Illness and narrative identity: examining past and future life story chapters in individuals with bipolar disorder, diabetes mellitus or no chronic illness

The purpose of this study was to investigate whether narrative identity challenges are specific to Bipolar Disorder (BD) as a mental illness or a reflection of living with chronic illness. Nineteen individuals diagnosed with BD, 29 individuals diagnosed with Type 1 Diabetes Mellitus (T1DM) and 25 controls without chronic mental or somatic illness identified past and future life story chapters which were self-rated on emotional tone and self-event connections and content-coded for agency and communion themes. Individuals with BD self-rated their past chapters as more negative and less positive, and their chapters were lower on content-coded agency and communion themes compared to T1DM and controls. There were fewer group differences for future chapters, but BD was associated with lower self-rated positive emotional tone and self-stability connections as well as lower content-coded agency and communion themes. The results indicate that narrative identity is affected in individuals with BD above and beyond the consequences of living with chronic illness. This may reflect distinct effects of mental versus somatic illness on narrative identity.

Variation in self and familiar facial recognition in bipolar disorder patients at different clinical stages

Previous studies suggest a close relationship between self-disorders and schizophrenia or unipolar depression. However, few studies have explored the characteristics of self-processing in bipolar disorder (BD) during different clinical states. This study compared the differences in self-face recognition (SFR) among patients with bipolar mania (BPM), bipolar depression (BPD), bipolar remission (RM), and healthy controls (HC). Images of subject's own face, a familiar face, and an unfamiliar face were combined in pairs at a certain proportion to obtain three types of blended images. We then compared the tendency between BD and HC while judging two kinds of blended faces emerging from presentation software. The results showed that the BPM and BPD groups seemed to lack an advantage in self-recognition. Self-processing and familiarity processing were significantly enhanced in BPM patients, while only familiarity processing was enhanced in BPD. The severity of clinical symptoms was not significantly correlated with self-bias or familiarity bias in BD.

Finding the Person in the Disorder: Adapting Metacognitive Reflection and Insight Therapy for Bipolar Mood Disorder (MERIT-BD)

Metacognitive Reflection and Insight Therapy (MERIT) was originally developed as an integrative recovery-oriented therapeutic approach to address the needs of people with a diagnosis of schizophrenia and other forms of severe mental illness. The approach, conceptualized as transtheoretical, aims to promote a more coherent and synthetic sense of self, through stimulating insight, sense of coherence, and metacognitive capacity. We argue that MERIT therapy, designed to facilitate peoples’ ability to form complex ideas about themselves and others and to use this knowledge to respond to psychological problems, has application in addressing deficits associated with bipolar disorder (BD), where there may be a significant injury to the person’s sense of self. That is, the therapy addresses the nascent sense of self in a context where disturbance of mood is dominant, and in relation to the experience of episodic manic episodes which may be understood as dissociative events, often associated with shame. The application of the therapeutic approach, which we term MERIT-BD draws upon MERIT’s primary principle of facilitating complexity and integration of the self, and additionally addresses shame, allowing for the facilitation of metacognitive capacity and insight in the context of finding the person. This approach will be illustrated with case vignettes illustrating the application of key components of MERIT-BD. Early findings drawn from a series of case studies are encouraging.

"My life disappeared in illness": bipolar disorder and themes in narrative identity

Bipolar Disorder (BD) has substantial consequences for the course of life and the formation of self and identity. In the present study, we extended the existing literature by examining narrative identity. Fifteen female outpatients with remitted BD and fifteen non-clinical control participants described past and future chapters in their life stories. The chapters were coded for agency, communion, redemption and contamination. Patients diagnosed with BD described their past chapters with lower agency, lower communion and more contamination compared to the control group. Contrary to our expectations, the future chapters described by the BD patients did not differ significantly from the control group. A focus on narrative identity may contribute to understanding the disorder and inspire interventions targeting personal recovery.

An investigation of self-compassion and nonattachment to self in people with bipolar disorder

BACKGROUND

There have been longstanding theories and research evidence into the important role of the person's vulnerability at the level of self-concept in bipolar disorder (BD). The current study investigated two emerging self-related constructs, self-compassion and nonattachment to self in BD. Specifically, we examined the levels of the two constructs in people with BD compared with those from the general population, and the associations between the constructs and bipolar symptomologies within the BD group.

METHODS

The BD group consisted of 302 individuals with a diagnosis of BD participating in an international randomised controlled trial. A general population sample (n = 372) was recruited from an Australian university as a comparison group. All participants completed measures of self-compassion and nonattachment to self. The BD group completed additional measures of depression and symptoms of hypo/mania.

