Skip to main content

Let's Face It: Facial Emotion Processing Is Impaired in Bipolar Disorder

  • Tamsyn Elizabeth Van Rheenen (a1) (a2) and Susan Lee Rossell (a1) (a2)

Patients with bipolar disorder (BD) have difficulty in recognizing and discriminating facial emotions. However, beyond this broad finding, existing literature is equivocal about the specific nature of impairments, and progress toward adequately profiling facial emotion processing in BD is hampered by methodological inconsistencies. The current study aimed to advance the literature by comparing 50 BD patients and 52 controls on a series of facial emotion processing tasks. Results indicated that patients with BD had a small, yet consistent impairment in emotion processing overall. This impairment did not vary as a function of specific emotions, tasks, or intensities between groups, and was not influenced by current mood state. These results suggest that past inconsistencies in the literature are unlikely to be attributable to task related artifacts influencing the estimation of an effect. These findings add to our understanding of social cognition in BD, and have important implications for clinicians treating patients with the disorder. (JINS, 2014, 20, 1–9)

Corresponding author
Correspondence and reprint requests to: Tamsyn Van Rheenen, Cognitive Neuropsychiatry Lab, Monash Alfred Psychiatry research centre (MAPrc), Level 4, 607 St Kilda Rd, Melbourne, VIC 3004, Australia. E-mail:
Hide All
Abrosoft (2012). Fantamorph.
Addington J., Addington D. (1998). Facial affect recognition and information processing in schizophrenia and bipolar disorder. Schizophrenia Research, 32, 171181.
Ambadar Z., Schooler J.W., Cohn J.F. (2005). Deciphering the enigmatic face. Psychological Science, 16, 403410. doi:10.1111/j.0956-7976.2005.01548.x
Bozikas V.P., Tonia T., Fokas K., Karavatos A., Kosmidis M.H. (2006). Impaired emotion processing in remitted patients with bipolar disorder. Journal of Affective Disorders, 91, 5356.
Brotman M.A., Guyer A.E., Lawson E.S., Horsey S.E., Rich B.A., Dickstein D.P., Leibenluft E. (2008). Facial emotion labeling deficits in children and adolescents at risk for bipolar disorder. American Journal of Psychiatry, 165, 385389.
Brotman M.A., Skup M., Rich B.A., Blair K.S., Pine D.S., Blair J.S., Leibenluft E. (2008). Risk for bipolar disorder is associated with face processing deficits across emotions. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 14551461.
Derntl B., Seidel E.-M., Kryspin-Exner I., Hasmann A., Dobmeier M. (2009). Facial emotion recognition in patients with bipolar I and bipolar II disorder. British Journal of Clinical Psychology, 48, 363375. doi:10.1348/014466509×404845
Ekman P., Friesen W.V. (1976). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists Press.
Feinberg T.E., Rifkin A., Schaffer C., Walker E. (1986). Facial discrimination and emotional recognition in schizophrenia and affective disorders. Archives of General Psychiatry, 43, 276279. doi:10.1001/archpsyc.1986.01800030094010
Getz G.E., Shear P.K., Strakowski S.M. (2003). Facial affect recognition deficits in bipolar disorder. Journal of the International Neuropsychological Society, 9, 623632.
Gray J., Venn H., Montagne B., Murray L., Burt M., Frigerio E., Young A.H. (2006). Bipolar patients show mood-congruent biases in sensitivity to facial expressions of emotion when exhibiting depressed symptoms, but not when exhibiting manic symptoms. Cognitive Neuropsychiatry, 11, 505520. doi:10.1080/13546800544000028
Guyer A.E., McClure E.B., Adler A.D., Brotman M.A., Rich B.A., Kimes A.S., Leibenluft E. (2007). Specificity of facial expression labeling deficits in childhood psychopathology. Journal of Child Psychology and Psychiatry, 48, 863871. doi:10.1111/j.1469-7610.2007.01758.x
Harmer C.J., Grayson L., Goodwin G.M. (2002). Enhanced recognition of disgust in bipolar illness. Biological Psychiatry, 51, 298304.
