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David Baxter PhD

Late Founder
Instability of self-esteem and affect discovered in remitted bipolar disorder
By Liam Davenport
03 September 2007
Bipolar Disorders 2007; 9: 490-495

Patients with bipolar disorder experience instability of self-esteem and affect even when in remission, so this may be a marker of vulnerability to the disorder, UK study findings indicate.

A central feature of bipolar disorder is changes in beliefs about the self, with grandiose self-belief a common aspect of mania and low self-esteem prevalent in periods of depression. However, it is unclear whether unstable self-esteem is a characteristic of remitted bipolar disorder.

Richard Bentall, from the University of Manchester, and colleagues therefore asked 18 patients with bipolar disorder in remission, 16 patients with unipolar disorder in remission, and 19 healthy controls to keep a diary for 1 week, completed twice daily, of self-esteem and positive and negative affect. The Pragmatic Inference Task was also administered to measure attributional style.

The results, published in the journal Bipolar Disorders, show that the average levels of positive affect were significantly lower in the unipolar group than in the remitted bipolar group, with those of controls falling between the two extremes and not significantly different from either, at averages of 21.45, 28.89, and 24.42, respectively.

A similar pattern was seen for average levels of self-esteem, at respective averages of 27.86, 31.73, and 31.38. Average levels of negative affect were significantly lower in controls than in the unipolar patients, with levels in bipolar patients lying nonsignificantly in between, at 11.83, 15.19, and 14.14, respectively.

However, bipolar patients were found to have strong fluctuations in self-esteem and affect, significantly higher than those seen in both unipolar patients and controls, which were not significantly different from each other. Both unipolar and bipolar patients had a pessimistic attributional style.

The team notes: "Given that cognitive behavioral therapy explicitly addresses beliefs about the self, it seems possible that instability of mood and self-esteem will have some prognostic indications for how this kind of treatment is delivered to bipolar patients."

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