"Tell me, how bright your hypomania is, and I tell you, if you are happily in love!"--among young adults in love, bright side hypomania is related to reduced depression and anxiety, and better sleep quality.

Just Accepted by International Journal of Psychiatry in Clinical Practice

“Tell me, how bright your hypomania is, and I tell you, if you are happily in love!” – Among young adults in love, bright side hypomania is related to low depression and anxiety and better sleep quality

Int J Psych Clin Pract Downloaded from informahealthcare.com by McMaster University on 10/17/14 For personal use only.

Serge Brand, Stephan Foell, Hafez Bajoghli, Zahra Keshavarzi, Nadeem Kalak, Markus Gerber, Norman B. Schmidt, Peter J. Norton and Edith Holsboer-Trachsler doi: 10.3109/13651501.2014.968588 Abstract Background: Studies on adolescents and adults show that romantic love (RL) is associated with favorable emotional states. However, data on these associations are scarce for adults. The aim of the present study was therefore to explore the associations between RL, symptoms of depression, anxiety, hypomania (bright side and dark side) and sleep among a sample of adults. Method: A total of 844 participants currently in love (M = 24.79 years, 75.8% females) took part in the study. They completed a series of questionnaires related to romantic love, symptoms of depression, anxiety, hypomania (bright side and dark side), and sleep. Results: An increased state of RL was associated both with the bright (BRHYP) and the dark side of hypomania (DAHYP). Relative to participants with BRHYP, participants with DAHYP reported stronger symptoms of depression and state anxiety, and poor sleep quality. Conclusions: The pattern of results adds to our knowledge that in adults RL is not entirely a joyful and happy period of life. Rather, data suggest that for young adults in love, bright vs. dark side of hypomania was associated with a different quality of psychological functioning and sleep. We conclude that experiencing romantic love might be a critical life event associated with symptoms of depression and anxiety and poor sleep.

© 2014 Informa UK, Ltd. This provisional PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. DISCLAIMER: The ideas and opinions expressed in the journal’s Just Accepted articles do not necessarily reflect those of Informa Healthcare (the Publisher), the Editors or the journal. The Publisher does not assume any responsibility for any injury and/or damage to persons or property arising from or related to any use of the material contained in these articles. The reader is advised to check the appropriate medical literature and the product information currently provided by the manufacturer of each drug to be administered to verify the dosages, the method and duration of administration, and contraindications. It is the responsibility of the treating physician or other health care professional, relying on his or her independent experience and knowledge of the patient, to determine drug dosages and the best treatment for the patient. Just Accepted articles have undergone full scientific review but none of the additional editorial preparation, such as copyediting, typesetting, and proofreading, as have articles published in the traditional manner. There may, therefore, be errors in Just Accepted articles that will be corrected in the final print and final online version of the article. Any use of the Just Accepted articles is subject to the express understanding that the papers have not yet gone through the full quality control process prior to publication.

MPCP_A_968588_Coverpage.indd 1

9/30/2014 2:29:03 PM

“Tell me, how bright your hypomania is, and I tell you, if you are happily in love!” – Among young adults in love, bright side hypomania is related to low depression and anxiety and better sleep quality

PT ED

Serge Brand1,2, Stephan Foell1, Hafez Bajoghli3,4, Zahra Keshavarzi3, Nadeem Kalak1,

Markus Gerber2, Norman B. Schmidt5, Peter J. Norton6 and Edith Holsboer-Trachsler1 1

Disorders, Basel, Switzerland, 2Department of Sport and Health Sciences, Department of Sport Science, University of Basel, Basel, Switzerland, 3Psychiatry & Psychology

Research Center (PPRC), Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran, 4ASEAN Institute for Health Development, Mahidol University,

Nakhonpathom, Thailand, 5Florida State University, Department of Psychology,

Tallahassee, FL, USA and 6University of Houston, Department of Psychology, Houston

CE

TX, USA

AC

Correspondence author: Serge Brand PhD, Psychiatric Hospital of the University of Basel, Center for Affective, Stress and Sleep Disorders, Wilhelm Klein-Strasse 27, 4012 Basel – CH. +4161 32 55 114 (voice); +4161 32 55 513 (fax). E-mail: [email protected]

Short title: romantic love in early adulthood Abstract

ST

Background: Studies on adolescents and adults show that romantic love (RL) is associated with favorable emotional states. However, data on these associations are scarce for adults. The aim of the present study was therefore to explore the associations between RL, symptoms of depression, anxiety, hypomania (bright side and dark side) and sleep among a sample of adults. Method: A total of 844 participants currently in love (M = 24.79 years, 75.8% females) took part in the study. They completed a series of questionnaires related to romantic love, symptoms of depression, anxiety, hypomania (bright side and dark side), and sleep. Results: An increased state of RL was associated both with the bright (BRHYP) and the dark side of hypomania (DAHYP). Relative to participants with BRHYP, participants with DAHYP reported stronger symptoms of depression and state anxiety, and poor sleep quality. Conclusions: The pattern of results adds to our knowledge that in adults RL is not entirely a joyful and happy period of life. Rather, data suggest that for young adults in love, bright vs. dark side of hypomania was associated with a different quality of psychological functioning and sleep. We conclude that

JU


Psychiatric Hospital of the University of Basel, Center for Affective-, Stress-, and Sleep

1

experiencing romantic love might be a critical life event associated with symptoms of depression and anxiety and poor sleep.

