Emotional face processing in pediatric bipolar disorder: Evidence for functional impairments in the fusiform gyrus

Susan B. Perlman, Jay C. Fournier, Genna Bebko, Michele A. Bertocci, Amanda K. Hinze, Lisa Bonar, Jorge R.C. Almeida, Amelia Versace, Claudiu Schirda, Michael Travis, Mary Kay Gill, Christine Demeter, Vaibhav A. Diwadkar, Jeffrey L. Sunshine, Scott K. Holland, Robert A. Kowatch, Boris Birmaher, David Axelson, Sarah M. Horwitz, L. Eugene ArnoldMary A. Fristad, Eric A. Youngstrom, Robert L. Findling, Mary L. Phillips

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Objective Pediatric bipolar disorder involves poor social functioning, but the neural mechanisms underlying these deficits are not well understood. Previous neuroimaging studies have found deficits in emotional face processing localized to emotional brain regions. However, few studies have examined dysfunction in other regions of the face processing circuit. This study assessed hypoactivation in key face processing regions of the brain in pediatric bipolar disorder. Method Youth with a bipolar spectrum diagnosis (n = 20) were matched to a nonbipolar clinical group (n = 20), with similar demographics and comorbid diagnoses, and a healthy control group (n = 20). Youth participated in a functional magnetic resonance imaging (fMRI) scanning which employed a task-irrelevant emotion processing design in which processing of facial emotions was not germane to task performance. Results Hypoactivation, isolated to the fusiform gyrus, was found when viewing animated, emerging facial expressions of happiness, sadness, fearfulness, and especially anger in pediatric bipolar participants relative to matched clinical and healthy control groups. Conclusions The results of the study imply that differences exist in visual regions of the brain's face processing system and are not solely isolated to emotional brain regions such as the amygdala. Findings are discussed in relation to facial emotion recognition and fusiform gyrus deficits previously reported in the autism literature. Behavioral interventions targeting attention to facial stimuli might be explored as possible treatments for bipolar disorder in youth.

Original languageEnglish
Pages (from-to)1314-1325.e3
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number12
StatePublished - Dec 2013


  • emotion
  • face processing
  • functional magnetic resonance imaging (fMRI)
  • fusiform gyrus
  • pediatric bipolar disorder


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