Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis

Abstract

People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies (n = 2451), to BPD in six studies (n = 1001), to attention deficit hyperactivity disorder in three studies (n = 232), to anxiety disorders in two studies (n = 320), to schizophrenia in one study (n = 223), and to post-traumatic stress disorder in one study (n = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.

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

“…This is the first SR to describe the relationship between ED and BD psychopathology. Together with our two previous SRs, 13,14 it represents a primer in understanding the ED construct in BD, which has previously received little attention. Enhanced knowledge in this area may identify specific treatments that can optimize ED outcomes according to personalized medicine and promote recovery by aiding the development of new transdiagnostic treatments 36 .…”

“…Existing systematic reviews (SR) and meta‐analyses (MA) showed that patients diagnosed bipolar disorder (BD) are particularly prone to higher ED levels 13,14 . BD is a severe chronic mental illness characterized by changes in synaptic plasticity and neuronal connectivity resulting from several genetic, epigenetic, and environmental factors 15–17 .…”

A Magnetic Resonance Spectroscopy Study on Polarity Subphenotypes in Bipolar Disorder

“…Affective disorders are one of the leading causes of morbidity and mortality after cardiovascular diseases, cancer, and road traffic accidents. Bipolar disorder (BD) belongs to affective disorders and is characterized by emotional dysregulation [ 8 , 9 , 10 ], affecting roughly >1% of the global population, regardless of sex, ethnicity, or social income [ 11 , 12 , 13 , 14 ]. It is associated with significant psychosocial morbidity and mortality due to increased suicidality and medical poly-comorbidity [ 12 , 13 , 14 ].…”