Wednesday, May 31, 2006

Do Bipolar Youth Misread Faces?

Web MD points out an interesting study that found that bipolar youth may see hostility even in faces that are neutral:

Compared with those without bipolar disorder, bipolar youths gave higher hostility ratings to the neutral faces and reported being more fearful of those faces, the study shows.

While viewing the neutral faces, bipolar youths' fMRI brain scans showed more activity in the left amygdala, a brain area related to fear, compared with the brain scans of nonbipolar participants.

Which came first: bipolar disorder or seeing hostility in neutral faces? The study doesn't answer that question. It also doesn't show whether bipolar participants felt more irritable or aggressive after viewing neutral faces.


In my clincial experience, I often find that bipolar youth, particularly those who are aggressive, tend to misread social cues--that is, they perceive actual situations as worse than they are or read into people's actions or expressions, more hostility and threatening behavior than is actually there. For example, if someone stares at them, they may perceive it as a threat rather than a look of curiosity. Often a youth who is poor at reading other people's behavior will strike out aggressively in a case where aggression is not called for--whether that is because of fear or anger, or both is sometimes hard to tease out. Teaching youth who are bipolar or potentially aggressive to read faces, nonverbal movements and social interactions more clearly is a first step to teaching better coping skills.

46 Comments:

Blogger TMink said...

Interesting study. I wonder if folks with bipolar afective disorder are capable of using logic to overcome their paranoia. Some folks with BAD have trouble just taking their medicine and then there are people who have very difficult symptoms and fight against them succesfully. I tend to think that the brain dysfunction of the disorder preceedes the perceptive errors.

Trey

10:54 AM, May 31, 2006  
Blogger Helen said...

Trey,

Perhaps, but it is hard to know what comes first--the cognitive error or the brain dysfunction. Maybe they play off of each other. I have found that with some bipolar patients, using cognitive behavioral restructuring--that is, having the patient reframe the thought about a social situation etc. can calm some of the behavior--at least to the point where it can be controlled. This is different than using logic.

I agree that medication is a big issue. Many bipolar patients do not want to take their meds--it flattens their affect out too much--they miss the highs of mania.

11:29 AM, May 31, 2006  
Anonymous Randy said...

Is there any evidence to suggest that people that can be taught to "read" faces or appropriately interpret non-verbal movements?

11:52 AM, May 31, 2006  
Blogger Helen said...

Randy,

Cognitive behavioral therapy teaches patients to deal with interpersonal conflicts. It is not as much a matter of always learning exactly what other people mean but how to control anger once you feel it. For example, if a patient sees someone at the mall who they interpret "looks at them the wrong way" and they feel fear, then anger and an overwhelming urge to hit the other person, techniques such as cooling down, walking away, telling themselves that the person is curious, not threatening can help. The point is, that much of the anger and aggressiveness that stems from misinterpretation of social cues is either not necessary because it is based on a false interpretation or even if true--the anger may be out of proportion to the circumstances. And Paul Elkman, a renowned expert in emotions and nonverbal communications, teaches people to read faces, he has a good book, "Telling Lies" that talks about reading faces.

12:03 PM, May 31, 2006  
Blogger Dr. Melissa said...

Autistic kids have this problem, too. Any eye contact is perceived as aggression. Forget the facial expression--just meeting their eyes. While many behavioral programs no longer emphasize eye-contact, I think it's imperative. There must be a desensitization of eye contact so the child doesn't miss so many visual cues.

The interesting thing about Autistic kids, though, is that while they might not sense through vision another person's emotional state, they seem to intuit--much as an animal does--another's emotional state. My son almost always knows how someone feels even when he doesn't make eye contact.

The bi-polar people seem to lack this ability. They enjoy the la-la land. It is self-reinforcing. Even the depression has a pay-off--everyone else must jump through hoops for the person. I wonder how much of the swinging behavior is caused by biochemical swings or if the behavior itself causes the biochemical swings. I think the latter is true more often than the psychological profession would care to admit.

Simple experiments showing biochemical changes just from change facial expressions (i.e. smiling makes someone feel happy and changes biochemistry). Wouldn't the more extreme behavior create more extreme biochemistry?

12:07 PM, May 31, 2006  
Blogger TMink said...

