Personality Patterns and Outcome in Depressive and Bipolar Disorders

Abstract

Personality traits and disorders have a strong influence on the course and outcome of depressive and bipolar disorders. Studies of the influence of personality disorders (PD) and some PD clusters on outcome of mood disorders are controversial and suggest that more specific assessment of underlying traits or dimensions is needed. Utilizing the Munich Personality test (MP-T) scales of von Zerssen, this study tries to identify specific personality traits that may influence the outcome and clinical course of unipolar endogenous depression and bipolar disorder. Six unipolar depressives and 6 bipolar patients, according to DSM III-R and ICD 10 criteria, were assessed with the MP-T self- and family-reporting scales. Three years later, their outcome scores were correlated with the corresponding premorbid personality profile. Preliminary results show that introversion has a negative effect on outcome of unipolar melancholic depression, while extraversion, esoteric tendencies and rigidity have a positive influence. Neuroticism has a negative influence on outcome of bipolar disorder, but not on unipolar endogenous depression. Data from the literature suggest that neuroticism, hostility and social dysfunction seem to have a negative prognostic value only for nonendogenous depressives and bipolar disorder, thus supporting the notion that the diagnostic distinction between bipolar disorder, endogenous and nonendogenous depression is relevant to prognostic discussions. These observations help to understand the differences between depressive syndromes and their relationship to prognosis, but also to comprehend the role of personality in clinical and theoretical research of mood disorders.

Social inhibition and treatment‐resistant depression

“…Our fi ndings are consistent with previous studies indicating that introversion may not only contribute to the onset of depression, but may also be associated with a poorer outcome for depressed patients (e.g. Heerlein et al, 1998). Our fi nding, although not formally signifi cant, that depressed patients high on social inhibition were somewhat more likely to report plans to attempt suicide, provides some support for the suggestion that introversion may be a risk factor for suicidal behaviour among depressed patients (Roy, 1998).…”

“…Introversion has been identifi ed as relevant to the onset, phenomenology and course of depression (Goldberg, 2001;Janowsky, 2001;Verkerk, Denollet, van Heck, van Son, & Pop, 2005). The impact of introversion on the outcome of depression is less well established, although it has been suggested that introversion may be associated with a relatively poor prognosis (Heerlein, Richter, Gonzalez, & Santander, 1998;Janowsky, 2001).…”

Can personality traits predict increases in manic and depressive symptoms?

“…In some ways, this finding is not surprising, because neuroticism has been shown to correlate with such a broad range of outcomes (Duggan et al, 1990;Scott et al, 1995;Heerlein et al, 1998). Thus, this finding extends neuroticism findings from unipolar depression and other psychopathologies to bipolar disorder.…”

“…Elevations of specific personality traits may induce certain maladaptive behavioral components, which increase vulnerability to symptoms of mania and depression. As described above, few studies have examined personality traits as predictors of bipolar symptoms, and results to date have been discordant (Strakowski et al, 1993;Clayton et al, 1994;Akiskal et al, 1995;Heerlein et al, 1998).…”

“…For example, higher Novelty-Seeking scores (particularly the subscales of Impulsiveness and Disorderliness), as measured using the Tridimensional Personality Questionnaire, predicted a lack of functional recovery in the 6 months following a first episode of mania for 27 patients (Strakowski et al, 1993). In another study of 6 bipolar individuals, self-and familyreported neuroticism predicted frequency and severity of relapses, quality of remission, and chronicity of symptoms, over a 3 year period (Heerlein et al, 1998). In short, the few existing studies on personality traits as predictors of bipolar course have yielded inconsistent findings.…”