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How is affective instability defined and measured? A systematic review

Published online by Cambridge University Press:  27 September 2013

S. Marwaha ,
Z. He ,
M. Broome ,
S. P. Singh ,
J. Scott ,
J. Eyden  and
D. Wolke
S. Marwaha*
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
Z. He
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
M. Broome
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
S. P. Singh
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
J. Scott
Affiliation:
Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK FondaMental Foundation, Fondation de Coopération Scientifique Hôpital A. Chenevier, Creteil, France INSERM, U 955, IMRB, Psychiatry Genetic, Creteil, France
J. Eyden
Affiliation:
Department of Psychology, University of Warwick, Coventry, UK
D. Wolke
Affiliation:
Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK Department of Psychology, University of Warwick, Coventry, UK
*
*Address for correspondence: Dr S. Marwaha, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. (Email: S.Marwaha@warwick.ac.uk)
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Abstract

Background

Affective instability (AI) is poorly defined but considered clinically important. The aim of this study was to examine definitions and measures of AI employed in clinical populations.

Method

This study was a systematic review using the PRISMA guidelines. MEDLINE, Embase, PsycINFO, PsycArticles and Web of Science databases were searched. Also five journals were hand searched. Primary empirical studies involving randomized controlled trials (RCTs), non-RCTs, controlled before and after, and observational investigations were included. Studies were selected, data extracted and quality appraised. A narrative synthesis was completed.

Results

A total of 11 443 abstracts were screened and 37 studies selected for final analysis on the basis that they provided a definition and measure of AI. Numbers of definitions for each of the terms employed in included studies were: AI (n = 7), affective lability (n = 6), affective dysregulation (n = 1), emotional dysregulation (n = 4), emotion regulation (n = 2), emotional lability (n = 1), mood instability (n = 2), mood lability (n = 1) and mood swings (n = 1); however, these concepts showed considerable overlap in features. A total of 24 distinct measures were identified that could be categorized as primarily measuring one of four facets of AI (oscillation, intensity, ability to regulate and affect change triggered by environment) or as measuring general emotional regulation.

Conclusions

A clearer definition of AI is required. We propose AI be defined as ‘rapid oscillations of intense affect, with a difficulty in regulating these oscillations or their behavioural consequences’. No single measure comprehensively assesses AI and a combination of current measures is required for assessment. A new short measure of AI that is reliable and validated against external criteria is needed.

Keywords

Affective instabilitydysregulationmood lability
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 9 , July 2014 , pp. 1793 - 1808
Copyright
Copyright © Cambridge University Press 2013 

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