Cognitive styles in individuals with bipolar disorders

Background. Published studies of emotional processing and cognitive style in bipolar disorders tend to have small sample sizes or use non-clinical samples. Larger clinically representative studies are needed. Method. Self-esteem, dysfunctional attitudes and personality style were compared in unipolar (N = 16) and bipolar disorder (N = 77); and then investigated in the different phases of bipolar disorder (remitted = 26; depressed = 38; hypomanic = 13). One-year outcome was assessed in 36 bipolar subjects. Results. Unipolar subjects and bipolar subjects differed significantly in their mean levels of negative self-esteem (unipolar = 15.5; bipolar = 12.7; P < 0.05). Bipolar subjects with hypomania reported mean levels of dysfunctional beliefs that were higher than individuals in remission but lower than depressed subjects (remitted = 136.7; depressed = 153.8; hypomanic = 144.8; P < 0.05). Hypomanic subjects recorded the highest levels of negative as well as positive self-esteem. In the exploratory analysis of outcome, negative self-esteem (Exp [B] 1.91; 95% Cl 1.11 to 3.32; P < 0.05) was the most robust predictor of relapse. Conclusions. There are similarities in the cognitive style of individuals with unipolar as compared to bipolar disorders. Cognitive style in hypomania represents a phase between remission and depression rather than the polar opposite of depression. The implications of these findings are considered for psychological and neural network models.