Rejection sensitivity differentiates unipolar, bipolar depression

By Eleanor McDermid, Senior medwireNews Reporter

Asking about heightened rejection sensitivity during a depressive episode may help physicians to identify patients with underlying bipolarity, say researchers.

The team found that rejection sensitivity was common in patients with unipolar and bipolar depression regardless of current mood, but patients with bipolar disorder were more likely to have heightened rejection sensitivity when they were depressed.

“This suggests that increased rejection sensitivity when depressed may be a further clinical feature assisting clinicians in distinguishing bipolar from unipolar depression,” write lead study author Anna Ehnvall (Gothenburg University and Psychiatric Outpatient Clinic, Varberg, Sweden) and colleagues.

Most of the 113 patients with bipolar disorder and 146 with unipolar depression reported long-standing rejection sensitivity (ie, trait rejection sensitivity), and all but 11.6% said they had increased rejection sensitivity when depressed (state rejection sensitivity).

On ordinal regression analysis, bipolar disorder was a highly significant predictor for heightened rejection sensitivity during depression, the team reports in Bipolar Disorders. Indeed, having unipolar depression reduced the likelihood for depressive state rejection sensitivity by about 60%.

Trait rejection sensitivity predicted depressive state rejection sensitivity, and vice versa, while trait anxiety predicted both trait and state rejection sensitivity.

Up to two-thirds of the patients said they had increased problems with pain during depressive episodes, including headaches, body aches and pains, and chest pain. Notably, pain experienced during depression correlated with state but not trait rejection sensitivity, and – for headaches and body pains – this remained significant on regression analysis.

Ehnvall et al comment that using terms such as “unexplained” and “psychosomatic” to describe pain with no clear cause can be frustrating for patients, and that having negative thoughts about pain can make it feel worse.

“Educating patients and clinicians about the links between depression, rejection sensitivity, and pain during depression, and thereby normalizing these related experiences, might in itself help to reduce pain symptoms,” they say.

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