Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-23T00:55:42.290Z Has data issue: false hasContentIssue false
  • English
  • Français

Personality and bipolar disorder: dissecting state and trait associations between mood and personality

Published online by Cambridge University Press:  07 December 2010

J. H. Barnett ,
J. Huang ,
R. H. Perlis ,
M. M. Young ,
J. F. Rosenbaum ,
A. A. Nierenberg ,
G. Sachs ,
V. L. Nimgaonkar ,
D. J. Miklowitz  and
J. W. Smoller
J. H. Barnett
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Department of Psychiatry, University of Cambridge, Cambridge, UK Cambridge Cognition Limited, Cambridge, UK
J. Huang
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
R. H. Perlis
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
M. M. Young
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
J. F. Rosenbaum
Affiliation:
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
A. A. Nierenberg
Affiliation:
Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
G. Sachs
Affiliation:
Bipolar Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
V. L. Nimgaonkar
Affiliation:
Department of Psychiatry, University of Pittsburgh School of Medicine and Graduate School of Public Health, WPIC, Pittsburgh, PA, USA
D. J. Miklowitz
Affiliation:
Department of Psychiatry, UCLA Semel Institute, UCLA School of Medicine, Los Angeles, CA, USA
J. W. Smoller*
Affiliation:
Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genetic Research, and Psychiatric Genetics Program in Mood and Anxiety Disorders, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
*
*Address for correspondence: J. W. Smoller, M.D., Sc.D., Simches Research Building, 185 Cambridge Street, 2nd Floor, Boston, MA 02114, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Some personality characteristics have previously been associated with an increased risk for psychiatric disorder. Longitudinal studies are required in order to tease apart temporary (state) and enduring (trait) differences in personality among individuals with bipolar disorder (BD). This study aimed to determine whether there is a characteristic personality profile in BD, and whether associations between BD and personality are best explained by state or trait effects.

Method

A total of 2247 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder study completed the NEO Five-Factor Inventory administered at study entry, and at 1 and 2 years.

Results

Personality in BD was characterized by high neuroticism (N) and openness (O), and low agreeableness (A), conscientiousness (C) and extraversion (E). This profile was replicated in two independent samples, and openness was found to distinguish BD from major depressive disorder. Latent growth modeling demonstrated that manic symptoms were associated with increased E and decreased A, and depressed symptoms with higher N and lower E, A, C and O. During euthymic phases, high N and low E scores predicted a future depression-prone course.

Conclusions

While there are clear state effects of mood on self-reported personality, personality variables during euthymia predict future course of illness. Personality disturbances in extraversion, neuroticism and openness may be enduring characteristics of patients with BD.

