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Summary: A new study shows we can improve bipolar disorder treatment with a more comprehensive and nuanced understanding of patient personality traits and types.

Key Points:

  • Personality traits can predict risk of depressive disorders
  • Combinations of personality traits form personality types
  • Specific personality types may predict risk of developing bipolar disorder
  • A combination of various personality types may increase risk of relapse of bipolar disorder symptoms

What Role Does Personality Play in Bipolar Disorder Treatment?

When we talk about personality and mental health, it’s easy to miss the mark. The persona people present the world may not reflect what’s going on inside. When we see a person who appears to be happy, then we may assume that person isn’t, can’t be, or probably isn’t depressed, and probably doesn’t have a clinical diagnosis for bipolar disorder. However, as we navigate life, we learn how inaccurate these observations can be.

Take the comedian Robin Willilams, for instance. Many people believe he was one of the funniest humans ever. But Robin Williams – despite being apparently outgoing, happy, and gregarious – had severe bipolar disorder, and tragically died by suicide.

What does that teach us?

That the way a person behaves doesn’t always represent how they feel, and how they appear on the outside – i.e. what we think of as their personality traits – may not be their personality traits at all, and might actually be misleading.

So how can we identify what their real personality traits are, what their real personality type is, and how those impact bipolar disorder treatment?

We can use an evidence-based metric that relies on self-report questionnaires, rather than external behavior.

Personality Tests: One Way to Improve Bipolar Disorder Treatment

A group of researchers from the Department of Psychiatry at the University of Michigan published a study called “Predictive Evidence for the Impact of Personality Styles on Depression and Functioning in Two Bipolar Disorder Cohorts” to explore the role of personality on bipolar disorder treatment – specifically, how it might impact relapse.

To explore this idea, the research team identified this research objective:

“We examine whether personality trait combinations (styles) enhance our ability to prospectively predict symptoms and functioning across time in two independent longitudinal research cohorts.”

After reporting data that indicates relapse rates for people with bipolar disorder may be as high as 73 percent within 5 years of initial remission of symptoms – with close to 60 percent reporting more than one relapse – the research team noted the following facts:

  • Understanding more about patient personality traits could inform and improve bipolar disorder treatment
  • Currently, identifying the presence of neuroticism is the primary focus of leveraging personality traits to improve bipolar disorder treatment
  • Considering the combined impact of multiple personality traits may inform ways to improve bipolar disorder treatment in the future

A five-factor model of personality traits designed in 1992 is the most useful tool for the purposes of our study. The five traits in this model include:

  1. Neuroticism (N): defined as low emotional stability and tendency to experience negative emotional stats
  2. Extraversion (E): describes the extent to which a person is outgoing, energetic, and sociable
  3. Openness to Experience (O): describes the extent to which a personal displays imagination, curiosity, and open-mindedness
  4. Agreeableness (A): describes personal tendency to show compassion, cooperation, and trust
  5. Conscientiousness (C): describes personal level of organization, dependability, and self-discipline

Since personality is multidimensional, focusing on one trait – most studies in the past have focused solely on neuroticism – risks missing the full picture, and may give us an incomplete picture of the impact of personality on depression, relapse to bipolar depression, and how we can improve bipolar disorder treatment.

Let’s take a closer look at the relationship between personality traits and types, which will help us understand the results of the study.

Personality Traits, Types, and Depression Risk

And understanding of the multidimensional nature of personality led to studies that focused on the combination of personality traits, how they combine to form a personality type, and how personality type may impact risk of developing depression. Those studies showed the following:

  • High neuroticism (N) combined with high openness (O) is associated with increased depression risk.
  • Low neuroticism (N) combined with high agreeableness (A) s associated with decreased depression risk.
  • High neuroticism (N) combined with low conscientiousness (C) is associated with increased depression risk.
  • High consciousness (C), can have a protective effect when combined with high neuroticism (N).
  • Low consciousness (C) combined with low extraversion (E), low Openness (O) or low agreeableness (A) is associated with increased depression risk.

When we review that list, it makes sense. And let’s be clear: these are self-reported traits from private personality tests and assessments. This eliminates the confounding factor of how people appear, and instead allows people to self-identify, thereby offering a personality profile that’s likely to be far more accurate and reliable than their external behavior or appearance, which may be curated for various reasons.

Before we share the results of the study, we’ll quickly review what bipolar disorder is, and the current prevalence of bipolar disorder around the world and in the U.S.

Bipolar Disorder: Facts and Figures

Here’s a good general definition of bipolar disorder provided by the National Institute of Mental Health (NIMH):

“Bipolar disorder is characterized by dramatic shifts in mood, energy, and activity levels that affect a person’s ability to carry out day-to-day tasks. These shifts in mood and energy levels are more severe than the normal ups and downs that are experienced by most people.”

And here’s recent data on the prevalence of bipolar disorder, based on a review of over 250,000 patient records analyzed in 25 population and community-based studies.

Prevalence of BD I &II Worldwide

  • Type 1:
    • Lifetime: 1.06%
    • 1 year: 0.71%
  • Type 2:
    • Lifetime: 1.57%
    • 1-year: 0.50%
With a world population of around 4.75 billion adults 18+, one (1) percent is about 47.5 million, meaning that during any given recent year, close to 25 million people have one of the two types of bipolar disorder.