PT ED CE AC ST JU


Key words: romantic love, early adulthood, anxiety, depression, sleep

2

Introduction Falling and being in love is a cross-cultural universal behavior (Aaron et al. 2005; Bartels and Zeki 2000; Fisher 1998; Jankoviak and Fischer 1992). From the view-point of evolutionary psychology, falling in love is an important feature in both short-term and longterm mating strategies (Buss 2013). Moreover, independent of gender, from the view-point of developmental psychology, falling and being in love are important prerequisites for the

PT ED

achievement of psychosocial and psychosexual skills, including those involved in the exploration of intimacy and sexuality (Carver et al. 2003; Montgommery and Sorell, 1998).

psychology also shows that mating and falling in love are by no means an “easy business”. In recent years, a growing number of biological and neuroimaging studies of young adults falling and being in love have revealed that above all falling in love is not purely a cognitiveemotional state; the cognitive-emotional changes also have neurophysiological correlates

CE

such as increased cortisol levels (Marazziti and Canale, 2004; Loving et al., 2009), increased NGF (nerve growth factors) levels (Emanuele et al., 2006), and higher neuronal activity in brain areas responsible for reward and motivation (Aaron et al. 2005). Other research stressed the importance of oxytocin: to illustrate, Scheele et al. (2013) observed that

AC

oxytocin enhanced brain reward system responses in men viewing the face of their female partners. Likewise, oxytocin enhanced the attractiveness of unfamiliar female faces independent of the dopamine reward system (Striepens et al. 2014). However, from studies assessing adolescents we learn that experiencing romantic love is by no means exclusively rewarding and joyful: and, surprisingly, research on the relation between unpleasant

ST

emotions and being in love in young adults is scarce. For adolescents, Bajoghli et al. (2013) showed that among a sample of female and male adolescents (N= 201, mean age: M = 17.73 years), romantic love was associated with higher scores for hypomania and lower scores of depressive symptoms, but, importantly, also with higher state anxiety. Davila et al. (2009)

JU


This holds true for adolescents and young adults. However, research on evolutionary

assessed 71 early adolescent girls (mean age: M = 13.45 years), finding that participants engaging in more romantic activities also reported stronger symptoms of depression over time. Dysphoric states were further associated with higher parent-adolescent stress. Likewise, Starr et al. (2012) reported that early adolescent girls reporting more romantic activities also had higher scores for depression, anxiety, externalizing and eating disorders.

3

Further, Desrosiers et al. (2014) found that more marked symptoms of depression were associated with avoidant and anxious attachment styles. These studies indicate that for adolescents early stage of romantic love is also accompanied by negative effects such as depression, anxiety, and externalizing problems. As regards adults, to the best of our knowledge, only two studies focused on participants in love, not only experiencing joyful feelings: Stoessel et al. (2011) were the

PT ED

first to thoroughly investigate both young adults who were happily in love and those who were unhappily in love, thus shifting the focus from positively motivated young adults

sadness at this same stage. Stoessel et al (2011) found that, compared to participants happily in love, those unhappily in love had reduced brain activity in the anterior cingulate cortex and posterior cingulate cortex, and the bilateral insula. Unhappy lovers also exhibited

clinical depressive symptoms. Further, Bajoghli et al (2014) showed that a decreased state of

CE

RL was associated with the dark side of hypomania (DAHYP), stronger symptoms of

depression and state anxiety, and poorer sleep quality. From these two studies we learn that experiencing romantic love is by no means an exclusively pleasant live event (Bajoghli et al., 2014), and that different mood states reflect specific neuronal and regional activities

AC

(Stoessel et al., 2011).

The present study builds on previous studies (Brand et al. 2007; Bajoghli et al 2011, 2013, 2014), but expands these studies, in that 1) a larger sample of young adults was assessed; 2) romantic love was further associated with concentration and tiredness during the

ST

day; 3) romantic love was further associated with sleep-related features such as sleep quality, feeling of being restored or daytime concentration. Next, unlike the most part of the studies, 4) participants unhappily in love were not excluded. Last, the present study expands previous research in that 5) a distinction was made between those participants reporting a bright side hypomania (BRHYP) and a dark side hypomania (DAHYP).

JU


during the early stage of intense romantic love to mood states of despair, uncertainty, and

As regards the hypomania, previous research showed that in adolescents the early stage of romantic love was associated with higher scores for hypomania (Brand et al., 2007), that increased scores of hypomania seemed to be associated with female gender and with developmental tasks (Brand et al., 2010), and that the distinction between bright (BRHYP) and dark side hypomania (DAHYP) is also observable among a larger sample of adolescents

4

and in non-clinical samples of adolescents (Holtmann et al., 2009). Moreover, Brand et al. (2011) assessed the distribution of hypomania in a large non-clinical sample of young adults (N=862; 74.1% females, mean age: 24.7 years). Data showed that about 20% of participants were in a current state of hypomania, as self-reported. After a cluster analysis, 57,6% of these hypomaniacs were classified as “active/elated" (bright side-hypomania; BRHYP) and 42.4% were classified as “irritable/risk-taking” (darkside-hypomania; DAHYP). Compared

PT ED

to the ‘bright side’ and non-hypomanic participants, the darkside-hypomaniacs reported more sleep disturbances, depressive symptoms, somatic complaints, perceived stress,

participants had better sleep quality, lower stress scores, more positive self-instructions and higher levels of self-efficacy and physical activity. Overall, from these studies we learn that 1) states of hypomania are observable among adolescents in love (Brand et al., 2007;

Bajoghli et al, 2011, 2013), and not in love (Brand et al., 2010; Holtmann et al., 2009), and

CE

among young adults in love (Bajoghli et al., 2014), and not in love (Brand et al., 2011); that 2) states of hypomania go along with different further states of psychological functioning; that 3) there is a need to further investigate hypomania among young adults, and that, 4) and most importantly, for scientific and practical reasons a further distinction between BRHYP

AC

and DAHYP is justified.

