The clinical significance of emotional urgency in bipolar disorder: A scoping review

Abstract

Abstract Background. Emotional urgency, defined as a trait concept of emotion-based impulsivity, is at least moderately associated with general psychopathology. However, its clinical significance and associations with clinically relevant features of bipolar disorder is unclear. This scoping review aims address this gap by determining the extent of evidence in a niche scope of study. Methods. Evidence of between-group differences of positive and negative urgency, its associations with mood severity, and all peripheral associations related to illness and psychosocial outcomes were synthesized based on PRISMA checklists and guidelines for scoping reviews (PRISMA-ScR). Design. Electronic databases were searched of articles published between January 2001 and May 2023. An initial search yielded 999 entries; a total of 10 articles were selected for this review. Results: Differences in urgency scores between bipolar disorder and healthy controls were large (Cohen’s d ranged from 1.77 to 2.20). Negative urgency was at least moderately associated with overall trauma, emotional abuse, neglect, suicide ideation, neuroticism, and irritable/cyclothymic temperament, whereas positive urgency was at least moderately associated with various aspects of aggression and quality of life. Positive but not negative urgency was associated with quality of life. Conclusion: Large between-group differences found for emotional urgency in bipolar disorder imply large clinical significance. Emotional urgency was associated with clinical features indicating worser features and outcomes. Given the high clinical heterogeneity of the disorder, emotional urgency may be an important phenotype indicative of greater disorder severity.