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Bipolar Disorder: A Cognitive Curse or an Ego Booster?

What do Britney Spears, Kurt Cobain, Marilyn Monroe, Jim Carrey, Robert Pattinson and Ben Stiller all have in common? Other than being rich, famous and having household names, they all struggle(d) with a mood disorder called Bipolar.

Bipolar Disorder (BD) is a mental disorder involving extremes. The stereotypical bipolar patient vacillates between severe depression and severe manic episodes with brief too long periods of remission between episodes. Remission simply refers to the time where a patient isn’t exhibiting symptoms from either category (e.g. they aren’t “cured” of BD, they just aren’t having a manic or depressive episode). A manic episode generally consists of extreme impulsivity, lack of control, feelings of grandeur, distractibility, racing thoughts, and feelings of irrational elation among other things; whereas depression generally consists of hopelessness, extreme sadness, lack of energy, irritability, lack of appetite and other various other symptoms.

Someone having a manic episode might, for instance, drive 800 miles to Las Vegas, blow all their money gambling, get married by an Elvis impersonator, and feel inspired to write a book. On the flip side, someone having a depressive episode might not even have the energy to get out of bed or eat. For more visual learners, refer to the graph below:

Ideally a person stays within the “good times” and “bad times,” and maybe occasionally dips above or below the blue and yellow line, this is good and healthy. Imagine your best and worst day ever. Now multiply those emotions by ten and imagine swinging between the two on a regular basis; now you’re approaching what someone with BD experiences.

Although BD patients fall on a vast spectrum of severity of the disease, ranging from rapid cycling bipolar disorder (where the patient spins between severely depressed and manic minute to minute) to bipolar II (where the patient needs only to have one manic episode in order to be diagnosed and has not had a psychotic break as in BD I patients), it is generally known that cognitive impairments accompany the disorder.

Studies that have been done in the past demonstrate these significant deficits but have also found that deficiencies are also found in the remission period between states, when they appear to be functioning normally (Rubinsktein et al. 2000 & Martínez-Arán et al. 2004). This may seem self evident when you imagine the daily life of someone suffering from the average case of BD.

Waking up, the person could either find themselves full of energy, elated, full of new ideas, extremely confident and outgoing, ready to face the world, or they could wake up to find themselves exhausted, irritable, anxious or even suicidal. They could even wake up, “normal,” not suffering from either pole, or they could fall somewhere on the large spectrum of bipolar symptoms and states.

Throughout the day their moods can change seemingly randomly and stress triggers can often send them into an episode of either extreme. Clearly, this constant state of being unaware when your mood will change, and the ever looming possibility of a psychotic break (complete break from reality where all thoughts and emotions are extremely impaired) would cause anyone cognitive difficulty and stress.

Surprisingly, with all the evidence for cognitive impairments, past studies suggest that BD patients are unaware of these deficits. Rodriguez and her fellow researchers wanted to further examine this phenomenon by testing working memory, and the participants ability to accurately rate how well they performed.

They hypothesized that participants with BD attributes would experience decreased working memory, but would self-appraise their ability as higher than it actually was. Working memory is an active component of short term memory that not only maintains information, but also processes it, and self-appraisals are essentially a person’s ability to rate their own performance. A great example of working memory is when someone needs to look up a phone number. First they open the phone book and search through the names to find the right number. Once they find it, they need to actively hold it in their memory while dialing it into the phone. If they misdial, but are sure they dialed the right number, that would be an example of a positive self appraisal.

Participants were given a self-report test, the results of which correlate strongly with BD (note: these participants did NOT need a BD diagnosis in order to participate in the study). They were then given several different tests to assess their working memory.

The results clearly proved that the higher a participant’s risk for BD, the more likely they were to give themselves high self appraisals; however they found no evidence that risk for BD correlated with working memory deficits. Basically, despite no significant difference between BD risk and non- BD risk participants, the BD persons rated their performance higher than their counterparts.


TAKE AWAY MESSAGE: So what does all this mean and why should you care?

-Working memory is not impaired in BD patients (although there is evidence for other cognitive impairments).

-BD patients self-appraise their ability higher than it actually is.

-Positive self-appraisals could be an early sign of bipolar disorder risk.

-This could help doctors diagnose patients sooner and help get their illness under control before it gets out of hand.



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– J. S. RUBINSZTEIN, A. MICHAEL, E. S. PAYKEL and B. J. SAHAKIAN (2000). Cognitive impairment in remission in bipolar affective disorder. Psychological Medicine, 30, pp 1025-1036.

– Martínez-Arán, A., Vieta, E., Colom, F., Torrent, C., Sánchez-Moreno, J., Reinares, M., Benabarre, A., Goikolea, J., Brugué, E., Daban, C. and Salamero, M. (2004), Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disorders, 6: 224–232. doi: 10.1111/j.1399-5618.2004.00111.x

– Rodriguez, C., Ruggero, C. J., Callahan, J. L., Kilmer, J. N., Boals, A., & Banks, J. B. (2013). Does risk for bipolar disorder heighten the disconnect between objective and subjective appraisals of cognition?. Journal Of Affective Disorders, 148(2-3), 400-405. doi:10.1016/j.jad.2012.06.029

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