Beck (1983) proposed that individuals in a manic phase can exhibit an autonomous tendency and individuals in a depressive state can exhibit a tendency towards over-dependence upon others. Within the cognitive model framework, it is also postulated by Lam et al. (1999) that extreme achievement-orientated attitudes in bipolar affective disorder might lead to extreme striving behaviour and irregular daily routine. Lam et al. (in press) carried out a principal component analysis of the Dysfunctional Attitude Scale for 143 bipolar 1 patients. Four factors were derived: (1) "goal-attainment", (2) "dependency", (3) "achievement" and (4) "antidependency". No significant differences were found when the validation sample was compared with 109 patients suffering from unipolar depression in any of the four factors. However, the DAS scores correlated significantly with the depression scores. When subjects who were likely to be in a major depressive episode were excluded and any residual depression symptoms controlled for, the scores of bipolar patients were significantly higher than euthymic unipolar patients in factor 1 ("goal-attainment") and factor 4 ("antidependency").
The goal-attainment subscale appears to capture the risky attitudes described earlier. Examples of the goal-attainment subscale are as follows: "I should be happy all the time", "A person should do well at everything he undertakes", "I ought to be able to solve problems quickly and without a great deal of effort" and "If I try hard enough, I should be able to excel at anything I attempt". The antidependency subscale consists of two items (see Figure 12.1), which are congruent with the tendency towards autonomy proposed previously.
Lametal. also found that, as postulated by Beck (1983), depressed bipolar patients exhibit similar dependency needs to those expressed by patients suffering from unipolar depression. However, in this study, the euthymic bipolar subjects also endorsed beliefs centring on antidependency, and to a significantly greater extent than did the euthymic unipolar subjects. This difference remained despite the inclusion of those subjects with depressive symptoms. Hence, the evidence suggests that bipolar individuals may have ambivalent attitudes of wanting to depend on and validate their personal worth via others and yet at the same time want to be independent from others.
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