RESULTS

Participants with BD showed significantly lower self-compassion and nonattachment to self than those from the comparison group after controlling for demographic variables (e.g., gender, age, education, occupation). In the BD group, lower self-compassion and nonattachment to self were associated with greater severity of depression on both self- and clinician-rated scales. Nonattachment to self but not self-compassion was negatively associated with hypo/mania symptomology.

LIMITATIONS

The cross-sectional design cannot determine the direction of the relationships between study variables. Nonattachment to self is a novel psychological construct and further research is needed to replicate study findings.

CONCLUSIONS

The study findings suggest that self-compassion and nonattachment to self may be meaningful targets in psychological interventions for people with BD.

Self-concept structure and borderline personality disorder: evidence for negative compartmentalization

BACKGROUND AND OBJECTIVES

Borderline personality disorder (BPD) is characterized by an unstable and incongruent self-concept. However, there is a dearth of empirical studies investigating self-concept in BPD. In order to bridge this research gap, the purpose of this study was to apply an in-depth analysis of structural aspects of the self-concept in BPD.

METHODS

We examined the degree of compartmentalization, i.e., a tendency to organize knowledge about the self into discrete, extremely valenced (i.e., either positive or negative) categories (Showers, 1992).

RESULTS

We hypothesized and found that BPD patients had the most compartmentalized self-concept structure and a higher proportion of negative self-attributes relative to both a non-clinical and a depressed control group. Moreover, BPD patients rated negative self-aspects as more important than positive ones relative to non-clinical controls.

LIMITATIONS

We cannot determine whether causal relationships exist between psychological symptoms and self-concept structure. Moreover, further comparisons to patients with other psychiatric disorders are necessary in order to further confirm the clinical specificity of our results.

CONCLUSIONS

Our findings indicate that a negative compartmentalized self-concept is a specific feature of BPD. Implications for future research, psychological assessment, and psychotherapeutic treatment are discussed.

What goes up must come down: the burden of bipolar depression in youth

BACKGROUND

In the pediatric bipolar disorder literature, mania has eclipsed depression as the mood state of most interest. Though depressive episodes tend to be more prevalent and persisting than manic episodes, research about the associated consequences is limited. The goal of the present study was to compare the influences of depressive and manic symptoms on domains of functioning in which youth with bipolar disorder often demonstrate deficits.

METHOD

Youth meeting DSM-IV-TR criteria for bipolar spectrum disorders (I, II, and NOS) between the ages of seven and 13 were recruited from a clinic in a large Midwestern city (N=54). Both parent and clinician report of manic and depressive symptoms were used in regression analyses to determine how each set of symptoms was related to child functioning.

RESULTS

Parent-rated child depression symptoms were associated with problem behaviors (p<0.05), and lower quality of life (p<0.001). Clinician-rated child depression was associated with greater psychiatric illness (p<0.05), lower child self-concept (p<0.001), lower quality of life (p<0.05), hopelessness (p<0.05), and suicidal ideation (p<0.05). Parent-rated mania was associated with better self-esteem (p<0.05) and physical wellbeing (p<0.05). Clinician-rated mania was associated with greater psychiatric illness (p<0.05) and physical wellbeing (p<0.05).

LIMITATIONS

The specific outcomes predicted by parent and clinician-rated symptoms vary. Though the overall story told--that bipolar depression is associated with significant impairment in youth--is consistent, further research is necessary to more fully understand the impact of each mood state.

CONCLUSION

Mania is undoubtedly destructive, but this study provides evidence to suggest that depression may be more deleterious to youths' psychosocial functioning and quality of life; more attention to understanding and ameliorating the effects of bipolar depression on youth is warranted.

Impaired episodic memory for events encoded during mania in patients with bipolar disorder

To date, very few studies have focused on autobiographical memory in patients with bipolar disorder. We examined whether mood state at the time of event encoding (i.e., manic, depressed, euthymic) influences subsequent recollection in these patients. We administered the Autobiographical Interview, a method that allowed us to dissociate episodic and semantic aspects of autobiographical memory. We also compared the memory perspective from which patients recollected these events. Patients were selectively impaired in recollecting episodic details of events encoded during mania but not depression or euthymia. No significant differences emerged between patients and controls for recollection of non-episodic details, regardless of mood state. Patients with bipolar disorder were also more likely than matched controls to recall memories from an observer perspective. These preliminary findings indicate a moderating influence of mood state at the time of event encoding on the subsequent recollection of autobiographical events in patients with bipolar disorder.