Past-Year Prevalence of BD I &II in the U.S (From the NIMH)

  • Type I&II: 2.8%
    • Females: 2.8%
    • Males: 2.9%
With a population of around 260 million adults, one (1) percent is about 2.6 million, meaning that during any given recent year, around 7.3 million people have one of the two types of bipolar disorder.

That information helps. Although the overall percentages of bipolar disorder worldwide and in the U.S. appear small – anything around one percent may seem insignificant – the actual numbers reveal the true size and scope of the disorder in the population. That’s why studies like this are important: they concern the wellbeing of millions of people.

Now let’s take a look at the results of the study.

Using Personality Traits to Improve Bipolar Disorder Treatment: Which Traits Play a Role?

The research team collected data on over 2,500 people with a clinical diagnosis for bipolar disorder and analyzed the impact of personality traits and types on depression and functioning for 14 years after diagnosis and treatment. The team used data from two groups of individuals – called cohorts – who completed follow up assessments every two months and/or every two years, depending on the cohort.

Using a model considering all potential combinations of personality traits/styles, researchers calculated the following:

  • The number of risk-related personality styles, i.e. styles associated with poor outcomes
  • The number of protective-related personality styles, i.e. styles associated with better outcomes

In the first cohort, for every additional risk style relative to protective style, the researchers reported:

  • Incident rate of depression: 13.4% increase
  • incident rate for poor life functioning: 11.1% increase

In the second cohort, a similar pattern, but overall lower rates, emerged:

  • Incident rate of depression: 5% increase
  • incident rate for poor life functioning: 2.9% increase

Combining both groups for cross -validation yielded the following outcomes:

  • Incident rate of depression: 5%-11% increase
  • incident rate for poor life functioning: 5%-11% increase

When looking at single personality traits, researchers observed:

  • High neuroticism (N) was associated with increased depression risk
  • Low neuroticism (N) was associated with decreased depression risk

All the patients in this study had a diagnosis of bipolar disorder. Therefore, these figures show the impact of personality trait and type on relapse of bipolar disorder symptoms after initial treatment, as well as the relationship between personality type and poor life functioning, a negative outcome associated with the presence of bipolar disorder.

We’ll discuss these results below.

Personality Traits and Bipolar Disorder: What Increases Risk of Relapse?

According to the risk profiles we describe in the third section of this article, above, trait combinations – i.e. types – that increase risk of relapse include:

  • High neuroticism (N) + high openness (O)
  • High neuroticism (N) + low conscientiousness (C)
  • Low consciousness (C) + low extraversion (E)
  • Low consciousness (C) + low Openness (O)
  • Low consciousness (C) + low agreeableness (A)

Here’s how Dr. Kelly Ryan of the University of Michigan describes these results:

“These findings are really exciting because we don’t know why some patients with bipolar disorder are more resilient and bounce back or have fewer episodes of depression, but now we can see that this could be linked to the makeup of their personality. We hope that this can eventually inform the treatment planning that clinicians do for patients, knowing who may be at higher risk.”

Dr. Ryan is right: these findings are exciting, and can likely help us improve bipolar disorder treatment, particularly during the maintenance phase of recovery, after the end of a formal treatment program. We can help patients understand how their personality might put them at risk. We can also use this information to create a more individualized and responsive ongoing care/aftercare plan, and prioritize continuing care that aligns with their personality traits and type.

To learn more about treatment for bipolar disorder at Crownview Psychiatric Institute, please visit our treatment page:

Bipolar Disorder Treatment

If you want to stay on this page, we’ll summarize our approach to treatment for bipolar disorder below.

Treatment for Bipolar Disorder

At Crownview Psychiatric, we create comprehensive, holistic, individualized treatment plans that include the following components:

Psychotherapy:

Therapists may use additional cognitive-based, trauma-informed exposure therapies if needed.

Medication:

  • Mood stabilizers
  • Antidepressants

Additional psychiatric medications may also support patients with bipolar disorder, if needed.

 Education:

  • The science behind bipolar disorder and treatment for bipolar disorder
  • The science of trauma

Therapists and counselors may facilitate educational/process groups on healthy relationships, positive communication, and overall health and wellness may also support patients with bipolar disorder, if needed.

 Adjunct Therapies:

  • Nicotinamide adenine dinucleotide (NAD+) therapy
  • IV vitamins

Therapists and counselors may facilitate educational/process groups on healthy relationships, positive communication, and overall health and wellness may also support patients with bipolar disorder, if needed.

 Complementary/Expressive Therapies:

  • Meditation
  • Yoga
  • Mindfulness

Patients may engage in additional experiential or expressive therapies as needed, and if they help reduce symptoms and improve treatment progress.

Finding Help: Resources

If you or someone you know needs professional treatment and support for bipolar disorder, please contact us here at Crownview Psychiatric Institute: we can help. In addition, you can find support through the following online resources:

About Angus Whyte

Angus Whyte has an extensive background in neuroscience, behavioral health, adolescent development, and mindfulness, including lab work in behavioral neurobiology and a decade of writing articles on mental health and mental health treatment. In addition, Angus brings twenty years of experience as a yoga teacher and experiential educator to his work for Crownview. He’s an expert at synthesizing complex concepts into accessible content that helps patients, providers, and families understand the nuances of mental health treatment, with the ultimate goal of improving outcomes and quality of life for all stakeholders.