Correlation between emotion dysregulation and mood symptoms of bipolar disorder: A systematic review and meta‐analysis

Abstract

BackgroundEmotion dysregulation (ED) is a transdiagnostic construct characterized by difficulties regulating intense emotions. People with bipolar disorder (BD) are more likely to show ED and use maladaptive emotion regulation strategies than adaptive ones. However, little is known about whether ED in BD is a trait or it is rather an epiphenomenon of mood symptoms.MethodsWe conducted a systematic review and meta‐analysis of the evidence across major literature databases reporting correlations between measures of emotion regulation (overall ED and different emotion regulation strategies) and measures of depressive and (hypo)manic symptoms in BD from inception until April 12th, 2022.ResultsFourteen studies involving 1371 individuals with BD were included in the qualitative synthesis, of which 11 reported quantitative information and were included in the meta‐analysis. ED and maladaptive strategies were significantly higher during periods with more severe mood symptoms, especially depressive ones, while adaptive strategies were lower.ConclusionED significantly correlates with BD symptomatology, and it mainly occurs during mood alterations. ED may be a target for specific psychotherapeutic and pharmacological treatments, according to precision psychiatry. However, further studies are needed, including patients with mood episodes and longitudinal design, to provide more robust evidence and explore the causal direction of the associations.

The shared and disorder-specific resting state functional connectivity associated with emotion regulation between ADHD and bipolar disorder

“…Growing evidence from both human behavioral and neuroimaging studies suggest that ED is a trans-diagnostic risk factor as well as the treatment and intervention foci across many mental disorders including ADHD and BD, although it is not included as a formal diagnostic criterion in DSM-5 (American Psychiatric Association, 2013; Carmassi et al, 2022; Kebets et al, 2021; Lenzi et al, 2018). Such as, consistent findings demonstrated that both ADHD and BD patients reported higher ED level and preferred to adopt more maladaptive ER strategies compared to healthy controls (Beheshti et al, 2020; De Prisco et al, 2022; Minò, 2022; Miola et al, 2022; Oliva et al, 2023; Shaw et al, 2014; Soler-Gutiérrez et al, 2023). On the other hand, some other studies show that while BD group exhibited higher scores on affective instability than ADHD group (Richard-Lepouriel et al, 2016; Sesso et al, 2021), ADHD group scored higher on emotional intensity (Richard-Lepouriel et al, 2016; Torrente et al, 2017).…”

Adaptive and maladaptive emotion regulation in bipolar disorder

“…4 A better understanding of which ER strategies are related to which mental state in BD is of utmost importance in developing personalized therapeutic approaches. In this context, the present systematic review and metaanalysis published in this issue of the journal by Oliva et al 5 fills this knowledge gap, as it was previously unknown whether ER strategies can change according to the mood state in BD. 5 They showed that ED and maladaptive strategies were significantly higher during periods of more severe mood symptoms, especially depressive symptoms, while adaptive strategies were lower.…”

“…In this context, the present systematic review and metaanalysis published in this issue of the journal by Oliva et al 5 fills this knowledge gap, as it was previously unknown whether ER strategies can change according to the mood state in BD. 5 They showed that ED and maladaptive strategies were significantly higher during periods of more severe mood symptoms, especially depressive symptoms, while adaptive strategies were lower. Manic symptoms were also correlated with ED, but less than were depressive symptoms.…”