Hey Helen,
I agree with you, and certainly the mind/body/experience systems have more in common than they are separate, but I think I am becoming a bit of an amateur neurologist! In the contiuum of bipolar, some folks are SO affect driven that CBT is not as helpful as with people whose affective system is not so disordered.
I do tend to think of CBT as applied logic, I mean that as a compliment! Figuring out or accepting that the problem is the illness not the other person is hard and I guess you can color me hopefully skeptical about CBT in some cases of bipoar.
As for meds, I figure that one third of the time the person with bipolar feels really ok and one third of the time they feel that they do not deserve the meds and one third of the time who are those stupid doctors to tell them that they are sick anyway. So it makes sense that medication compliance is difficult. And hypomania can be really fun. They feel alive and people love being around them and life is a party. It is difficult at times to not envy the hypomanic episodes till I think about the horrid depression and real mania that goes with it.

Trey

12:14 PM, May 31, 2006  
Anonymous Randy said...

So, contra to Dr. Helen's assertion in her original post, people cannot be taught to "read" faces or appropriately interpret non-verbal movements. They can only be taught to dampen their responses
As someone with Autistic Spectrum Disorder, I haven't learned non-verbal communication, even after trying for 54 years.

12:19 PM, May 31, 2006  
Blogger Dr. Melissa said...

Randy,
Paul Eckman, as far as I know, has not tried to teach non-verbal facial cues to anyone on the Autism Spectrum or someone psyche disordered, either.

Perhaps the teaching came too late. Asperger's Syndrome folks and High Functioning Autistic folks can often gain amazing skills when intervened with at a young age. The key is WHERE you look. Autism Spectrum people find direct eye-gazing almost impossibly uncomfortable--where a huge percentage of non-verbal cues come from. They end up looking at shoulders or some fixed object.

A dear friend of mine uses subtitles in English when watching a movie so he doesn't miss what is happening. He simply misses so much of the message because he can't look at the faces.

12:34 PM, May 31, 2006  
Anonymous Anonymous said...

Who misses the message?

You might be surprised.

1:28 PM, May 31, 2006  
Blogger Michele said...

There are a lot of children that have Asperger's that are first suspected of being Bi-polar (this is only from what I've read, I'm no expert), maybe this has a lot to do with it. My aspie used to laugh when I would get angry with her because I would get two vertical lines on my forehead (scrunching my eyebrows together). She called them my "elevens". She still has no clue that someone is angry with her, or will become angry, unless you say "I am angry." I suspect the mis-diagnosis comes from autistics not understanding how to express or interperet subtle emotions, and, in my case, having poor self-control. With my daughter I see "rage" and "delirously happy." Are bi-polar and autism related, I wonder?

1:55 PM, May 31, 2006  
Anonymous Anonymous said...

And of course those intentionally misdiagnosed - in an attempt to avoid civil and criminal liability - will not be effected by any of this. It will just be more smokescreen and rent-seeking by certain parties.

2:52 PM, May 31, 2006  
Blogger Michele said...

Another thing came to me after reading your post. This would explain why it is especially important to keep autistic kids out of special classes for kids with emotional disturbance. Both sets of kids have trouble with reading expressions. One set is hypersensitive to facial cues that may be neutral. The other set tends to have a permanent neutral expression, and and difficulty "couching" their words. Someone would end up being the punching bag. Neither would learn any beneficial social skills from this arrangement.
I had a school psychologist tell me it didn't matter whether your kid had a diagnosis of E.D. or Autism, as long as they got identified as having a disability by the school system. But I think mis-idenification could really endanger children, especially if they were to be placed in a program apart from the mainstream class environment.

3:49 PM, May 31, 2006  
Blogger Wickedpinto said...

No realy comment, but it makes me think of something that madame Ann said about how she was on a train in Wisconsin, and someone said "why is everyone smiling?" even though noone was, it was just that that person somehow saw the neutral faces on the train as joyous, but Ann just saw faces.

And I think she just posted that yesterday. Kinda interesting coinkindinkification.

4:15 PM, May 31, 2006  
Anonymous Anonymous said...

Very rare that I get to comment about this, but I do face/object recognition research in a cog neuroscience program.

