Facial emotion recognition and its relationship to subjective and functional outcomes in remitted patients with bipolar I disorder

Abstract

Outcome in bipolar disorder (BD) is multidimensional and consists of clinical and psychosocial domains. Difficulties in affect recognition and in emotional experience are a hallmark of BD, but there is little research investigating the consequences of this deficit on the psychosocial status of patients who are in remission. This cross-sectional study examined the relationship of facial affect recognition and treatment outcomes in terms of psychopathology, quality of life, and psychosocial functioning in remitted BD patients compared to healthy volunteers. Altogether, 47 outpatients meeting diagnostic criteria for bipolar I disorder according to DSM-IV and 45 healthy control subjects were included in the study. Patients were particularly impaired in the recognition of facial expressions depicting disgust and happiness. For patients, the most frequently observed misidentifications included disgusted faces misrecognized as angry expressions, fearful faces misrecognized as disgusted or surprised expressions, surprised faces misrecognized as fearful expressions, and sad faces misrecognized as fearful or angry expressions. Regarding emotional experience, shame, guilt, sadness, fear, lifelessness, loneliness, and existential fear were experienced more intensely by patients. These findings demonstrate deficits in experiencing and recognizing emotions in BD patients who are in remission and underscore the relevance of these deficits in the psychosocial context.