Attachment, reflective functioning and emotion regulation as predictors of proneness to develop bipolar disorder
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Date
03/07/2015Author
Madrid-Cuevas, Sonia
Metadata
Abstract
Background
Within the context of developmental psychopathology and the psychological factors
associated with the onset of severe mood instability, this thesis proposes that early
attachment related interactions underlie the development of reflective functioning and
effective emotional regulation necessary for optimal functioning. Both insecure attachment
and poor reflective functioning have been linked to various mental disorders in which
emotion dysregulation surfaces as a core feature. However, the underlying mechanisms by
which these constructs interact to predict increased risk to develop bipolar disorder have yet
to be considered.
Objectives
This project’s objectives were to investigate, through a quantitative cross sectional design,
the following questions: 1) In what way are attachment, reflective function and emotion
regulation associated with proneness to bipolar disorder? 2) Do reflective functioning,
emotion regulation, depression and specific metacognitive patterns mediate the influence of
attachment on increased likelihood of developing bipolar disorder?
Method
An online survey was used to ask 2325 participants to complete questionnaires measuring
the variables of hypomanic traits, attachment relationship style, mood, emotion regulation,
metacognitive patterns and reflective functioning. The survey was designed to give
participants feedback immediately after entry completion, which proved to be a very
successful recruitment strategy. For the analysis of the data, structural equation modeling
(SEM), multivariate and univariate statistics were used.
Results
SEM analysis demonstrated that internal dysfunctional emotion regulation is the strongest
predictor of bipolar disorder proneness, whilst anxious insecure attachment holds a strong
direct relationship with internal dysfunctional emotion regulation not mediated by reflective
functioning. Thus, anxious insecure attachment and reflective functioning emerged as
indirect predictors to bipolar proneness, being fully mediated by internal dysfunctional
emotion regulation strategies, depressive symptoms, perceived well being and negative
metacognitive patterns. The use of dysfunctional emotion regulation strategies directly
predicted low mood and indirectly predicted decreased well being and increased risk to
develop bipolar disorder. Furthermore, in this sample the presence of hypomanic traits alone
did not imply proneness to bipolar disorder, but it was the combination of hypomanic traits
and depressive symptoms that best predicted increased likelihood of experiencing bipolar
disorder.
Discussion
The results highlight the importance of investigating the underlying mechanisms of severe
mood instability. The findings support the manic defense hypothesis, which suggests that
manic symptoms emerge to offset underlying depressive mood. It was concluded that severe
mood instability emerges and is maintained because of the influence of developmental
interpersonal risk factors such as anxious insecure attachment. The latter fosters
dysfunctional cognitive features that promote the use of maladaptive emotion regulation
strategies, which in turn give rise to depressive mood, diminished well being and ultimately
increased risk to develop bipolar disorder. Thus, to better understand and treat bipolar
disorder it is important to focus on tackling these psychological aspects of the disorder.