Psychological factors that confer risk for bipolar disorder

There are a number of psychological domains that may be dysfunctional in people with bipolar disorder, and which, if the dysfunction occurs prior to onset of mood symptoms, may signify risk for onset of mood symptoms. Cognitive dysfunction has been examined as a possible endophenotype for bipolar disorder, with some suggestion that changes in cognitive function may antedate onset of mood symptoms. Domains of social cognition, including emotion comprehension, theory of mind and empathy represent under-studied domains of psychological function that may be dysfunctional in people with bipolar disorder. Temperament and personality factors, such as ruminative tendencies and neuroticism, may also leave some people vulnerable to mood instability. This review summarizes the evidence for dysfunction in each of these domains for people with bipolar disorder and examines whether there is any evidence that this dysfunction antedates the onset of mood symptoms or confers risk for illness.