مقیاس هایپوجنون شخصیتی، پنج عامل بزرگ، و ارتباط آن با افسردگی و شیدایی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|34167||2002||12 صفحه PDF||سفارش دهید||6004 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Personality and Individual Differences, Volume 32, Issue 4, March 2002, Pages 649–660
The present study investigates (1) if the Hypomanic Personality Scale [Hyp; Eckblad, M., & Chapman, L.J., (1986). Development and validation of a scale for hypomanic personality. Journal of Abnormal Psychology, 95, 214–222.] correlates with other personality traits and (2) whether the Hyp scales or other measures such as Neuroticism and Extraversion are more strongly associated with affective symptoms. The participants (n=224) completed questionnaires including the Hyp scale, the NEO-FFI, and the CES-D and were independently interviewed with the CIDI to assess depression and mania. The results showed that the Hyp scale correlated only with the NEO-FFI dimensions Extraversion and Openness. In contrast to Extraversion, the Hyp scale was significantly associated with symptoms of depression and mania, and was more strongly related to manic symptoms than Neuroticism was. Decile scores of the Hyp scale were not associated with depressive symptoms, but were associated with manic symptoms. Discussion focuses on the question of whether the Hyp scale represents a possible risk factor for bipolar disorder. The possibility of a “manic defense” against depression is also discussed.
There is a long European tradition of describing links between affective disorders and certain temperaments or personality types, such as the cyclothymic, the depressive or hypomanic (e.g. Kraepelin, 1921, Kretschmer, 1921 and von Zerssen, 1996). Most of the research within the last 20 years, however, has dealt with cyclothymia (e.g. Akiskal, 1992, Depue et al., 1989, Depue & Slater, 1981 and Lovejoy & Steuerwald, 1997) or dysthymic-depressive personality (e.g. Hartlage et al., 1998, Klein & Miller, 1993 and Klein & Shih, 1998), while the validity of the construct of hyperthymia or hypomanic personality has not been addressed that often. The terms ‘Hypomanic Personality’ or ‘hyperthymia’ describe people who are characterized by a cheerful, optimistic, extraverted, self-confident and energetic temperament, although they can also be irritable, rude, reckless and irresponsible (e.g. Akhtar, 1988, Akiskal, 1992 and Eckblad & Chapman, 1986). In contrast to manic or hypomanic episodes as described in the DSM IV (American Psychiatric Association, 1994), these features are thought to represent the enduring, habitual self of the individual. Although these traits are thought to be fairly stable, periods of depressive symptoms are often present in individuals with these traits (e.g. Akhtar, 1988 and Akiskal, 1992). Eckblad and Chapman (1986) developed a 48-item self-report questionnaire to assess such stable hypomanic traits. Examples for the items are “I am frequently so hyper that my friends kiddingly ask me what drug I’m taking (true)” or “I often get so happy and energetic that I am almost giddy (true)”. In their initial study they found evidence that individuals scoring high on the ‘Hypomanic Personality Scale (Hyp)’ had more episodes of mood disorders, more psychotic-like symptoms, higher substance abuse and a lower psychosocial functioning compared with controls. Similar results were obtained in a large sample of adolescents by Klein, Lewinsohn, and Seeley (1996). Meyer, Salkow, and Hautzinger (2001) found that the Hyp scale predicted depressive but not anxiety symptoms at a 3-year follow-up. Hirschfeld (1999) has described the ‘hypomanic personality’ as a myth, because some studies have found that remitted bipolar patients did not differ from controls on Extraversion. However, why should the trait Extraversion reliably differentiate between bipolar patients and control groups, if it is not even able to predict future bipolar disorders in the Zurich study (Ernst, Angst, Klesse, & Zuberbühler, 1996)? In contrast, the Hyp scale of Eckblad and Chapman predicted the onset of bipolar disorders over a 13-year follow up with a prevalence of such disorders of about 25% for the risk group, but none in the control group (Kwapil, Miller, Zinser, Chapman, Chapman, & Eckblad, 2000). Even more compelling is that Kwapil et al. (2000) found that these results were not due to mood disorder episodes reported 13 years ago. Much of the research that focused on the premorbid personality of patients with bipolar disorder has described patients during remission (Goodwin & Jamison, 1990). If one talks about personality research, the Big Five model of personality is currently perhaps the most widely used personality model in psychology (e.g. Costa & Widiger, 1994, Cox et al., 1999, DeNeve & Cooper, 1998 and Nigg & Hinshaw, 1998). And at least three of the Big Five dimensions have been linked with affective disorders: (1) Extraversion has been discussed as a factor referring to bipolar disorder. However, the results are mixed (e.g. Goodwin & Jamison, 1990). While Hirschfeld, Klerman, Keller, Andreasen, and Clayton (1986) found higher introversion levels among patients than control subjects, Solomon et al. (1996) reported that persons with bipolar I disorder were characterized by higher scores in hysteria (seen as part of Extraversion). However, using a different approach Maier, Minges, Lichtermann, and Heun (1995) found no evidence for higher extraversion in relatives of patients with bipolar disorder. (2) Neuroticism: besides the vast literature about the relation between depression and neuroticism (e.g. Fergusson et al., 1989, Kendler et al., 1993 and Saklofske et al., 1995) this dimension predicted future unipolar disorders (Ernst et al., 1996). Some studies also reported higher neuroticism scores in bipolar patients compared with other groups (e.g. Jain et al., 1999 and Solomon et al., 1996). However, Maier et al. (1995) did not find any evidence for a familial aggregation of neuroticism in families of bipolar patients. Furthermore, high neuroticism scores did not predict future bipolar disorders (Ernst et al., 1996). Elevated neuroticism scores are perhaps more closely related to specific clinical characteristics such as number of episodes than to the vulnerability for bipolar disorder itself (e.g. Moorhead & Scott, 2000). Finally, (3) Conscientiousness: In its extreme form this trait means rigidity