As regards sleep, the reasons why we also focused more specifically on sleep and sleep-related behavior are as follows: Restoring sleep is crucial for optimal and maximal cognitive, emotional, and behavioral performance; on the flip side, poor sleep is associated

ST

with a broad variety of cognitive and behavioral issues (cf. Diekelmann & Born, 2010). Dramatically, poor sleep impairs affect (Yoo et al., 2007; Baglioni et al., 2011; Talbot et al., 2010; Vendeckerkhove and Cluydts, 2012). In these regards, Tempesta et al. (2010) showed that poor sleep biased the facial emotion recognition of neutral (but not of happy and sad) faces. Accordingly, we hold that accurate management of emotions might be particularly

JU


negative coping strategies and lower self-efficacy. By contrast, ‘bright side’ hypomanic

important during the stage of romantic love. To fill these research gaps, the aims of the present study were to examine

associations between the experience of being in love and symptoms of anxiety, depression and hypomania among a sample of young adults. We also included assessment of subjective sleep experience, because little evidence is currently available on the relation between

5

romantic love and sleep among young adults. For adolescents, to the best of our knowledge, findings are mixed. Whereas Brand et al. (2007) found that early stage of romantic love was associated with shorter sleep duration, Bajoghli et al. (2011, 2013) were unable to replicate this association. The following four hypotheses were formulated. First, following Starr et al. (2012) and Davila et al. (2009) we expected that increased scores of romantic love were associated

PT ED

with higher symptoms of depression. Following Starr et al (2012) and Bajoghli et al (2013) we also assumed that increased scores of romantic love were associated with increased state

2013, 2014), we expected that RL was also associated with both bright side (BRHYP) and dark side hypomania (DAHYP). Fourth, we assumed that the distinction between BRHYP and DAHYP was also associated with opposite degrees in anxiety, depression, and sleep. Last, as regards sleep duration, no hypothesis was formulated, given that previous results

CE

were predominantly based on research on adolescents (Brand et al. 2007; Bajoghli et al.

2011; 2013), with to a shorter degree also on adults (Bajoghli et al., 2014), and given that results were mixed.

Sample

AC

Method

At total of 968 adults took part in the internet-administered study. Of these, 96 (11.37%) had had more than 5% missing data and were therefore excluded from further analyses (Schafer & Graham, 2002), as were 14 participants (1.61%) who systematically ticked only right-

ST

hand or only left-hand answer boxes and completed the electronic questionnaire within a few minutes, and as were also 14 participants (1.61%) reporting not being currently in love. Overall, 844 adults (M = 24.79 years, SD = 5.72; 640 females [75.8%]: M = 24.47 years (SD = 5.23); 204 males [24.2%] M = 25.79 (SD = 6.49); t(842) = 2.88, p = .004, d = 0.22) took part in the study. The study protocol was carried out in accordance with the Declaration of

JU


anxiety. Third, based on previous research (Brand et al., 2007, 2010, Bajoghli et al., 2011,

Helsinki, and the local ethics committee approved the study. Study design and data collection The study was performed by an internet-administered approach. The URL of the

study was posted on the homepages of five German-speaking universities of Switzerland and on five German universities (homepages of the faculties of psychology and medicine, and on

6

the so called ‘market places’). Previous studies comparing internet-administered questionnaires with paper and pencil questionnaires have found no disadvantages of the electronic version (cf. Mangunkusumo et al. 2005; Vereecken & Maes L, 2006; Wang et al., 2006). A commercially available software (http://www.questback.com/de/) was used for data collection. The software is an easily applicable tool for the creation of internet-based studies. The software provider guarantees that all data are stored on a server accessible neither to any

PT ED

third party, nor to the persons carrying out the study. The user of the software receives the raw data related to the questionnaires, but not the IP-address of participants. Thus, both data

the software was designed to block recruitment of subjects whose IP-addresses have been already used.

Participants were informed about the purpose of the study and about the voluntary basis of their participation. They were also assured of the confidentiality of their responses, and

CE

informed consent was obtained on the first page of the electronic questionnaire. Moreover, participants could stop or withdraw from the study without giving any further explanation. To improve compliance, participants could take part in a prize draw, though, to do so, they needed to provide an email-address. As a token, twenty iPod® Shuffles® were raffled. Data

Materials

AC

were automatically gathered and afterwards converted into a SPSS®-file for further analysis.

Assessing love status

To assess the condition of being in love or not, participants answered the following

ST

self-administered questions: “Are you currently in love with another person?” (answers: yes or no). “How many times have you already been in love?” As previously already used (Marazziti and Canale 2004; Bajoghli et al. 2013, 2014), to assess intensity of the experience of romantic love, we relied on three items modified from the Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman et al. 1986): 1. “How much time do you think about

JU


security and participant anonymity were ensured. Moreover, to avoid repeat participation,

the loved person?”; 2. “While thinking about the loved person, do you feel distracted?”; and 3. “How well can you resist to the impulse to think about the loved person?”. Answers are given on five-point Likert scales ranging from 1 (= not at all) to 5 (= the whole day (item 1; extremely (item 2), or from 5 (= not at all) to 1 (= extremely for item 3). Sum scores ranged from 3 to 15; the higher the sum score, the more the respondent experienced intense

7

romantic love. Depressive symptoms The Beck Depression Inventory (BDI; Beck et al. 1961) was used to assess severity of depressive symptoms. It consists of 21 items covering a range of affective, behavioral, cognitive, and somatic symptoms that are indicative of unipolar depression. Participants were asked to select from four alternative responses that reflect increasing levels

PT ED

of depressive symptomatology. The potential range for summed scores was 0 to 63, with higher scores indicating more marked depressive symptoms (Cronbach’s alpha = .91).

The State-Trait Anxiety Inventory (Laux et al. 1981) asks about current (state) and chronic (trait) anxiety symptoms. Typical items are: “ I feel tense ” (state anxiety); “ I feel relaxed ”, “ I ’m happy ” (trait anxiety). Answers are given on a four-point rating scale

ranging from “practically always” to “practically never" (scoring is reversed for some items).

