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Abstract The vast personal and economic burden of mood disorders is largely caused by their under- and misdiagnosis, which is associated with ineffective treatment and worsening of outcomes. Here, we aimed to develop a diagnostic algorithm, based on an online questionnaire and blood biomarker data, to reduce the misdiagnosis of bipolar disorder (BD) as major depressive disorder (MDD). Individuals with depressive symptoms (Patient Health Questionnaire-9 score ≥5) aged 18–45 years were recruited online. After completing a purpose-built online mental health questionnaire, eligible participants provided dried blood spot samples for biomarker analysis and underwent the World Health Organization World Mental Health Composite International Diagnostic Interview via telephone, to establish their mental health diagnosis. Extreme Gradient Boosting and nested cross-validation were used to train and validate diagnostic models differentiating BD from MDD in participants who self-reported a current MDD diagnosis. Mean test area under the receiver operating characteristic curve (AUROC) for separating participants with BD diagnosed as MDD (N = 126) from those with correct MDD diagnosis (N = 187) was 0.92 (95% CI: 0.86–0.97). Core predictors included elevated mood, grandiosity, talkativeness, recklessness and risky behaviour. Additional validation in participants with no previous mood disorder diagnosis showed AUROCs of 0.89 (0.86–0.91) and 0.90 (0.87–0.91) for separating newly diagnosed BD (N = 98) from MDD (N = 112) and subclinical low mood (N = 120), respectively. Validation in participants with a previous diagnosis of BD (N = 45) demonstrated sensitivity of 0.86 (0.57–0.96). The diagnostic algorithm accurately identified patients with BD in various clinical scenarios, and could help expedite accurate clinical diagnosis and treatment of BD.

Previous research has shown that moral failures increase compensatory behaviors, such as prosociality and even self-punishment, because they are strategies to re-establish one’s positive moral self-image. Do similar compensatory behaviors result from violations in normative eating practices? Three experiments explored the moral consequences of recalling instances of perceived excessive food consumption. In Experiment 1 we showed that women recalling an overeating (vs. neutral) experience reported more guilt and a desire to engage in prosocial behavior in the form of so-called self-sacrificing. In Experimental 2 this logic was applied to actual spontaneous helping behaviors toward an experimenter, with participants who recalled an overeating (vs. neutral) experience exhibiting more such helping in the laboratory. Experimental 3 expanded the investigation to self-inflicted pain: overeating (vs. neutral) recall led to higher levels of self-punishment as indicted by longer time periods spent engaging in the cold pressor task. In sum, failures in normative food consumption can be viewed as moral transgressions that elicits both interpersonal and intrapersonal compensatory behaviors aimed at restoring a positive moral self-image.