Elevated amygdala responses to emotional faces in youths with chronic irritability or bipolar disorder

Laura A. Thomas, Pilyoung Kim, Brian L. Bones, Kendra E. Hinton, Hannah S. Milch, Richard C. Reynolds, Nancy E. Adleman, Abigail A. Marsh, R. J.R. Blair, Daniel S. Pine, Ellen Leibenluft

Research output: Contribution to journalArticlepeer-review

43 Scopus citations


A major controversy in child psychiatry is whether bipolar disorder (BD) presents in children as severe, non-episodic irritability (operationalized here as severe mood dysregulation, SMD), rather than with manic episodes as in adults. Both classic, episodic BD and SMD are severe mood disorders characterized by deficits in processing emotional stimuli. Neuroimaging techniques can be used to test whether the pathophysiology mediating these deficits are similar across the two phenotypes. Amygdala dysfunction during face emotion processing is well-documented in BD, but little is known about amygdala dysfunction in chronically irritable youth. We compared neural activation in SMD (n = 19), BD (n = 19), and healthy volunteer (HV; n = 15) youths during an implicit face-emotion processing task with angry, fearful and neutral expressions. In the right amygdala, both SMD and BD exhibited greater activity across all expressions than HV. However, SMD and BD differed from each other and HV in posterior cingulate cortex, posterior insula, and inferior parietal lobe. In these regions, only SMD showed deactivation in response to fearful expressions, whereas only BD showed deactivation in response to angry expressions. Thus, during implicit face emotion processing, youth with BD and those with SMD exhibit similar amygdala dysfunction but different abnormalities in regions involved in information monitoring and integration.

Original languageEnglish
Pages (from-to)637-645
Number of pages9
JournalNeuroImage: Clinical
Issue number1
StatePublished - 2013


  • Amygdala
  • Bipolar disorder
  • Emotion
  • Face
  • Severe mood dysregulation


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