CE

Higher mean scores reflect greater state or trait anxiety (Cronbach’s alphas: 0.89 and 0.87). Hypomania

To assess hypomanic state, all participants filled out a self-assessment tool for hypomanic symptoms in outpatients, the Hypomania Check List-32 (Angst et al. 2005:

AC

Brand et al. 2007). Hypomanic state is assessed by aggregating responses to 32 statements concerning behavior (e.g., “I spend more money/too much money ”), mood (e.g., “ My mood is significantly better” ), and thoughts (e.g., “ I think faster ” ) over the last 4 weeks. Answers were “yes ” or “ no ”. The higher the overall score, the more pronounced are

ST

hypomanic-like features (Cronbach’s alpha: 0.86). Additionally, items were assigned to either the so-called favorable (“bright” side) or unfavorable (“dark” side) hypomania clusters (Bajoghli et al. 2013; Brand et al. 2007, 2011); whereas the “bright” side of hypomania relates to elation, mental and physical activity, and positive social interaction, the “dark” side of hypomania is related to disinhibited/stimulation-seeking and irritable-erratic

JU


State-trait-anxiety

dimensions. Accordingly, participants were split into two groups of bright (BRHYP) or dark (DAHYP) side hypomania.

8

Sleep Sleep and sleep-related items A retrospective sleep log covering the previous five weekdays and nights was taken from a conventional and widely used manual for cognitive-behavioural treatment of sleep complaints (Backhaus and Riemann 1996). Participants were asked to fill it in once. For the evenings, participants answered, on eight-point scales, questions about daytime tiredness (1

PT ED

= not at all tired; 8 = very tired), concentration (1 = very low concentration; 8 = high

concentration), and mood (1 = very bad mood; 8 = very good mood). For the mornings, the

mood (1 = very bad mood; 8 = very good mood). Thus, for concentration, mood, and

restoring sleep, higher scores are more positive; for tiredness, higher scores reflect greater tiredness. In addition, sleep onset latency (in minutes) and total sleep time (in hours) was requested.

CE

Sleep disturbances

To assess sleep disturbances, the Insomnia Severity Index (ISI; Bastien et al. 2001) was employed. The ISI is a seven-item screening measure for insomnia and an outcome measure for use in treatment research. The items, answered on 5-point rating scales ranging

AC

from 0 (= not at all) to 4 (= very much), refer in part to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association 2000) criteria for insomnia by measuring difficulty in falling asleep, difficulties remaining asleep, early morning awakenings, increased daytime sleepiness, impaired daytime performance, low

ST

satisfaction with sleep, and worrying about sleep. The higher the overall score, the more the respondent is assumed to suffer from insomnia (Cronbach’s alpha = 0.87). Statistical analysis

First, a series of Kolmogorov-Smirnov-tests showed that data were normally

distributed. Second, a series of correlation computations were performed between RL and

JU


questionnaire asked about restoring sleep (1 = not at all restoring; 8 = very restoring), and

symptoms of anxiety, depression and hypomania, and sleep. Third, the dichotomous variable bright side (BRHYP) and dark side (DAHYP) was introduced and further used for a series of t-tests with Hypomania group (BRHYP vs. DAHYP) as independent variable and symptoms of anxiety, depression and sleep as dependent variables. An alpha of below 0.05 was accepted as nominal level of significance, whereas for t-tests, the alpha level was set at

9

below 0.01. Moreover, effect sizes were reported (Cohen’s d = 0.2 – 0.49 small effect [S], d = 0.5 – 0.79 middle effect [M]; d > 0.8 large effect [L]. Statistics was performed with SPSS® 20.0 (IBM Corporation, Armonk NY, USA) for Apple MacIntosh®. Results Correlations between romantic love, symptoms of depression, and state and trait anxiety, and hypomania

PT ED

Table 1 gives the descriptive and correlational overview of the items. Accordingly, correlation coefficients are not reported in the text.

anxiety, and bright (BRHYP) and dark side (DAHYP) hypomania, but not with trait anxiety. Depressive scores were related to state anxiety and the dark side of hypomania. Age did positively correlate with romantic love and state anxiety. State anxiety did positively

correlate with trait anxiety and DAHYP. BRHYP and DAHYP did positively correlate.

CE

Being in love, psychological functioning and sleep and sleep-related dimensions

Table 2 gives the descriptive and correlative overview of the sleep and sleep-related dimensions

The general pattern of results is such that higher scores for being in love were associated

AC

with better sleep and more positive scores on sleep-related dimensions such as sleep quality, number of awakenings after sleep onset, and shortness of sleep onset latency. Moreover, higher scores for being in love were associated with better mood in the morning and in the evening, higher concentration and decreased sleepiness during the day.

ST

Bright and dark side of hypomania as independent variable As shown in Table 1, scores of romantic love were associated both with higher

scores of BRHYP and DAHYP; in parallel, higher symptoms of depression were associated with higher state anxiety and DAHYP, but not with BRHYP. The pattern of results suggested that differences in in romantic love and psychological dimensions might be

JU


Higher scores for being in love were associated with higher scores for depression, state

explained by differences in hypomania. Accordingly, hypomania group (BRIHYP (n = 398; 278 females; 120 males) vs. DAHYP (n = 147; 105 females; 42 males)1) was used as independent variable and psychological functioning and sleep and sleep-related dimensions

1

Note that 299 participants (35.43%) could not be assigned neither to the BRHYP, nor to the DAHYP group.