or even obsessive-compulsive tendencies which are often seen in relatives with affective disorders (e.g. Klein Depue, 1985, Lauer, 1997, Maier et al., 1992 and Maier et al., 1995). This indicates that traits which are characteristic for the Typus melancholicus (von Zerssen, 1996) are also linked to bipolar disorder. However, von Zerssen (1996) has hypothesized that the Typus manicus and Typus melancholicus are uncorrelated. Most of these studies do not address the question of whether these traits are the result of the illness history or predate the onset of the disorder. In addition, the evidence for elevated levels of traditional personality traits in relatives of patients with bipolar affective disorder is fairly mixed. Another approach is to look at the correlation between a potential risk factor and such variables. The Hyp scale seems to be such a promising instrument, but despite the compelling prospective evidence (Kwapil et al., 2000), little basic research has been conducted on the Hyp scale. Pertaining to personality variables, the scale has been correlated with anxiety (e.g. French et al., 1996 and Klein et al., 1996) and attributional style (Thompson & Bentall, 1990), but we were unable to identify published articles describing the association between the Hyp scale and other personality variables. The studies dealing with the Hyp scale and trait anxiety have received mixed support as a correlate of the Hyp scale with French et al. (1996) who identified an association, but others did not (e.g. Meyer et al., 2001 and Petzel & Rado, 1990). Except for Klein et al. (1996) all these studies used a trait anxiety measure but none has ever used a neuroticism scale that is more common in the clinical studies (e.g. Moorhead & Scott, 2000 and Solomon et al., 1996). No study has ever looked at the association between the Hyp scale and extraversion. Although the evidence pertaining to extraversion is mixed for patients (e.g. Goodwin & Jamison, 1990), it is expected that a correlation to the Hyp scale exists. However, the correlation will be far from perfect, because the Hyp scale assesses symptoms like habitually decreased need for sleep, pressured speech or being overly talkative which are part of concepts such as the Typus manicus (von Zerssen, 1996) or hyperthymia (Akiskal, 1996) but are not characteristic of extraversion. The third dimension discussed before in reference to patients with affective disorders was ‘Conscientiousness’. However, the association between the Hyp scale and this dimension has only be studied for its extreme form, i.e. obsessive-compulsive traits. Meyer (2001) and Meyer, Drüke, and Hautzinger (2000) were able to show that there is a strong tendency for people scoring high on the Hyp scale to report more obsessive-compulsive traits than controls do. Therefore, there might be an association between the Hyp scale and conscientiousness. However, according to von Zerssen’s model (1996) the Hyp scale and conscientiousness could also be uncorrelated. Pertaining to the remaining two factors of the Big Five — openness and agreeableness — no prior research has linked them to bipolar affective disorder so that no hypothesis about possible associations can be postulated. Some of the rationale for a personality hypothesis is based on the family history pattern of affective disorders. Relatives of bipolar patients have an elevated risk for both bipolar and unipolar affective disorders. We hypothesize that the risk for unipolar depression is associated with obsessive-compulsive traits (≈ as part of Typus melancholicus), whereas the risk for mania is associated with hypomanic traits (≈ as part of Typus manicus). In reference to the intercorrelations between the Hyp scale and the Big Five dimensions, the association of the Hyp scale and the personality dimensions with self-rated depression will be estimated to replicate the reported association between the Hyp scale and depression (e.g. Klein et al., 1996 and Meyer et al., 2001), and to investigate whether other variables than the Hyp scale are more closely related to affective symptoms. Most models of personality as a risk factor have used continuous scores (e.g. French et al., 1996 and Klein et al., 1996) in which higher levels of personality traits are expected to suggest higher vulnerability. In high-risk research on schizophrenia, however, it is preferable to compare a risk group (defined by a cut-off score e.g. upper decile) with a control group. Although empirical evidence and theoretical models provide guidelines for such a procedure for schizophrenia (e.g. Lenzenweger, 1999, Lenzenweger & Korfine, 1992, Meehl, 1990 and Tyrka et al., 1995), comparable data is not available for bipolar disorders. Therefore empirical studies are needed to test whether a categorical or dimensional view is more appropriate. One way to gather information about this subject is to use a procedure chosen by French et al. (1996): they related decile scores on the Hyp scale to BDI scores. The advantage of this procedure is that the total sample is included in the analysis. Usually for practical reasons, only certain people are studied who belong either to the control or risk group, while most people are excluded, and we have no further data and information about them. Interestingly French et al. (1996) found that the depression scores were not highest among the people who are normally considered the high-risk group, i.e. the ones scoring in the upper decile of the Hyp scale. Rather, less elevated Hyp scores were associated with more depression-related symptoms. In line with other authors (e.g. Bentall & Thompson, 1990 and Lyon, 1999, French et al. (1996) argued that people with ‘Hypomanic Personality’ are defensive about depression-related symptoms. And therefore self-ratings of the frequency and intensity of depression-related symptoms were — post hoc — not expected to be highest among the people scoring in the upper decile of the Hyp scale. In contrast, Klein et al. (1996) found higher risk of mood disorders with higher Hyp scores. However, using the CES-D as a self-rating instrument for depression Klein et al. (1996) only tested for significant differences between the two extreme groups. French et al. (1996) also only used self-report questionnaires to assess depression. The present study therefore included observer-rated criteria for depressive and manic symptoms from a clinical interview.