It's true that autistic spectctrum disorder (ASD) kids are also very face-reading impaired. (some like the one Michele mentioned may even have prosopagnosia- the inability to decipher face information). A Yale researcher (Bob Schultz) found that one ASD patient's "face area" of their brain activated when he was looking at Pokemon figures. Schizophrenics, too, are poor at face reading and show different face processing in the brain. It sounds like with all of these there might be some sort of improper interaction with the amygdala which provides "proper" emotional valence with faces most of the time. The problem is that it all feeds back to the brain's lower levels and often reinforces these learned mistakes.

About a year ago Time did a brain and behavior issue on this stuff (where I also found the Schultz study). A guy named Jim Tanaka at the Univ of Victoria in Canada has developed a video game that helps train ASD kids to be better at reading faces. Hopefully, that will turn out well.

One other thing: these differences in face processing can be detected as fast as 160-180ms after seeing a face. It would be very time consuming to un-learn this stuff.

4:37 PM, May 31, 2006  
Anonymous LissaKay said...

Having lived here in Bipolarville with my son for the past 5 years, I can attest to the fact that kids with bipolar have difficulties not only with interpreting facial signs and cues, but also with their reaction to what they think they see. My son would fly into the most incredible rages at the slightest provocation. It almost seemed like paranoia, but not quite ... he would insist that friends, teachers, etc all hated him, that all the neighbors were out to get him in trouble, everyone lies about him. No amount of reasoning would break through. No, the boy who came over to invite him to play basketball was really out to get him some how.

The bipolar mind operates in a way that is completely baffling to others. The way they think, reason and use logic is not the same as it is for others. They think in black and white terms, no shades of gray. Completely linear thinking, but with disconnects ... cause and effect progression from A to B to C to D. They get distressed because they can't see the progression, and only see A resulting in D.

The executive functioning is totally messed up. That is the part of our brain that we use to determine the probably outcome of an action ... using information gathered in the past along with new information from the situation at hand, and making a probability judgment on the outcome of the action about to occur. We learn early on that putting our hand on the hot stove is a bad idea. Kids with bipolar disorder keep reaching out for it, even after being burned several times.

I am a huge fan of Dr Papalos, the author of The Bipolar Child. Visit his site, http://www.bipolarchild.com/ and read some of his articles. He has an amazing way of explaining the unexplainable. Bipolar is a whole lot more than just mood swings. It's a whole different way of thinking.

10:24 PM, May 31, 2006  
Blogger Wickedpinto said...

Let me say this? I think "psychology" is nothing more than "enforced philosophy?"

there is a LOT of help that informed philosophers might offer, but in general? I think psychology is a joke.

No offense lady helen, I just believe that the environment of most, can be fixed if those said same individuals are allowed to READ.

1:50 AM, June 01, 2006  
Anonymous Anonymous said...

wickedpinto,

What are you talking about? I think your post is missing a few words. (And even with them I doubt it would make a ton of sense.)

Hmmm...1:50AM....perhaps a few too many "wicked pintos"? :)

2:43 AM, June 01, 2006  
Blogger Wickedpinto said...

In terms of "children" I would say that they need less "treatment, and cousel" than they need. . . well, parents.

We are not a generation of psycho's, but rather, my generation, is a generation of. . .

really nothing.

We look for a thing and find NOTHING in our mother, we find NOTHING in our fathers, and ESPECIALY, despite our efforts, we find NOTHING in our schools.

The schools have taught our parents that they aren't necessary, but then the schools are absent.

I'm not at all impressed by teachers, and I think that parents shouldn't be as well.

2:48 AM, June 01, 2006  
Blogger jw said...

It wouldn't surprise me at all to find that bipolars have trouble reading others' body language. The same for other things like aspergers ...

I also think that there are some, who may well be diagnosed with bipolar, who read body language too well. My son and I find ourselves bombarded with data about those around us. Both of us need to withdraw to turn off the "noise."

I wonder how others "read" me. Due to being phototoxic/photophobia I wear a hat and dark glasses. Most of my face is not visible, my eyes are hidden.

Interesting stuff ...

5:10 AM, June 01, 2006  
Blogger TMink said...

My experience with young Asperger's Disordered patients is that many of them can learn to read emotions. But my work with them is largely pre-puberty. THe brain keeps growing until we are 25, but puberty brings on some important changes in plasticity (metaphorically speaking.)

