Understanding familial liability for emotion regulation difficulties in bipolar disorder

Psychol Med. 2022 Oct;52(13):2614-2621. doi: 10.1017/S0033291720004626. Epub 2020 Dec 17.


Background: There has been relatively limited work focused on understanding whether relatives of individuals with bipolar disorder (BD) have difficulties in the regulation of emotion, particularly in relation to perceptions about whether emotions can be effectively regulated, or trait behaviours that acknowledge emotions as self-regulators themselves. In this study, we assessed the presence and extent of difficulties in these dimensions of emotion regulation in individuals with BD compared to unaffected first-degree biological relatives (FDR) for the first time.

Methods: In total, 161 participants, including euthymic individuals with BD, unaffected FDRs, and healthy controls, were compared on the Difficulties in Emotion Regulation Scale (DERS) - a multi-dimensional measure of habitual emotion regulation. Clinical data were also collected and examined in relation to DERS scores in a secondary analysis.

Results: In the BD group, difficulties were evident for most dimensions of emotion regulation as measured by the DERS; and correlated with an earlier onset of illness and more mood episodes. FDRs displayed generally normal emotion regulation, except in terms of their beliefs that emotions can be effectively regulated; on this dimension, their reported difficulty was intermediate to the BD group and controls.

Conclusion: Habitual emotion regulation difficulties in BD persist irrespective of mood state, are related to the course of illness, and should be targeted in psychological interventions. Further, the perception that emotions cannot be effectively regulated during times of distress seems to represent an endophenotype for BD.

Keywords: Emotion; emotional acceptance; emotional clarity; endophenotype; familial liability; first-degree relatives; genetics; self-efficacy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Affect
  • Bipolar Disorder* / psychology
  • Emotional Regulation*
  • Emotions / physiology
  • Endophenotypes
  • Humans