The forgotten affective route of social cognition in patients with bipolar disorders

Social cognition (SC) research in bipolar disorders (BD) has provided evidence about deficits in different phases of the illness. Most of the studies have focused on two aspects of SC: theory of mind and emotion recognition. However, according to influential models of social neuroscience, two aspects of understanding others need to be distinguished: the cognitive (theory of mind and emotion recognition) and the affective route (empathy and compassion) of SC. We aimed to determine whether individuals with BD significantly differ from healthy controls on measures of the affective route of SC according to the available evidence. We conduct a narrative review of original research based on a social neuroscience model of SC. BD is associated with alterations of the affective route of SC during acute episodes and remission. During mania and subthreshold depression, an increase in empathy (“over-empathizing”) and discomfort (empathy) has been reported, respectively. A pattern of high empathic distress and low compassion appears during remission. This article is the first to review the evidence on the affective route of SC in BD, revealing trait and state alterations. We emphasize the need to consider this affective dimension of SC in future research, to design more specific interventions in BD patients.