Self-Compassion May Buffer Against Depression, Anxiety in Bipolar Disorder

A focus on practicing self-compassion may protect against symptoms of depression, emotional regulation, and anxiety in patients with bipolar disorder.

Self-compassion partially mediated the relationship between maladaptive perfectionism and psychiatric symptoms in patients with bipolar disorder, according to study data published in the Journal of Affective Disorders.

Investigators conducted a secondary data analysis of baseline data from a randomized controlled trial of an online self-management program for individuals with “late stage” bipolar disorder. Study participants (age 18-65 years) were defined as having “late stage” bipolar disorder if they had experienced 10 or more mood episodes. Data were extracted from 301 participants, among whom 70.8% were women. The mean (standard deviation) age of participants was 44 (11.7) years, and 97.0% reported psychotropic medication use in the previous month.

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At baseline, patients underwent structured interviews and questionnaires to capture sociodemographic data and clinical measures of depression, anxiety, and emotion regulation difficulties. The Almost Perfect Scale-Revised was used to identify adaptive and maladaptive perfectionism in patients; the 26-item Self-Compassion Scale measured self-compassion using 6 subscale dimensions that include self-kindness, self-judgment, and mindfulness.

Maladaptive perfectionism was a significant predictor of low self-compassion, and low self-compassion, in turn, was a significant predictor of self-reported depression (both P <.01). Patients with greater maladaptive perfectionism scores had more severe self-reported depression, an effect partially mediated by self-compassion. However, self-compassion did not appear to predict clinician-rated depression or to mediate the relationship between perfectionism and clinician-rated depression, suggesting a discrepancy between self- and clinician-rated measures.

Lower self-compassion was also associated with greater levels of anxiety and emotion regulation difficulties. Self-compassion partially mediated the relationship between maladaptive perfectionism and anxiety as well as the relationship between maladaptive perfectionism and emotion regulation difficulties.

Females were overrepresented in the study, which focused on participants with “late-stage” bipolar disorder who were not currently within a mood episode. “[It] is therefore unclear whether findings would extend to those earlier on in terms of stage of illness or with higher levels of current symptomatology,” researchers noted.

“Given evidence that self-compassion may be modifiable through psychotherapy, the present findings suggest that individuals with [bipolar depression] who exhibit maladaptive perfectionistic tendencies may potentially benefit from psychological interventions designed to foster self-compassion,” the researchers concluded.


Fletcher K, Yang Y, Johnson SL, et al. Buffering against maladaptive perfectionism in bipolar disorder: the role of self-compassion. J Affect Disord. 2019;250:132-139.