Keywords

Bipolar disorderextraversionNEO-FFIneuroticismpersonality.
Type
Original Articles
Information
Psychological Medicine , Volume 41 , Issue 8 , August 2011 , pp. 1593 - 1604
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, HS, Hirschfeld, RM, Yerevanian, BI (1983). The relationship of personality to affective disorders. Archives of General Psychiatry 40, 801–810.Google Scholar
Akiskal, HS, Kilzieh, N, Maser, JD, Clayton, PJ, Schettler, PJ, Traci Shea, M, Endicott, J, Scheftner, W, Hirschfeld, RM, Keller, MB (2006). The distinct temperament profiles of bipolar I, bipolar II and unipolar patients. Journal of Affective Disorders 92, 19–33.Google Scholar
Bagby, RM, Bindseil, KD, Schuller, DR, Rector, NA, Young, LT, Cooke, RG, Seeman, MV, McCay, EA, Joffe, RT (1997). Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients. Psychiatry Research 70, 83–94.CrossRefGoogle ScholarPubMed
Bagby, RM, Rector, NA, Bindseil, K, Dickens, SE, Levitan, RD, Kennedy, SH (1998). Self-report ratings and informants' ratings of personalities of depressed outpatients. American Journal of Psychiatry 155, 437–438.Google Scholar
Bagby, RM, Young, LT, Schuller, DR, Bindseil, KD, Cooke, RG, Dickens, SE, Levitt, AJ, Joffe, RT (1996). Bipolar disorder, unipolar depression and the Five-Factor Model of personality. Journal of Affective Disorders 41, 25–32.CrossRefGoogle ScholarPubMed
Bienvenu, OJ, Hettema, JM, Neale, MC, Prescott, CA, Kendler, KS (2007). Low extraversion and high neuroticism as indices of genetic and environmental risk for social phobia, agoraphobia, and animal phobia. American Journal of Psychiatry 164, 1714–1721.CrossRefGoogle ScholarPubMed
Clark, LA, Vittengl, J, Kraft, D, Jarrett, RB (2003). Separate personality traits from states to predict depression. Journal of Personality Disorders 17, 152–172.CrossRefGoogle ScholarPubMed
Colman, I, Ploubidis, GB, Wadsworth, ME, Jones, PB, Croudace, TJ (2007). A longitudinal typology of symptoms of depression and anxiety over the life course. Biological Psychiatry 62, 1265–1271.Google Scholar
Costa, PTJ, McCrae, RR (1992). Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) Professional Manual. Psychological Assessment Resources Inc.: Odessa, FL.Google Scholar
Cox, BJ, MacPherson, PS, Enns, MW, McWilliams, LA (2004 a). Neuroticism and self-criticism associated with posttraumatic stress disorder in a nationally representative sample. Behavioral Research and Therapy 42, 105–114.CrossRefGoogle Scholar
Cox, BJ, McWilliams, LA, Enns, MW, Clara, IP (2004 b). Broad and specific personality dimensions associated with major depression in a nationally representative sample. Comprehensive Psychiatry 45, 246–253.CrossRefGoogle Scholar
Duggan, C, Milton, J, Egan, V, McCarthy, L, Palmer, B, Lee, A (2003). Theories of general personality and mental disorder. British Journal of Psychiatry 181 (Suppl. 44), S19–S23.CrossRefGoogle Scholar
Enns, MW, Cox, BJ (1997). Personality dimensions and depression: review and commentary. Canadian Journal of Psychiatry 42, 274–284.Google Scholar
Eysenck, HJ, Rachman, S (1965). Dimensions of personality, pp. 14–28. In The Causes and Cures of Neurosis. Robert R. Knapp: San Diego, CA.Google Scholar
Fava, GA, Kellner, R (1991). Prodromal symptoms in affective disorders. American Journal of Psychiatry 148, 823–830.Google Scholar
Ferguson, CJ (2010). A meta-analysis of normal and disordered personality across the life span. Journal of Personality and Social Psychology 98, 659–667.CrossRefGoogle ScholarPubMed
First, M, Spitzer, RI, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version. American Psychiatric Press Inc.: Washington, DC.Google Scholar
Foster, JA, MacQueen, G (2008). Neurobiological factors linking personality traits and major depression. Canadian Journal of Psychiatry 53, 6–13.CrossRefGoogle ScholarPubMed
Furukawa, T, Hori, S, Yoshida, S, Tsuji, M, Nakanishi, M, Hamanaka, T (1998). Premorbid personality traits of patients with organic (ICD-10 F0), schizophrenic (F2), mood (F3), and neurotic (F4) disorders according to the five-factor model of personality. Psychiatry Research 78, 179–187.Google Scholar
Goldberg, LR (1993). The structure of phenotypic personality traits. American Psychologist 48, 26–34.Google Scholar
