On the last track, we discussed the differences found between
men and women
with bipolar disorder in the areas of differences in suicide rates; affect of
bipolar and unipolar women; and mania in men.
On this track, we will present three temperamental disturbances and how
these effect a client’s vulnerability for bipolar disorder: hyperthymic,
cyclothymic, and dysthymic.
3 Temperamental Disturbances
1. Hyperthymic Temperament
The first temperament as you know is the hyperthymic temperament. Clients
this temperament in adolescence exhibit chronic cheerfulness, overly
optimistic outlooks, exuberance, tend to be extraverted, seek stimuli,
overconfidence, and pushiness. Those exhibiting hyperthymic temperament
much more at risk for developing hypomanic episodes, especially if the
client has been given an antidepressant medication and is not simultaneously
taking a mood stabilizer.
Those clients who once exhibited temperamental
disturbances may experience the same temperament once their moods have
returned to baseline. In other words, the bipolar client with a
temperamental disturbance will consistently exhibit abnormal moods even
during their “normal” periods. However, the symptoms of the
not nearly as severe as a hypomanic episode.
Technique: Personality Checklist
Maxine, age 42, a bipolar client of mine, reported the same symptoms
associated with hyperthymic temperament. Maxine reported that she felt
confused. She stated, “I don’t quite understand. I’ve
always been really
upbeat, so some weeks are just a little worse than others. It’s no
deal. You tell me I’m bipolar. Fine. But I know I can’t
difference between my manic episodes and my regular personality.” To
Maxine with her confusion, I asked her to complete “Personality Checklist”.
Personality Checklist Part I
I gave Maxine sheet of paper with a list of personality traits in one column
and a list of manic/depressive symptoms in the other column. I asked
Maxine to check off personality traits first.
These Personality Traits included, but were not
limited to, the following:
Maxine checked off the following traits: optimistic, affectionate,
talkative, and ambitious.
Personality Checklist Part II
Next, I asked Maxine to check off the symptoms that
characterized her manic episodes.
This list of Symptoms included, but was not limited
to, the following:
1. Full of energy
2. Doing too many things
3. Highly distractible
6. Sped up
Maxine checked off the following symptoms: euphoric, grandiose, sleeping
little, racing thoughts, highly anxious. With this list of traits versus
symptoms, Maxine could now differentiate between her own lively personality
and her manic symptoms.
2. Cyclothymic Temperament
The second temperament as you know is the cyclothymic temperament. Clients
from a cyclothymic temperament often exhibit frequent mood shifts such as
unexplained tearfulness to giddiness, and variable sleeping patterns and
changing levels of self-esteem. Those clients who display a cyclothymic
temperament during adolescence were at risk for developing bipolar
depressive episodes. Also, during their baseline episodes, they experience
small mood shifts and easy irritability.
Lawrence, age 45, displayed a
cyclothymic temperament. He stated, “It just seemed to me that I
almost…PMSing. I know I’m a guy, but that’s what it
feels like. At times,
I’m easy to get along with and then all of a sudden I snap and become Mr.
Hyde. But it’s different when I’m depressed, I mean, it’s
worse.” As you
can see, Lawrence was suffering from cyclothymic temperament.
3. Dysthymic Temperament
In addition to the hyperthymic and cyclothymic temperaments, the third
temperament is the dysthymic temperament. Clients who exhibit this
temperamental disturbance display such characteristics as chronic sadness, tearfulness, joylessness, and lack of energy. Obviously, these clients
susceptible to major depressive episodes. However, as with hyperthymic
temperament, the line between personality traits and actual bipolar disorder
Carol was a bipolar I disorder client of mine who underwent
frequent, major depression. However, like Maxine who we discussed earlier
on in the track, Carol could not distinguish between the two. She stated, “I’ve
always been a bit melancholy, so what’s the difference?” I
Carol to complete the "Personality Checklist” except instead of manic
symptoms, I gave Carol a list of depressive symptoms.
traits Carol checked off included the following: indecisive, withdrawn, self-critical, passive, and pessimistic. The depressive symptoms Carol
check off in the other column included: loss
of interest, sleeping too much, more easily fatigued, and hopelessness.
With this exercise, Carol could now discriminate between her depressive
episodes and her normal personality traits.
On this track, we presented three temperamental disturbances and how these
affect a client’s vulnerability for bipolar disorder: hyperthymic,
cyclothymic, and dysthymic.
On the next track, we will examine steps I take to prevent a client’s
suicide: establishing a family history, reviewing a checklist of risk
factors, and giving advice to the client’s family.
Peer-Reviewed Journal Article References:
Akiskal, H. S., & Akiskal, K. (1992). Cyclothymic, hyperthymic, and depressive temperaments as subaffective variants of mood disorders. American Psychiatric Press Review of Psychiatry, 11, 43–62.
Meyer, T. D., Barton, S., Baur, M., & Jordan, G. (2010). Vulnerability factors for bipolar disorders as predictors of attributions in ability-based and chance-based tests. Journal of Individual Differences, 31(1), 29–37.
Ng, T. H., Burke, T. A., Stange, J. P., Walshaw, P. D., Weiss, R. B., Urosevic, S., Abramson, L. Y., & Alloy, L. B. (2017). Personality disorder symptom severity predicts onset of mood episodes and conversion to bipolar I disorder in individuals with bipolar spectrum disorder. Journal of Abnormal Psychology, 126(3), 271–284.
Online Continuing Education
What are three temperamental disturbances that affect a client’s
vulnerability for bipolar disorder?
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