10

as independent variables. Table 3 shows the descriptive and statistical overview. The general pattern of results is such that compared to the DAHYP group participants, BRHYP group participants reported more favorable scores (middle to large effect sizes) for symptoms of depression and state anxiety, sleep disturbance, mood (morning), concentration and tiredness during the day, sleep onset latency and awakenings after sleep onset. No meaningful differences were found for

PT ED

romantic love, trait anxiety, sleep duration, and mood in the evening. Discussion

romantic love was associated both with favorable and unfavorable patterns of psychological functioning and sleep. Introducing bright and dark side hypomania as factor, it turned out

that compared to participants with dark side hypomania (DAHYP), participants with bright side hypomania (BRHYP) reported more favorable patterns of psychological functioning

CE

and sleep. The quality of hypomania seems therefore a good reference to the affective load of being in love.

The following four hypotheses were formulated, and each of these is considered in turn.

AC

First, we expected that increased scores of romantic love were associated with higher symptoms of depression, and data did confirm this assumption. Therefore, the present data are in accord with research on adolescents (Starr et al., 2012; Bajoghli et al., 2013), though we could extend this observation also for young adults, for whom, to the best of our

ST

knowledge, only two previous studies (Stoessel et al., 2011; Bajoghli et al., 2014) did report these observations.

With the second hypothesis we assumed that increased scores of romantic love were

associated with increased state anxiety, but not trait anxiety, and again, this assumption could be confirmed. Accordingly, we also confirmed previous studies (Starr et al., 2012;

JU


The key findings of the present study were that among a sample of young adults,

Bajoghli et al. 2013), and again, we expanded previous research also on young adulthood (cf. Bajoghli et al., 2014). With the third hypothesis we expected associations between romantic love and

hypomania scores; also this assumption was confirmed, reflecting previous research ((Brand et al., 2007, 2010, Bajoghli et al., 2011, 2013, 2014). Importantly, the present pattern of

11

results also showed that a further distinction between a sunny side (bright side, BRHYP) and a dark side (DAHYP) could be made. Most importantly, with the fourth hypothesis, we assumed that the distinction between BRHYP and DAHYP was also associated with opposite degrees in anxiety, depression, and sleep, and data did fully confirm these assumptions. As Table 3 suggests, distinguishing between two dichotomous states of hypomania does clearly reflect two well-

PT ED

distinguishable cognitive-emotional processes, though, the present data do not allow a

deeper understanding of the underlying cognitive-emotional algorithms. Most importantly,

becoming involved in a (short or long term) relationship also entails a broad variety of risks and risk taking behavior. More specifically, falling and being in love are associated with the exploration of intimacy and sexuality (Carver et al. 2003; Montgommery and Sorell (1998), identity formation and building the capacity for intimacy and self-disclosure (Carver et al.,

CE

2003; Florsheim, 2003; Kroger 2000; Kuttler and LaGreca, 2004). For adolescents, but also for adults, Collins et al (2009) reported that falling and being in love are accompanied by experiencing and dealing with a broad variety of one’s own emotions, moral concepts and behavior, but also with emotions, moral concepts and behavior of a basically unknown

AC

person: love, passion, excitement, joy, enthusiasm, commitment, hate, appreciation, jealousy, risk taking, self-disclosure, coping with uncertainty, confidence, euphoria; moral concepts such as aims of life, attitudes towards sexuality, money, family planning, peers, religion, commitment to the family; dealing with such crucial and vital issues demands

ST

particular attention and efforts. In these respects, one may assume that dealing with such a broad variety of cognitive, emotional, and behavioral aspects of risk taking are also accompanied by emotions of insecurity, uncertainty, and dysphoria. Accordingly, we might explain the high state anxiety scores and more severe depressive symptoms concomitantly to bright side hypomanic states in the light of these developmental issues as described above. In

JU


these two cognitive-emotional frameworks lend support to the notion that being in love and

our opinion, this interpretation of the data matches the observation of Desrosiers et al. (2014), who showed that increased symptoms of depression were associated with avoidant and anxious attachment styles. However, the pattern of results also raises further issues, in that common sense, lay opinion and scientific observation claim that being in love, almost by definition, as accompanied by feelings of joy, happiness, elation, and optimism. In these

12

regards, symptoms of depression and anxiety, along with poor sleep quality and interrupted sleep continuity, seem counter-intuitive and demand particular attention. The present data do not allow a deeper understanding on the underlying psychological mechanisms as to why being in love is also associated with symptoms of depression and anxiety. We claim the following possibilities: First, romantic feelings remain unanswered, and by definition, lack of response causes sadness, despair, uncertainty and anxiety. Second, again by definition,

PT ED

there are issues as to the short- and long-term outcome of the chosen partner. Third, from an evolutionary point of view (Buss, 2013; Brüne, 2008, Dunbar, et al. 2007; Hampton, 2010),

In other words: states of depression trigger social resources, avoid resource expenditure and protect against imponderable behavior. Likewise, states of anxiety lead to avoidance of

danger (and disappointments). Experiencing states of anxiety may lead to the rule of thumb: “Better safe, than sorry”. Fourth, again from an evolutionary point of view, if falling ‘madly’

CE

in love has the advantage to take quick decisions as to mating behavior and partner selection, symptoms of anxiety and depression seem to counteract to too hasty and imponderable behavior. Fifth, states of depression and anxiety might be considered emotion-focused appraisals (Lazarus & Folkman, 1984) to cope with uncertainty. Overall, from an

AC

evolutionary point of view, we assume that if people today do show states of anxiety and depression while being in love, then it must have had an advantage during evolution, and that, accordingly, ancestors not experiencing symptoms of depression and anxiety while being in love might have been extinct (cf. Buss, 2013; Brüne, 2008, Dunbar, et al. 2007;

ST

Hampton, 2010). As regards sleep, a broad variety of studies show an association between

(dysfunctional) cognitive-emotional processes and sleep quality (e.g. Baglioni et al. 2011; Talbot et al. 2010; Yoo et al. 2007; Harvey 2002; Gerber et al 2010; Vandekerckhove & Cluydts, 2010), and we were interested in exploring sleep-related dimensions as a function

JU


states of depression call for social support and avoid at the same time imprudent decisions.

of being in love among young adults. We found that affective states (being in love, depression, anxiety, bright side hypomania) were associated with sleep quality, sleep onset time and awakenings after sleep onset, as also with sleepiness and concentration. In this respect, we were able to show that being in love was associated with the psychological aspects of sleep.

