) and Moderate BAS (n = 119) sensitivity participants in the final sample completed baseline measures of symptoms, goal-setting, and reward responsiveness and were followed prospectively with semistructured diagnostic interviews every 6 months. Consistent with the vulnerability hypothesis of the BAS model of bipolar disorder, high BAS participants had a greater likelihood, and shorter time to onset, of bipolar spectrum disorder than moderate BAS participants across an average of 12.8 months of follow-up (12.9% vs. 4.2%), controlling for baseline depressive and hypomanic symptoms, and family history of bipolar disorder. High reward responsiveness on a behavioral task and ambitious goal-striving for popular fame and financial success (but not impulsivity) also predicted first onset of bipolar spectrum disorder controlling for the covariates and BAS risk group, and ambitious goal-striving partially mediated the BAS risk group effect. We discuss implications of the findings for the BAS model of bipolar disorder and early intervention efforts.

Objective Stressful life events are associated with an increase in depressive symptoms and the onset of major depression. Importantly, research has shown that the role of stress changes over the course of depression. The present study extends the current literature by examining the effects of early life stress on emotional reactivity to current stressors. Method In a multiwave study (N = 281, mean age = 18.76; 68% female), we investigated the proximal changes that occur in depressive symptoms when individuals are faced with life stress and whether a history of childhood emotional abuse moderates this relationship. Results Results support the stress sensitivity hypothesis for early emotional abuse history. Individuals with greater childhood emotional abuse severity experienced greater increases in depressive symptoms when confronted with current dependent stressors, controlling for childhood physical and sexual abuse. Conclusions This study highlights the importance of emotional abuse as an indicator for reactivity to stressful life events.

Bipolar disorders and substance use disorders (SUDs) show high co-occurrence. One explanation for this co-occurrence may be common personality vulnerabilities involved in both. We tested whether high Behavioral Approach System (BAS) sensitivity and impulsiveness are shared personality vulnerabilities in bipolar spectrum disorders and substance use problems and their cooccurrence in a longitudinal study of 132 bipolar spectrum and 153 normal individuals. At Time 1, participants completed the BIS/BAS Scales and the Impulsive Nonconformity Scale. Substance use problems were assessed via the Michigan Alcoholism Screening Test and the Drug Abuse Screening Test at 4 month intervals for one year. Bipolar participants had higher rates of lifetime SUDs and substance use problems during the follow-up, relative to normal controls. In line with hypotheses, higher BAS sensitivity and impulsiveness predicted bipolar status and increased substance use problems prospectively. BAS Total, BAS Fun-seeking, and impulsiveness mediated the association 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, Email: lalloy@temple.edu. 1 During the end of the recruitment period of the LIBS Project sample, it was becoming difficult to complete the recruitment of normal controls matched to the bipolar participants on age, sex, and ethnicity, who had no history of any Axis I disorders. We found that some of the normal participants who matched the bipolar participants on demographics had a prior history of a single specific phobia (e.g., of spiders). Thus, we decided to allow normal participants with a history of one specific phobia into the control group. Control participants with a specific phobia represented a small proportion (about 5%) of the total control group. From an RST perspective, the presence of some control participants with specific phobia could lead the control group to score higher than the bipolar group on BIS sensitivity. However, this was not the case; the two groups did not differ on BIS sensitivity (see Table 1). NIH Public AccessAuthor Manuscript J Pers Soc Psychol. Author manuscript; available in PMC 2010 September 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript between bipolar spectrum status and prospective substance use problems, with impulsiveness as the most important mediator. High BAS sensitivity and impulsiveness may represent shared personality vulnerabilities for both disorders, and may partially account for their co-occurrence. KeywordsBipolar Spectrum; Substance Use; Behavioral Approach System (BAS) Sensitivity; ImpulsivenessTheory and evidence has accumulated on the role of long-term personality differences in vulnerability to clinical disorders. The hypothesized behavioral functions of neurobiological systems has provided a way of conceptualizing associations between personality traits and various forms of psychopathology. For example, the Reinfor...

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.