A comparison of mood-dependent memory in bipolar disorder and normal controls

Mood-dependent memory was investigated in a sample of 28 individuals, with a diagnosis of bipolar disorder I but not during acute episodes, and 30 non-clinical controls by using the word lists from Wechsler Memory Scale--Third Edition and abstract inkblot recognition. Positive or negative mood induction procedures were used prior to and after the stimuli were presented. After either the same or contrasting high or low mood inductions, participants attempted to recall the word list and performed an inkblot recognition task. Bipolar patients were significantly better at the inkblot recognition in the same mood state, showing mood-dependent memory. No differences were found in the verbal recall task. This study paves the way for further investigation into memory differences of this sort in mood disorders.

Bipolar disorder: what can psychotherapists learn from the cognitive research?

Randomized controlled trials of psychological treatment, principally cognitive therapy, for bipolar disorder have yielded inconsistent results. Given the status of this evidentiary base, we provide a more fine-grained analysis of the cognitive profiles associated with bipolar disorder to inform clinical practice. In this practice-friendly review, we consider evidence that both negative and positive cognitive styles are related to bipolar disorder. Cross-sectional and prospective evidence suggest that negative cognitive styles are related to depression within bipolar disorder, but there also is evidence that bipolar disorder is related to an elevated focus on goals as well as to increases in confidence during manic states. With such findings as backdrop, we consider the outcomes of psychological treatments for bipolar disorder and advance several suggestions for clinical practice.

The multistory self: why the self is more than the sum of its autoparts

A summary is presented of both the theoretical and clinical points made by the contributors to this issue of Journal of Clinical Psychology: In Session on the multiplicity of self. It is argued that there are many theoretical and clinical commonalities in the diverse range of psychotherapies that have been developed and that have been used in work with problems in the self-concept. Core problems encountered in clinical practice include an apparent self-integration that is attained through the exclusion of important parts of the self. The key to opening up clients who present such problems is through the use of experienced emotions and the therapeutic relationship. More extreme problems in the self-concept can be seen in the personality and psychotic disorders, in which the self may be chaotic or disintegrated. Such clients may need help with the development of a reflective self that can integrate and regulate the separate parts of the self-concept.

Using Hierarchical Classes to Analyze Organization of the Self-Concept

This study evaluated in several ways the concurrent and discriminant validity of measuring self-concept organization via Hierarchical Classes (HICLAS) analysis of interview-derived self-descriptions. College students (N = 85) listed and then described using their own words various self-aspects, and they completed standardized measures of depressive symptoms, self-esteem, and verbal ability. As expected, self-views were multifaceted and hierarchically organized. The proportion of negative self-descriptors provided was positively correlated with depressive symptoms and negatively correlated with self-esteem. Positive and negative self-descriptors were compartmentalized across self-aspects. These results supported the concurrent validity of the information yielded by HICLAS analysis. Supporting the discriminant validity of the method, indices of the elaboration of the self-concept were not correlated with depressive symptoms. No HICLAS variables were significantly confounded by individual differences in verbal ability. We conclude that HICLAS analysis of self-generated descriptors is a promising, flexible method of idiographic assessment of self-concept organization.

Psychological approaches to bipolar disorders: A theoretical critique

An outline is presented of five main psychological models of the bipolar disorders. These approaches include the Behavioural Activation/Inhibition Systems model, the Cognitive Therapy model, the Interpersonal and Social Rhythm Therapy model, the Interacting Cognitive Subsystems model, and the SPAARS model. Strengths and weaknesses are highlighted for each approach. It is concluded that although there is no model that can adequately account for even the key features of the bipolar disorders (such as periodicity, shifts in the valence of the self-concept, mixed affective states, and patterns of recovery and relapse), nevertheless, more recently developed multi-level approaches to emotion offer more sophisticated possibilities for modeling these complex disorders.

The I of the storm—Relations between self and conscious emotion experience: Comment on Lambie and Marcel (2002)

J. A. Lambie and A. J. Marcel (2002) outlined a framework for understanding varieties of conscious emotion experience. In their analysis, the self plays an important role in conscious emotion experience. In this critique, however, the authors propose that Lambie and Marcel's presentation of the self needs further specification if it is to account for varieties of conflicted emotional experience, particularly those characteristic of dissociative states. The authors propose that a more elaborated self-construct is necessary to account for these phenomena involving either the "splitting off of significant self-related concerns or the existence of multiple self-constructs. These arguments are illustrated by clinical and subclinical case examples.