So I do not know about post adolesence emotive recognition training with Asperger's Syndrome. I am wondering if the emotive recognition problems in bipolar are due to the patient's broken emotional thermostat. It is not so much a function of the emotive recognition centers of the brain, but is due to the disordered mood set of the brain. When the mood center is set to depressed, all data, including the emotive recognition data, is seen through this lens. Similarly, in a mixed state, the irritable mood colors the emotive recognition data in a different manner. THe test would be to identify the mood state of the patient and see what vector the cognitive distortions take. Is everyone happy with the patient when they are on the front side of a manic episode? Are they judgmental when the patient is depressed and aggressive when the patient is in a mixed state? Amateur neurologists want to know!

Trey

10:09 AM, June 01, 2006  
Anonymous Anonymous said...

Is this too simplistic?

Subject sees ambiguous face or behavior, gets a hostile reaction due to misreading, and "learns" that anything that cannot be identified with certainty is hostile.

Phillep

2:23 PM, June 01, 2006  
Blogger TMink said...

Actually, the role that mood plays in perception of ambiguous situations has been well documented. The original studies were conducted with depressed and non depressed subjects who rated faces significantly differently. Now, with advances in brain measurement, I bet someone has done the same type of study using direct brain measurement.

That mood effects perception is a fact.

Trey

3:31 PM, June 01, 2006  
Blogger Wickedpinto said...

Anonymous?

Yeah, I didn't articulate myself.

Pscychology, as a RESEARCH tool I appreciate completely. It is important to be able to understand the moment and psychology helps the psychologist to understand the individual a BIT more, and the situation MUCH more.

However, this idea that we can "fix people" which IS the basic goal of psychotherapy, I find offensive. Psychotherapy, is the desire of the therapist to impose their sense of what is right on the individual who they disagree with. Like in Star Trek 5 "My pain is my own, it makes me who I am, I don't want to let it go" "Closure" is a desire to force people to ignore who they are.

We are all flawed people, so if we are all flawed, why do psychotherapists think that they are LESS flawed than everyone else? Rather they actually EXPAND the flaws, by addressing attitude in flawed individuals, leaving the flaws in place, and including the flaws of the therapist themselves in the patient/guinee pig.

Resarch, and general understanding in psychology is all cool, but psychotherapy is just plane hackery.

Sorry if you are someone I offend lady helen, you don't come off like one of these world dominating egotists, but I bet you know a lot of them.

10:51 PM, June 01, 2006  
Blogger Sarebear said...

I'm often thinking my husband is mad at me, when it turns out he's not. But I can't seem to stop "reading" that in his expression, posture, mannerisms, and demeanor when he gets a certain way(s).

This post actually gave me a little bit of a bright spot to view my adolescence through, to maybe feel that HEY, this might explain part/alot of why I seemed to always be on a different page (most often a different chapter or book) than what others felt was going on, interpersonally/emotionally. In other words, it's not my ME-ness that's at fault here, but some biological/biochemical mistake in the brain, the bi-polarness, or it's effects on the brain/mind.

1:46 AM, June 02, 2006  
Blogger TMink said...

Wickedpinto typed: "However, this idea that we can "fix people" which IS the basic goal of psychotherapy, I find offensive. Psychotherapy, is the desire of the therapist to impose their sense of what is right on the individual who they disagree with."

Hmmm. I musta missed that class in grad school.

Trey

9:47 AM, June 02, 2006  
Blogger Wickedpinto said...

Yeah, I know, I started out with an actuall opinion, and then I somehow went out of my way to insult people who, in all honesty, I was trying to thank for talking realisticly about this crap.

But along the way I did everything in my power to screw this all up.

I'm sorry, I will take my lumps, since I deserve them, and be a little more rational and articulate from now on.

I really am sorry ya'all.

12:06 AM, June 03, 2006  
Blogger Wickedpinto said...

DOH! and I just did it again! "crap" should have been "stuff" the difference is "stuff" is tangible, and since this isn't and a more abstract situation, I resorted to my random word for "stuff" when I'm more irritated at myself. If I was irritated with others, it wouldn't have been "crap" that I used.

