Do I Disgust You? The Visual Missed Cues of Bi-Polar Patients

Did you ever get the feeling that someone didn’t like you? I mean–really, really didn’t like you, perhaps even saw you as beneath contempt? And–did you get that feeling before there was any interaction between you and the aforesaid person? Just, maybe, from a look on his or her face? Are you also, by chance, bipolar?

If so, your interpretation may very likely be totally wrong.  For, you see, bipolar (or BD) people have what researcher Catherine Harmer and her team call “an enhanced recognition of facial expressions of disgust,” meaning they see disgust in people’s faces, even when it isn’t there.

While it pretty much goes without saying that those in the depressive phase of the illness would mis-interpret facial expressions as negative (see (Gray et al., 2006), the (unpleasant) surprise was how poorly those who were ‘well’ did.

Harmer, et. al., looked at 20 patients aged 24-29 years, all of whom were what is termed ‘euthymic, (that’s just fancy talk for what we would basically define as ‘normal,’ meaning not depressed, not manic), for at least 6 months (in bipolar land, that’s an eternity). The researchers showed their subjects faces [kind of like the ones below] expressing 6 different emotions–happiness, surprise, sadness, fear, anger, and disgust, taken from the Ekman and Friesen Pictures of Affect Series (1976). Subjects were to assess the facial expression of faces presented on a computer as quickly and accurately as possible.

I hate to give away the ending so soon, but, in short, the BD subjects had a “statistically significant” impairment in accurately recognizing facial expressions.  This finding is in good company.

Lahera et al (2012) used the Facial Emotion Recognition Test on 39 euthymic outpatients and found a “significant impairment in facial emotion recognition compared with a similar sample of healthy volunteers.”

In 2000, Yurgelun-Todd et al chose only happy or fearful faces for 14 BD patients to identify.  A paltry 10 of the 14 were capable of accurately identifying the fearful faces, a tendency which was affirmed by Bozikas et al‘s (2007) work.  Other research revealed those with BD to be less accurate at identifying surprised faces.

Of course you might just be thinking, “and who really cares?”–and I wouldn’t blame you.  But actually the finding has some pretty serious repercussions.


Clearly, judging facial expressions is an important part of social interactions. Turns out that, even during periods of remission or euthymia, those with BD do not just suffer from cognitive impairment (in case you had forgotten, I went to town on that topic in the oh-so-cleverly titled “Bipolar Disorder and Cognitive Impairment“) as well as occupational impairment (never fear–I have plenty to say on this topic, too, if you’re curious, but I warn you this it isn’t pretty)–but I now I find they have social impairment, as well.

Along come Agustin Ibanez and his colleagues (2012) to tell us that “Recent studies of BD have reported social cognition deficits and emotional impairments.” Wouldn’t want to miss out on anything, would we? And what’s the example they give? That emotional responses to pictures or faces are impaired. Very nice.

And apparently this is all pretty well-known. A 2012 piece in NewsMedical, “Social cognition impaired in bipolar disorder patients,” reported on a different study that followed along the same lines.  25 BD subjects had to interpret facial expressions (in this case they utilized the Reading the Mind in the Eyes Test [RMET], where 36 sets of eyes depict mental states, and the subject is asked to describe that state). Once again, those with BD were significantly less accurate when compared to the controls.  And–this is important here–researchers correlated poorer scores on the cognitive tests with “reduced psychosocial functioning.”

And now let’s get back to Hammer, et. al., for a moment to add an additional layer.  There was that something they found in their work that they didn’t expect to find–and that has negative implications for those suffering from BD (I mean more negative implications). It wasn’t just that those with BD were worse at recognizing facial expressions. That’s old hat. Rather–remember? From the beginning?–in comparison to the control group, “bipolar patients detected more of the disgusted facial expressions while mislabeling significantly fewer other facial expressions,” or, in other words, the bipolar group “showed enhanced recognition of facial expressions of disgust.”

And, in fact, that’s easy to imagine.  If you look at faces and see disgust where there isn’t any, well, you’re not going to feel that great about yourself, and probably not going to venture forward in a number of social circumstances. Harmer, et. al., (going way out on a limb here) suggest the tendency to see disgust that isn’t there “could be associated with low self-esteem and increased anxiety.”

If we juxtapose this reading of disgust with the fact that those with BD have been found to demonstrate “significantly higher levels of. . .need for approval” (Scott et al 2000) than the general population, it should come as no surprise that those with BD, according to Depp et al (2013):

  • Have fewer social interactions than healthy comparison subjects;
  • have smaller social networks  than control groups; and
  • are less likely to achieve significant social milestones (such as marriage or civil unions) than the population at large.

I don’t know, but it sure makes you wonder. . .isn’t there any way to practice identifying faces or something?

If you need me as a model, I could volunteer as a model.  I’ll take, um, sadness, fear, and anger.


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