Perfectionism drives depression in bipolar/anxiety comorbidity

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By Joanna Lyford, Senior medwireNews Reporter

People with comorbid bipolar spectrum disorders (BSD) and anxiety tend to display higher levels of depressive symptoms than their counterparts with BSD alone, say researchers.

Writing in the Journal of Affective Disorders, they say that the increase in depressive symptoms is explained by a “perfectionistic cognitive style” – that is, a dysfunctional attitude to negative life events.

Lauren Alloy (Temple University, Philadelphia, Pennsylvania, USA) and colleagues studied 141 young adults, of whom 48 had bipolar II disorder, 50 had comorbid BSD and anxiety and 43 were psychiatrically healthy. Two-thirds of the participants were female and the mean age was 20 years.

Comparison of baseline data revealed that the BSD/anxiety group scored significantly higher than the BSD-only group on measures of sociotropy, perfectionism, dependency, and self-criticism.

Patients with comorbid BSD/anxiety also experienced more severe depressive symptoms but a similar level of hypomanic/manic symptoms over 1 year of follow-up; this difference remained significant after adjusting for initial symptom severity.

The BSD/anxiety group also scored significantly higher than controls on measures of sociotropy, autonomy, perfectionism, approval by others, negative cognitive style and depression.

The researchers then examined the influence of cognitive styles as mediators of the association between BSD/anxiety comorbidity and depressive symptoms. They found that perfectionism was a significant mediator, whereas sociotropy, dependency and self-criticism were not.

Together, the findings indicate “quite clearly that individuals with BSD/anxiety comorbidity interpreted their environments with cognitive styles that are more negative than those with BSDs only or healthy controls”, write the researchers.

They say that perfectionism “may be especially likely to mediate the comorbidity-depression relationship because of its integral association with both anxiety and depression.”

The authors conclude: “Future research should examine what, if any, anxiety-specific attitudes are adaptive in preventing an aggravation of hypo(manic) symptoms or episodes in individuals with both a bipolar and an anxiety disorder.”

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