Future Directions for Understanding Adolescent Bipolar Spectrum Disorders: A Reward Hypersensitivity Perspective

Abstract

The idea that bipolar spectrum disorders (BSDs) are characterized by enhanced sensitivity to rewarding stimuli is at the core of the reward hypersensitivity model, one of the most prominent and well-supported theories of BSDs. In this article, we present the reward hypersensitivity model of BSDs, review evidence supporting it, discuss its relevance to explaining why BSDs typically begin and consolidate during the period of adolescence, and consider three major unresolved issues for this model that provide important directions for future research. Finally, we present integrations of the reward hypersensitivity model with circadian rhythm and immune system models that should provide greater understanding of the mechanisms involved in BSDs, and then suggest additional directions for future research deriving from these integrated models.

Figure 1.

Reward Hypersensitivity Model of Bipolar Specturm Disorders Adapted from Alloy, Nusslock, & Boland (2015). Annual Review of Clinical Psychology, 11, 213–250. Note: The model is conceptual and not a path diagram.

Figure 2.

Integrated Reward Circadian Rhythm (RCR) Model of Bipolar Specturm Disorders Adapted from Alloy, Nusslock, & Boland (2015). Annual Review of Clinical Psychology, 11, 213–250. (Dashed lines indicate mediation) Note: The model is conceptual and not a path diagram.

Figure 3.

Integrated Reward-Inflammation Model of Unipolar Depression and Bipolar Disorder Symptoms Note: The model is conceptual and not a path diagram.