Psychological factors that may confer risk for bipolar disorder

Several psychological domains may be dysfunctional in people with bipolar disorder (BD). When dysfunction occurs prior to onset of mood symptoms, it may signify risk for onset of the full syndrome of illness. Among these domains, cognitive dysfunction has received considerable attention as a possible endophenotype for BD, with some suggestion that changes in cognitive function may antedate onset of mood symptoms in individuals at risk for BD. Domains of social cognition, including emotion comprehension, theory of mind, and empathy, along with autobiographical memory, represent understudied aspects of psychological function that may be dysfunctional in people with BD. Temperament and personality factors, such as ruminative tendencies and neuroticism, may also leave some people vulnerable to mood instability. This review summarises the evidence for dysfunction in each of these domains for people with BD and examines whether there is any evidence that this dysfunction antedates the onset of mood symptoms or confers risk for illness.