13

Despite the clarity of the findings, several considerations caution against overgeneralization. First, the cross-sectional design of the study precludes explanations as to the direction of influence. Second, only participants willing and able took part on the study. Third, participants were prevalently recruited among university students, who are not representative of a broader range of young adults, and therefore data might be biased. Fourth, no socio-demographic information such as socio-economic status, educational level

PT ED

and history of neuropsychiatric disorders were assessed; accordingly, the pattern of results might be biased due to further unassessed socio-demographic data. This holds also true for

results remains unexplored. Fifth, the lack of neurophysiological data also holds true for

sleep; sleep questionnaires assess the psychological, but not the neurophysiological aspect of sleep, and therefore, the associations between being in love, psychological functioning, and sleep dimensions might have been biased by common cognitive-emotional processes. Sixth,

CE

we note that 35.4% of the participants could not be assigned neither to the BRHYP, nor to

the DAHYP group; therefore, the pattern of results reporting the states of hypomania is not applicable to all participants and people in love. Seventh, we did not further explore genderrelated issues, as previous studies reported conflicting results (Brand et al., 2007; 2010);

AC

accordingly, future studies might formulate more appropriate designs to explore more thoroughly gender-related issues. Last, the pattern of results might have emerged due to further, but unassessed psychological and neurophysiological processes, which might have influenced two or more variables in the same direction. Future research might therefore

ST

assess physiological variables such as cortisol and sleep-EEGs, and for instance also the subjectively perceived quality of partnership.

JU


unassessed biological data, and a possible neurophysiological explanation of the pattern of

14

Key-points •

For young adults, being in love is associated with a broad range of different emotions

•

These emotions range from anxiety and depression to bright side hypomania

•

The discriminating between bright and dark site hypomania mirrors two well-

and behavior •

For young adults, being in love seems to be a critical life event seems to be both challenging and daunting

Statement of interest

ST

AC

CE

Authors declare no conflicts of interests.

JU


PT ED

distinguishable and specific favorable and unfavorable set of psychological states

15

References Aaron A, Fisher H, Mashek DJ, Strong G, Li H, Brown LL. 2005. Reward, motivation, and emotion systems associated with early-stage intense romantic love. J Neurophysiology 94:327-337. Angst J, Adolfsson R, Benazzi F, Gamma A, Hantouche E, Meyer TD, Skeppar P, Vieta E, Scott J. 2005. The HCL-32: a self-assessment tool for hypomanic symptoms in

PT ED

outpatients . J Affect Disord 88:217 – 233. Backhaus J, Riemann D. 1996. Schlafstörungen bewältigen [Coping with sleep disorders].

Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo C, Riemann D. 2011. Insomnia as a predictor of depression: a meta-analytic

evaluation of longitudinal epidemiological studies. J Affect Disord 135:10-9.

Bajoghli H, Joshaghani N, Gerber M, Mohammadi MR, Holsboer-Trachsler E, Brand S.

CE

2013. In Iranian female and male adolescents, romantic love is related to hypomania and low depressive symptoms, but also to higher state anxiety. Int J Psychiatry Clin Pract 17:98-109.

Bajoghli H, Joshaghani N, Mohammadi MR, Holsboer-Trachsler E, Brand S. 2011. In

AC

female adolescents, romantic love is related to hypomanic-like stages and increased physical activity, but not to sleep or depressive symptoms. Int J Psychiatry Clin Pract 15:164-170.

Bajoghli H, Keshavarzi Z, Mohammadi MR, Schmidt NB, Norton PJ, Holsboer-Trachsler E, Brand S. 2014. "I love you more than I can stand!" - Romantic love, symptoms of

ST

depression and anxiety, and sleep complaints are related among young adults. Int J Psychiatry Clin Pract. 18:169-174.

Bartels A, Zeki S. 2000. The neural basis of romantic love. Neuroreport 11:3829-3834. Bastien CH, Vallières A, Morin CM. 2001. Validation of the Insomnia Severity Index as an

JU


Weinheim GER: Beltz Psychologie Verlags Union.

outcome measure for insomnia research. Sleep Med 2:297-307.

Beck AT, Ward CH, Mendelson M, Mock J, & Erbaugh, J. 1961. An inventory for measuring depression. Archives of General Psychiatr 4:561-571.

16

Brand S, Angst J, Holsboer-Trachsler E. 2010. Is the increase of hypomanic stages during adolescence related to gender and developmental tasks? World J Biol Psych 11:594602. Brand S, Gerber M, Pühse U, Holsboer-Trachsler E. 2011. 'Bright side' and 'dark side' hypomania are associated with differences in psychological functioning, sleep and

PT ED

physical activity in a non-clinical sample of young adults. J Affect Disord 131:6878.

Brand S, Luethi M, von Planta A, Hatzinger M, Holsboer-Trachsler E. 2007. Romantic love,

Brüne M. 2008. Textbook of evolutionary psychiatry. The origins of psychopathology. Oxford, UK: Oxford University Press.

Buss D. 2013. Evolutionary Psychology: The New Science of the Mind. 4th edition. Upper Saddle River, NJ: Pearson Education.

CE

Carver K, Joyner K, Udry JR. 2003. National estimates of adolescent romantic relationships. In: Florsheim P, editor. Adolescent romantic relations and sexual behaviour. Mahwah, NJ: Lawrence Erlbaum Associates, pp 23 – 56.

AC

Collins WA, Welsh DP, Furman W 2009. Adolescent romantic relationships. Annu Rev Psychol 60:631-652.