Heerlein, A, Richter, P, Gonzalez, M, Santander, J (1998). Personality patterns and outcome in depressive and bipolar disorders. Psychopathology 31, 15–22.Google Scholar
Hettema, JM, Neale, MC, Myers, JM, Prescott, CA, Kendler, KS (2006). A population-based twin study of the relationship between neuroticism and internalizing disorders. American Journal of Psychiatry 163, 857–864.Google Scholar
Hirschfeld, RM, Klerman, GL (1979). Personality attributes and affective disorders. American Journal of Psychiatry 136, 67–70.Google Scholar
Hu, L, Bentler, PM (1999). Cutoff criteria for fit indices in covariance structure analysis: conventional versus new alternatives. Structural Equation Modeling 6, 1–55.Google Scholar
Jain, U, Blais, MA, Otto, MW, Hirshfeld, DR, Sachs, GS (1999). Five-factor personality traits in patients with seasonal depression: treatment effects and comparisons with bipolar patients. Journal of Affective Disorders 55, 51–54.CrossRefGoogle ScholarPubMed
Katz, R, McGuffin, P (1987). Neuroticism in familial depression. Psychological Medicine 17, 155–161.Google Scholar
Kendell, RE, DiScipio, WJ (1968). Eysenck personality inventory scores of patients with depressive illnesses. British Journal of Psychiatry 114, 767–770.Google Scholar
Kendler, KS, Gatz, M, Gardner, CO, Pedersen, NL (2006). Personality and major depression: a Swedish longitudinal, population-based twin study. Archives of General Psychiatry 63, 1113–1120.Google Scholar
Kendler, KS, Myers, J (2010). The genetic and environmental relationship between major depression and the five-factor model of personality. Psychological Medicine 40, 801–806.CrossRefGoogle ScholarPubMed
Kentros, M, Smith, TE, Hull, J, McKee, M, Terkelsen, K, Capalbo, C (1997). Stability of personality traits in schizophrenia and schizoaffective disorder: a pilot project. Journal of Nervous and Mental Disease 185, 549–555.CrossRefGoogle ScholarPubMed
Kleifield, EI, Sunday, S, Hurt, S, Halmi, KA (1994). The effects of depression and treatment on the Tridimensional Personality Questionnaire. Biological Psychiatry 36, 68–70.Google Scholar
Lauer, CJ, Bronisch, T, Kainz, M, Schreiber, W, Holsboer, F, Krieg, JC (1997). Pre-morbid psychometric profile of subjects at high familial risk for affective disorder. Psychological Medicine 27, 355–362.Google Scholar
Lozano, BE, Johnson, SL (2001). Can personality traits predict increases in manic and depressive symptoms? Journal of Affective Disorders 63, 103–111.CrossRefGoogle ScholarPubMed
Maier, W, Lichtermann, D, Minges, J, Heun, R (1992). Personality traits in subjects at risk for unipolar major depression: a family study perspective. Journal of Affective Disorders 24, 153–164.Google Scholar
Masters, JC, Furman, W (1976). Effects of affective states on noncontingent outcome expectancies and beliefs in internal or external control. Developmental Psychology 12, 481–482.Google Scholar
McCrae, RR, Costa, PT Jr. (1997). Personality trait structure as a human universal. American Psychologist 52, 509–516.Google Scholar
McCrae, RR, Terracciano, A (2005). Universal features of personality traits from the observer's perspective: data from 50 cultures. Journal of Personality and Social Psychology 88, 547–561.CrossRefGoogle Scholar
Meredith, W, Tisak, J (1990). Latent curve analysis. Psychometrika 55, 107–122.Google Scholar
Middeldorp, CM, Cath, DC, Van Dyck, R, Boomsma, DI (2005). The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychological Medicine 35, 611–624.Google Scholar
Modell, S, Huber, J, Holsboer, F, Lauer, CJ (2003). The Munich Vulnerability Study on Affective Disorders: risk factors for unipolarity versus bipolarity. Journal of Affective Disorders 74, 173–184.Google Scholar
Montgomery, SA, Asberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.Google Scholar
Mulder, RT (2002). Personality pathology and treatment outcome in major depression: a review. American Journal of Psychiatry 159, 359–371.Google Scholar
Nowakowska, C, Strong, CM, Santosa, CM, Wang, PW, Ketter, TA (2005). Temperamental commonalities and differences in euthymic mood disorder patients, creative controls, and healthy controls. Journal of Affective Disorders 85, 207–215.Google Scholar
Purcell, SM, Wray, NR, Stone, JL, Visscher, PM, O'Donovan, MC, Sullivan, PF, Sklar, P (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature 460, 748–752.Google Scholar