12:12 AM, June 03, 2006  
Blogger Wickedpinto said...

Yeah, you know what? The shovels in the shed and I'll just start climbing.

12:13 AM, June 03, 2006  
Anonymous Anonymous said...

Wow, thats very interesting that the study showed that.

I almost always saw hostility in people where it was not the case. I have also just recently been diagnosed with bipolar disorder, and I suspect I may have had it as a kid.

But, I remember the moment I realized that I was mis-interperting peoples social ques. I was in my freshman year of high school and, while I used to have a policy of being mean to anyone who I thought was being mean to me, I decided to be nice regardless of how I thought peopole were treating me. I was extremly suprised the first time I tried this, because the person I was nice to responded with shock and I realized that that guy wasn't neccessarily being mean to me.

I think it has a lot more to do with the fact that when your in a depressive kind of state, everything looks bad to you. So when theres something like a social que that is ambigous or neutral, you immediatly assume it to be the worst. Thats what I did. After all, it was like, why would anyone ever be nice to me? thats how I thought.

12:55 AM, September 30, 2006  
Anonymous MamaMia said...

This information is fascinating. As the step-parent of a twelve year old boy diagnosed with depression/ADHD and some LD, I find myself wondering more and more about possible bi-polar and/or aspergers or both? His pre-adolescent behavior mixed with his odd behavior is confusing. He seems to be in his own world most of the time, not conforming to household and family guidelines. He is primarily depressed, occassionaly happy and increasingly aggressive. He reads things into my neurtral looks like you all have been talking about. He has great difficulty completing tasks indpendently and fixates on doing certian hobbies that become his whole world. I find myself stuck in the middle of trying to teach him to follow structure and not wanting to push him too much for fear that he might have a break (he has been hospitalized once for depression/aggression). Sometimes he wrings his hands and makes anguished faces. Kids do not understand him. Does anyone have suggestions or comments? Does he sound as if he has bi-polar or aspergers?

4:59 PM, October 03, 2006  
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8:33 PM, April 23, 2007  
Blogger Clarissa said...

I am a nonviolent, nonaggressive 33-year-old with a bipolar 2 diagnosis who is thoroughly compliant about meds. I was diagnosed at 31, after roughly two decades of recurrent depression episodes that grew ever deeper, ever harder to reach with antidepressants.
The mild (hypo)mania I had on occasion was not easy to detect -- I was happy and ridiculously silly and witty and busy and I stayed up rather late working on projects that I loved.
I wasn't seeking drama, believe me -- I was just trying to live life, raise children, and be the best I could be, which wasn't much when the depression got so very bad. Praise God for treatment -- psychiatrists, psychologists, and the support of loving family and friends.

At any rate -- your information about misreading facial cues certainly struck home with me. Even as a child I remember a specific instance in the grocery store when I felt terrified of a couple I was certain wanted to kidnap me. What had happened? The woman smiled at me, and every time we passed in another aisle, she smiled again. That's all. But I perceived that smile as a threat -- a "What a cute little girl, I want her so I'll keep smiling, get her to like me, talk to her and whisk her away before anyone notices." Of course, we left without mishap ... I don't think I ever even told anyone. But I still remember the cold chills of fear -- and I never went to that store again when given a choice.

And the comment you made above about thinking people are looking at you in the mall -- that was my adolescence -- even much of my adulthood to date. I've been through enough therapy now to realize that the whole world is not about me, that everyone in the mall can't possibly be looking at me with disgust or laughing at me on the inside. But I hadn't come to that realization as a teen, and it was honestly nightmarish to go to a place like a mall or even my high school which was quite open and exposed.

I could think of example after example -- thinking about this has so many of them flooding back to me.

And I still struggle. But onward I go!

One of my first-degree relatives seems to have either bipolar disorder, Asperger's, or some kind of adjustment disorder -- he's another difficult-to-diagnose case. So reading about all this has also been interesting with him in mind.

And, by the way, we both had wonderful parents AND teachers.

9:22 PM, June 07, 2007  
Blogger Kim said...

I am reading these comments and I agree with wicked pinto on psychologist. the one who said he must have missed that in graduate school, the one psych i think mink, shows the egostical therapist that he is and many are. I will take a psychiatrist over any psychologist any day hands down

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