Realism
It has been repeatedly shown that depressive people are more realistic in several experiments that measure one’s sense of control . Patients with high self-reported depression scores correctly attribute errors to themselves in studies where errors are sometimes experimentally introduced. In contrast, normal subjects report more control over experimental tasks than they really possessed .
Realism may partly reflect the increased insight of depression , and its converse may be decreased insight in mania . Approximately 50% of patients with bipolar disorder do not recall or deny their manic episodes, even after controlling for the presence or not of psychotic symptoms. This may explain why bipolar disorder patients tend to describe depressive symptoms rather than manic, which may produce an overdiagnosis of major depressive disorder . Including family members during assessments and follow-up visits should help reduce this problem.
Depressive realism may also be reflected in existential despair . Existential states of despair can be difficult to differentiate from depressive episodes, even though they differ greatly from true bipolar depressive episodes.