Rector, NA, Hood, K, Richter, MA, Bagby, RM (2002). Obsessive-compulsive disorder and the five-factor model of personality: distinction and overlap with major depressive disorder. Behavioral Research and Therapy 40, 1205–1219.Google Scholar
Reich, J, Noyes, R Jr., Hirschfeld, R, Coryell, W, O'Gorman, T (1987). State and personality in depressed and panic patients. American Journal of Psychiatry 144, 181–187.Google Scholar
Rietschel, M, Beckmann, L, Strohmaier, J, Georgi, A, Karpushova, A, Schirmbeck, F, Boesshenz, KV, Schmal, C, Burger, C, Jamra, RA, Schumacher, J, Hofels, S, Kumsta, R, Entringer, S, Krug, A, Markov, V, Maier, W, Propping, P, Wust, S, Kircher, T, Nothen, MM, Cichon, S, Schulze, TG (2008). G72 and its association with major depression and neuroticism in large population-based groups from Germany. American Journal of Psychiatry 165, 753–762.Google Scholar
Rodgers, B (1990). Behaviour and personality in childhood as predictors of adult psychiatric disorder. Journal of Child Psychology and Psychiatry 31, 393–414.Google Scholar
Rosa, AR, Andreazza, AC, Kunz, M, Gomes, F, Santin, A, Sanchez-Moreno, J, Reinares, M, Colom, F, Vieta, E, Kapczinski, F (2008). Predominant polarity in bipolar disorder: diagnostic implications. Journal of Affective Disorders 107, 45–51.Google Scholar
Rubin, DB (1987). Multiple Imputation for Nonresponse in Surveys. John Wiley and Sons, Inc.: NY.Google Scholar
Sachs, GS (1990). Use of clonazepam for bipolar affective disorder. Journal of Clinical Psychiatry 51 (Suppl.), 31–34; discussion 50–53.Google Scholar
Sachs, GS, Guille, C, McMurrich, SL (2002). A clinical monitoring form for mood disorders. Bipolar Disorders 4, 323–327.CrossRefGoogle ScholarPubMed
Sachs, GS, Thase, ME, Otto, MW, Bauer, M, Miklowitz, D, Wisniewski, SR, Lavori, P, Lebowitz, B, Rudorfer, M, Frank, E, Nierenberg, AA, Fava, M, Bowden, C, Ketter, T, Marangell, L, Calabrese, J, Kupfer, D, Rosenbaum, JF (2003). Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biological Psychiatry 53, 1028–1042.Google Scholar
Santor, DA, Bagby, RM, Joffe, RT (1997). Evaluating stability and change in personality and depression. Journal of Personality and Social Psychology 73, 1354–1362.Google Scholar
Sauer, H, Richter, P, Czernik, A, Ludwig-Mayerhofer, W, Schochlin, C, Greil, W, von Zerssen, D (1997). Personality differences between patients with major depression and bipolar disorder – the impact of minor symptoms on self-ratings of personality. Journal of Affective Disorders 42, 169–177.CrossRefGoogle ScholarPubMed
Shea, MT, Leon, AC, Mueller, TI, Solomon, DA, Warshaw, MG, Keller, MB (1996). Does major depression result in lasting personality change? American Journal of Psychiatry 153, 1404–1410.Google Scholar
Simon, NM, Smoller, JW, Fava, M, Sachs, G, Racette, SR, Perlis, R, Sonawalla, S, Rosenbaum, JF (2003). Comparing anxiety disorders and anxiety-related traits in bipolar disorder and unipolar depression. Journal of Psychiatric Research 37, 187–192.Google Scholar
Solyom, L, Ledwidge, B, Solyom, C (1986). Delineating social phobia. British Journal of Psychiatry 149, 464–470.CrossRefGoogle ScholarPubMed
Tackett, JL, Quilty, LC, Sellbom, M, Rector, NA, Bagby, RM (2008). Additional evidence for a quantitative hierarchical model of mood and anxiety disorders for DSM-V: the context of personality structure. Journal of Abnormal Psychology 117, 812–825.Google Scholar
Trull, TJ, Sher, KJ (1994). Relationship between the five-factor model of personality and axis I disorders in a nonclinical sample. Journal of Abnormal Psychology 103, 350–360.CrossRefGoogle Scholar
Van Os, J, Jones, PB (2001). Neuroticism as a risk factor for schizophrenia. Psychological Medicine 31, 1129–1134.CrossRefGoogle ScholarPubMed
Wray, NR, Birley, AJ, Sullivan, PF, Visscher, PM, Martin, NG (2007). Genetic and phenotypic stability of measures of neuroticism over 22 years. Twin Research and Human Genetics 10, 695–702.CrossRefGoogle ScholarPubMed
Young, LT, Bagby, RM, Cooke, RG, Parker, JD, Levitt, AJ, Joffe, RT (1995). A comparison of Tridimensional Personality Questionnaire dimensions in bipolar disorder and unipolar depression. Psychiatry Research 58, 139–143.CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.Google Scholar