Davila J, Stroud CB, Starr LR., Miller MR, Yoneda A, Hershenberg R 2009. Romantic and sexual activities, parent-adolescent stress, and depressive symptoms among early adolescent girls. J Adolesc 32:909-924.

ST

Desrosiers A, Sipsma H, Callands T, Hansen N, Divney A, Magriples U, Kershaw T. 2014. "Love Hurts": Romantic Attachment and Depressive Symptoms in Pregnant Adolescent and Young Adult Couples. J Clin Psychol 70:95-106.

Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR. 2000. American

JU


hypomania, and sleep pattern in adolescents. J Adolesc Health 41:69-76.

Psychiatric Association. Washington DC: American Psychiatric Press Inc.

Diekelmann S, Born J. 2010. The memory function of sleep. Nat Rev Neurosci. 11:114-126. Dunbar R, Barrett L, Lycett J. 2007. Evolutionary Psychology. Oxford UK: Oneworld Publications.

17

Emanuele E, Politi P, Bianchi M, Minoretti P, Bertona M, Geroldi D. 2006. Raised plasma nerve growth factor levels associated with early-stage romantic love. Psychoneuroendocrinol 31:288-94. Fisher E. 1998. Lust, attraction, and attachment in mammalian reproduction. Human Nature 9:23-52. Florsheim P 2003. Adolescent romantic relations and sexual behaviour: Theories, research,

PT ED

and practical implications. Mahwah NJ: Lawrence Erlbaum Associates.

Gerber M, Brand S, Holsboer-Trachsler E, Pühse U. 2010. Fitness and exercise as correlates

Goodman WK, Price LH, Rasmussen SA. 1986. The Yale Brown-Obsessive-Compulsive Scale-I: Development, use and reliability. Arch Gen Psychiatry 46:1006–1011.

Hampton S. 2010. Essential Evolutionary Psychology. London UK: SAGE Publications.

Holtmann, M., Portner, F., Duketis, E., Flechtner, H. H., Angst, J., & Lehmkuhl, G. (2009).

CE

Validation of the Hypomania Checklist (HCL-32) in a nonclinical sample of German adolescents. [Validation Studies]. J Adolesc 32:1075-1088.

Jankoviak WR, Fischer EF. 1992. A cross-cultural perspective on romantic love. Ethology 31:149–155.

AC

Kroger J. 2000. Identity development. Adolescence trough adulthood. Thousand Oaks CA: Sage Publications.

Kuttler AF, La Greca AM. 2004. Linkages among adolescent girls' romantic relationships, best friendships, and peer networks. J Adolesc 27:395-414.

ST

Laux L, Glanzmann P, Schaffner P. 1981. State-Trait-Angstinventar [German version of Spielberger, et al.’s State-Trait-Anxiety Inventory]. Göttingen: Hogrefe.

Lazarus, RS, Folkman S. 1984. Stress, appraisal, and coping. New York: Springer. Loving TJ, Crockett EE, Paxson AA. 2009. Passionate love and relationship thinkers: Experimental evidence for acute cortisol elevations in women.

JU


of sleep complaints: is it all in our minds? Med Sci Sports Exerc 42:893-901.

Psychoneuroendocrinol 34:939-946.

Mangunkusumo RT, Moorman PW, Van Den Berg-de Ruiter AE. Van Der Lei J, De Koning HJ, Raat H. 2005. Internet-administered adolescent health questionnaires compared with a paper version in a randomized study. J Adol Health, 36:70.e1-70.e6.

18

Marazziti D, Canale D. 2004. Hormonal changes when falling in love. Psychoneuroendocrinol 29:931 – 936. Montgommery MJ, Sorell GT. 1998. Love and dating experience in early and middle adolescence: grade and gender comparisons. J Adolesc 21:677 – 89. Scheele D, Wille A, Kendrick KM, Stoffel-Wagner B, Becker B, Güntürkün O, Maier W, Hurlemann R. 2013. Oxytocin enhances brain reward system responses in men

PT ED

viewing the face of their female partner. Proc Natl Acad Sci U S A 110:2030820313.

2012. Love Hurts (in More Ways Than One): Specificity of Psychological

Symptoms as Predictors and Consequences of Romantic Activity Among Early Adolescent Girls. J Clin Psychol, 68:403-420.

Stoessel C, Stiller J, Bleich S, Boensch D, Doerfler A, Garcia M, Richter-Schmidinger T,

CE

Kornhuber J, Forster C. 2011. Differences and similarities on neuronal activities of people being happily and unhappily in love - an fMRI-study. Neuropsychobiol 64:52-60.

Striepens N, Matusch A, Kendrick KM, Mihov Y, Elmenhorst D, Becker B, Lang M,

AC

Coenen HH, Maier W, Hurlemann R, Bauer A. 2014. Oxytocin enhances attractiveness of unfamiliar female faces independent of the dopamine reward system. Psychoneuroendocrinol 39:74-87. Talbot LS, McGlinchey EL, Kaplan KA, Dahl RE, Harvey AG 2010.0Sleep deprivation in

ST

adolescents and adults: changes in affect. Emotion 10:831-41. Tempesta D, Couyoumdjian A, Curcio G, Moroni F, Marzano C, De Gennaro L, Ferrara M. 2010. Lack of sleep affects the evaluation of emotional stimuli. Brain Res Bull 82:104-108.

Vandekerckhove M, Cluydts R. 2010. The emotional brain and sleep: an intimate

JU


Starr LR, Davila J, Stroud CB, Clara Li PC, Yoneda A, Hershenberg R, Ramsay Miller M.

relationship. Sleep Med Rev. 14:219-26

Vereecken CA, Maes L. 2006. Comparison of a computer-administered and paper-andpencil-administered questionnaire on health and lifestyle behaviors. J Adol Health 38:426-432.