Hoertnagl C.M., Muehlbacher M., Biedermann F., Yalcin N., Baumgartner S., Schwitzer G., Hofer A. (2011). Facial emotion recognition and its relationship to subjective and functional outcomes in remitted patients with bipolar I disorder. Bipolar Disorders, 13, 537544. doi:10.1111/j.1399-5618.2011.00947.x
Lembke A., Ketter T.A. (2002). Impaired recognition of facial emotion in mania. American Journal of Psychiatry, 159, 302304.
Martino D.J., Strejilevich S.A., Fassi G., Marengo E., Igoa A. (2011). Theory of mind and facial emotion recognition in euthymic bipolar I and bipolar II disorders. Psychiatry Research, 189, 379384. doi:10.1016/j.psychres.2011.04.033
Montgomery S.A., Asberg M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
Neurobehavioral Systems Inc (2012). Presentation, Version 14.8.
Rossell S.L., Van Rheenen T.E., Groot C., Gogos A., Joshua N.R. (2013). Investigating affective prosody in psychosis: A study using the Comprehensive Affective Testing System. Psychiatry Research, 210, 896900. doi:10.1016/j.psychres.2013.07.037
Samamé C., Martino D.J., Strejilevich S.A. (2012). Social cognition in euthymic bipolar disorder: Systematic review and meta-analytic approach. Acta Psychiatrica Scandinavica, 125, 266280. doi:10.1111/j.1600-0447.2011.01808.x
Schaefer K.L., Baumann J., Rich B.A., Luckenbaugh D.A., Zarate C.A. Jr (2010). Perception of facial emotion in adults with bipolar or unipolar depression and controls. Journal of Psychiatric Research, 44, 12291235.
Schenkel L.S., Pavuluri M.N., Herbener E.S., Harral E.M., Sweeney J.A. (2007). Facial emotion processing in acutely ill and euthymic patients with pediatric bipolar disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 10701079.
Sheehan D.V., Lecrubier Y., Harnett Sheehan K., Amorim P., Janavs J., Weiller E., Dunbar G.C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59, 2233.
Summers M., Papadopoulou K., Bruno S., Cipolotti L., Ron M.A. (2006). Bipolar I and bipolar II disorder: Cognition and emotion processing. Psychological Medicine, 36, 17991809.
Van Rheenen T.E., Rossell S.L. (2013a). Genetic and neurocognitive foundations of emotion abnormalities in bipolar disorder. Cognitive Neuropsychiatry, 18, 168207. doi:10.1080/13546805.2012.690938
Van Rheenen T.E., Rossell S.L. (2013b). Is the non-verbal behavioural emotion-processing profile of bipolar disorder impaired? A critical review. Acta Psychiatrica Scandinavica, 128, 163178. doi:10.1111/acps.12125
Vaskinn A., Sundet K., Friis S., Simonsen C., Birkenæs A.B., Engh J.A., Andreassen O.A. (2007). The effect of gender on emotion perception in schizophrenia and bipolar disorder. Acta Psychiatrica Scandinavica, 116, 263270. doi:10.1111/j.1600-0447.2007.00991.x
Vederman A.C., Weisenbach S.L., Rapport L.J., Leon H.M., Haase B.D., Franti L.M., McInnis M.G. (2012). Modality-specific alterations in the perception of emotional stimuli in bipolar disorder compared to healthy controls and major depressive disorder. Cortex, 48, 10271034.
Venn H.R., Gray J.M., Montagne B., Murray L.K., Michael Burt D., Frigerio E., Young A.H. (2004). Perception of facial expressions of emotion in bipolar disorder. Bipolar Disorders, 6, 286293. doi:10.1111/j.1399-5618.2004.00121.x
Walker E., McGuire M., Bettes B. (1984). Recognition and identification of facial stimuli by schizophrenics and patients with affective disorders. British Journal of Clinical Psychology, 23, 3744. doi:10.1111/j.2044-8260.1984.tb00624.x
Young R., Biggs J., Ziegler V., Meyer D. (1978). A rating scale for mania: Reliability, validity and sensitivity. The British Journal of Psychiatry, 133, 429435. doi:10.1192/bjp.133.5.429
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 10
Total number of PDF views: 46 *
Loading metrics...

Abstract views

Total abstract views: 251 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th November 2017. This data will be updated every 24 hours.