Risk for bipolar disorder is associated with face-processing deficits across emotions

Melissa A. Brotman, Martha Skup, Brendan A. Rich, Karina S. Blair, Daniel S. Pine, James R. Blair, Ellen Leibenluft

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


Objective: Youths with euthymic bipolar disorder (BD) have a deficit in face-emotion labeling that is present across multiple emotions. Recent research indicates that youths at familial risk for BD, but without a history of mood disorder, also have a deficit in face-emotion labeling, suggesting that such impairments may be an endophenotype for BD. It is unclear whether this deficit in at-risk youths is present across all emotions or if the impairment presents initially as an emotion-specific dysfunction that then generalizes to other emotions as the symptoms of BD become manifest. Method: Thirty-seven patients with pediatric BD, 25 unaffected children with a first-degree relative with BD, and 36 typically developing youths were administered the Emotional Expression Multimorph Task, a computerized behavioral task, which presents gradations of facial emotions from 100% neutrality to 100% emotional expression (happiness, surprise, fear, sadness, anger, and disgust). Results: Repeated measures analysis of covariance revealed that, compared with the control youths, the patients and the at-risk youths required significantly more intense emotional information to identify and correctly label face emotions. The patients with BD and the at-risk youths did not differ from each other. Group-by-emotion interactions were not significant, indicating that the group effects did not differ based on the facial emotion. Conclusions: The youths at risk for BD demonstrate nonspecific deficits in face-emotion recognition, similar to patients with the illness. Further research is needed to determine whether such deficits meet all the criteria for an endophenotype.

Original languageEnglish (US)
Pages (from-to)1455-1461
Number of pages7
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number12
StatePublished - Dec 2008
Externally publishedYes


  • At risk
  • Bipolar disorder
  • Endophenotype
  • Face emotion labeling

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health


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