19

Wang YC, Lee CM, Lew-Ting CY, Hsiao CK, Chen DR, Chen WJ. 2006. Survey of substance use among high school students in Taipei: Web-based questionnaire versus paper-and-pencil questionnaire. J Adol Health 37:289-295. Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP 2007. The human emotional brain without

PT ED CE AC ST JU


sleep--a prefrontal amygdala disconnect. Curr Biol 23:R877-878.

20

ED

-

2

Romantic love

.19*

-

3

Depression

.16

.22**

-

4

State anxiety

.21**

.34*

.39***

5

Trait anxiety

.10

.10

6

Bright side hypomania

.09

.41***

7

Dark side hypomania

.10

.39***

Descriptive statistics M (SD) 24.79 (5.72) 9.46 (2.98) 15.93 (5.45)

-

45.00 (9.98)

.35**

-

19.32 (6.41)

.08

.09

-.09

-

15.69 (7.45)

.46***

.46***

.20**

.35***

15.41 (7.44)

AC

.10

ST

Notes: * = p < .05; ** = p < .01; *** = p < .001.

6

PT

Age (years)

CE

1

5

JU


Table Legends Table 1. Descriptive statistics and correlation matrix of the psychological variables (N = 844). 1 2 3 4

21

.55***

-.34***

-.42***

-.41***

State anxiety

.26**

-.22***

-.13**

-.21**

Trait anxiety

.54***

-.20***

-.23**

-.29***

Bright side

-.39***

-.35***

.38**

.42***

.39***

-.21***

-.09

-.35***

15.02 (9.35)

7.12h (2.45)

5.69 (2.06)

Dark side hypomania

SOL (min)

WASO

-.40***

.49***

-.35***

-.19***

-.38**

.49***

-.48***

.42***

.49***

-.28***

-.25***

-.28***

.29***

.23***

-.20***

.49***

-.35***

.51***

.39***

.51***

-.38***

.38***

-.31***

-.31***

-.23***

.32***

-.32***

.45***

4.85 (2.11)

5.96 (3.25)

4.25 (1.25)

5.01 (3.82)

30.5 (22.96)

.29***

5.21 (4.29)

ST

Notes: 1 = higher scores are more negative; 2 = higher scores are more positive; SOL = sleep onset latency; WASO = awakenings after sleep onset; ISI = Insomnia Severity Index. * = p < .05; ** = p < .01; *** = p < .001.

JU

M (SD)

AC

Descriptive statistics

Mood evening2

CE

hypomania

ED

Depression

Tiredness during the day1

PT


Romantic love

Table 2. Descriptive statistics and correlation matrix of psychological and sleep variables (N = 844). Concentration Mood Sleep Sleep duration Restoring sleep1 during the day1 morning1 disturbance (ISI)1 -.15** .09 .12* .16*** .40***

22

Dark side

hypomania

hypomania

(BRHYP; n =

(DAHYP; n =

398)

147)

10.54 (2.84)

Depression

d

10.44 (3.99)

0.89

0.03

15.42 (7.76)

26.43 (14.64)

16.45***

0.94

State anxiety

32.56 (12.99)

54.20 (20.72)

19.02***

1.25

Trait anxiety

18.11 (9.73)

21.03 (7.38)

1.46

0.34

Sleep disturbance

8.89 (6.02)

19.53 (10.26)

13.43***

1.26

Sleep duration (H)

7.56 (1.56)

6.46 (1.02)

0.99

0.05

Mood morning

6.46 (1.99)

4.12 (3.23)

2.59*

0.87

Concentration

6.80 (2.56)

4.36 (4.56)

3.54**

0.66

3.20 (1.23)

6.46 (2.99)

3.54**

1.43

during the day

the day Mood evening

AC

Tiredness during

CE

Romantic love

T

PT ED

Bright side

Sleep onset latency Awakenings after

5.68 (2.43)

4.56 (2.36)

1.56

0.47

21.05 (12.06)

35.00 (25.86)

1.23

0.70

2.05 (1.06)

6.56 (4.97)

4.52***

1.26

ST

sleep onset

Notes: degrees of freedom: always: (543); * = p < .05; ** = p < .01; *** = p < .001.

JU


Table 3. Descriptive and statistical overview of romantic love, psychological functioning, sleep and sleep-related dimensions, separately for participants reporting a bright (BRHYP) or a dark (DAHYP) side hypomania. Dimension Group Statistics

23

How much plastic is in the ocean? You tell me!

"I love you more than I can stand!" - romantic love, symptoms of depression and anxiety, and sleep complaints are related among young adults.

Tell me how much you move, I'll tell you how much you'll live. Editorial of the JONAFES I International Symposium of Physical Activity, Sport & Health.

Tell us how it was for you.

Can Your Microbiome Tell You What to Eat?

Only your eyes tell me what you like: Exploring the liking effect induced by other's gaze.

Things your most satisfied patients won't tell you.

Can We Tell if the Syndesmosis Is Reduced Using Fluoroscopy?

Think twice before you tell.

Catch me if you can.

What happens to your hearing if you are born blind?

Even if I showed you where you looked, remembering where you just looked is hard.

What if you can't sense your enemy… and your enemy is an invasive predator?

Tell the story of what you did.

What happens when you tell someone you self-injure? The effects of disclosing NSSI to adults and peers.

What your PI forgot to tell you: why you actually might want a job running a research lab.

Narrating your life after 65 (or: to tell or not to tell, that is the question).

Genetics and nutrition: or what your genes can tell you about nutrition.

Adenoma Detection Rate: I Will Show You Mine if You Show Me Yours.

"Let Me Tell You About My…" Provider Self-Disclosure in the Emergency Department Builds Patient Rapport.

Does Your SEM Really Tell the Truth?-How Would You Know? Part 4: Charging and its Mitigation.

It is amazing what you can see if you look.

Love What You Do and Do What You Love.

Tell me something I don't know.