Positive overgeneralization and Behavioral Approach System (BAS) sensitivity interact to predict prospective increases in hypomanic symptoms: A behavioral high-risk design

Recent work has identified Behavioral Approach System (BAS) sensitivity as a risk factor for the first onset and recurrence of mood episodes in bipolar disorder, but little work has evaluated risk factors for the prospective development of hypomanic symptoms in individuals at risk for, but without a history of, bipolar disorder. The present study used a prospective behavioral high-risk design to evaluate the impact of positive overgeneralization, a cognitive correlate of risk for hypomania, on hypomanic symptoms in individuals with high vs. moderate BAS sensitivity, but without a history of mood elevation. Hierarchical linear regressions indicated that upward positive overgeneralization and BAS sensitivity interacted to predict increased levels of hypomanic symptoms at follow-up, controlling for initial hypomanic symptoms. The pattern of this interaction was such that positive overgeneralization predicted higher levels of hypomanic symptoms among high-BAS, but not moderate-BAS, individuals. Thus, the self-reported tendency to experience grandiose increases in confidence following success may confer additional risk for mood elevation among individuals already at risk for developing bipolar disorder. Potential implications for prevention and treatment are discussed.

► We prospectively evaluated risk factors for the development of hypomanic symptoms.
► We used a sample at high versus low risk for the first onset of bipolar disorder.
► Upward positive overgeneralization (POG) predicted increases in hypomanic symptoms.
► POG only predicted hypomanic symptoms among high-BAS individuals.
► POG may confer additional risk for developing mood elevation.