Effects of personality functioning on the global functioning of patients with bipolar disorder I
Introduction
Bipolar disorder (BD) leads to serious deficits in global functioning and is considered by the World Health Organisation (WHO) to be a Top 10 cause of disability across the world. Patients who achieve full clinical recovery often experience difficulties maintaining complete functional recovery or return to pre-illness levels of global functioning (Sanchez-Moreno et al., 2009, Keck et al., 1998, Gitlin et al., 1995). Once the clinical symptoms are brought under control following a manic or depressive episode, the patient is generally expected to achieve pre-illness levels of global functioning. However, even patients who have already entered the remission phase may suffer from impairments in social, occupational, and interpersonal global functioning (Depp et al., 2006, MacQueen et al., 2001, Goldberg et al., 1995, Coryell et al., 1993).
A variety of factors influence the level of global functioning in patients with BD. For example, clinical variables, such as age of onset, frequency of cycles, subclinical symptoms, rapid cycling, and the presence of symptoms pertaining to psychotic and mixed cycles have a negative impact on global functioning (Rosa et al., 2009, Suppes et al., 2000, Goldberg and Keck, 1999). Similarly, environmental factors, such as the presence of psychiatric and medical comorbidities (Kupfer, 2005; Feinman and Dunner, 1996), drug side effects (Zarate et al., 2000), substance abuse comorbidity (Lish et al., 1994, McElroy et al., 1992), suicidal behaviour history (Hajek et al., 2005, Kilbourne et al., 2004), compliance with medication (Colom et al., 2003, Colom et al., 2000), life events (Ellicot et al., 1990), and social support (Cohen et al., 2004, Johnson et al., 2003, O'Connell et al., 1985), can affect global functioning. It is also important to note that personality traits can affect global functioning in patients with BD (Hajek et al., 2005, Hecht et al., 2005).
Many studies show that BD patients have significantly higher prevalence of personality disorder than general population (Barquero et al., 2007, George et al., 2003, Kay et al., 2002). Personality traits are considered to be factors affecting functioning in the BD and bipolar patients with personality psychopathology have poorer response to medications and more virulent course of illness (Fan and Hassel, 2008). Personality profiles in BD have been explored in several studies and some personality dimensions have even been suggested as a phenotype for BP (Savitz and Ramesar, 2006). Cloninger's Temperament and Character Inventory revised (Cloninger, 1999) has frequently been used as a measure of personality. Findings using this measurement confirmed that individuals with BD seem to have a different personality structure than healthy controls, although not all studies support this view (Nery et al., 2008). Vierck and Joyce (2015) assessed personality and cognitive functioning in BD and control participants and they found that the best determinants of good psychosocial functioning were good verbal memory and high self-directedness. The use of self- management techniques were associated with a low level of harm-avoidance.
Skodol et al. (2014) brought forward the personality functioning upon introduction of a novel hybrid personality model presented in the Diagnostic and Statistical Manual (DSM)−5 section III. Personality functioning, like other human tendencies, is the path along which an individual continuously contemplates and understands oneself and interactions with others. Mental representation of self and that of interpersonal relations are in mutual interaction and indivisibly interconnected. The self functioning incorporates identity and self-direction, whereas interpersonal functioning involves empathy and intimacy. The Personality and Personality Disorders Work Group identified the necessity that a new personality functioning measure was to be constructed in view of common psychological processes underlying all personality disorders. In that context, several valid and reliable measures assessing the capacities and psychopathologies of personality were examined, and the self-other dimensional perspective had a considerable employability for both clinical and empirical purposes (Bender et al., 2011). In a recent study (Hopwood et al., 2011) of patients with personality disorders participating in the Collaborative Longitudinal Personality Disorders Study (Gunderson et al., 2000) has claimed that in assessing personality psychopathology, “generalized severity is the most important single predictor of concurrent and prospective dysfunction”. Distorted thinking about self and others is a common factor in personality disorders and it's supported with extensive literature (Livesley and Jang, 2000, Masterson, 1988, Kernberg, 1987, Blatt and Lerner, 1983). Maladaptive patterns of mental representations about self and others have a structural function in conceptualization of general psychopathology of personality. Based on this primary feature of the LPFS, it has been suggested that LPFS will allow clinicians to assess the existence and severity of personality disorders in all subjects. Although personality disorders and personality traits have been studied in previous studies with BD, it has not been observed that level of personality functioning was assessed in these patients.
In the case of BD, the assessment of global functioning during the euthymic period and the identification of predictors of impaired global functioning would significantly contribute to the development of follow-up programs as well as the achievement of treatment and psychosocial rehabilitation for patients. However, few studies have investigated this type of global functioning using BD-specific measures. Furthermore, to the best of our knowledge, the effects of the level of personality functioning on global functioning during the euthymic period of BD have yet to be studied. Personality is an individual's unique constellation of consistent behavioural traits and it is formed and sustained from early ages. Personality disorders and also personality functioning are core structures of an individual. Global functioning in BD are known to be affected by many factors, and we think that these factors will have confounding effects when examining the effect of personality functioning on global functioning. Therefore, in this study, firstly, the variables reported in previous studies, which had an effect on the global functioning in BD during euthymic period were examined to evaluate the effects of personality functioning independently of other factors.
Section snippets
Sample and processing
The present study included subsequent patients who applied to the Psychiatry Polyclinics of Erenkoy Mental Health and Neurology Training and Research Hospital, had been diagnosed with BD-I using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), were in the remission phase, and confirmed their volunteerism by signing a consent form. The exclusion criteria consisted of being younger than 18 or older than 65 years of age, being illiterate, not being in the remission phase,
Results
The present study included 100 patients with BD. Table 1 reports the distribution of participants across socio-demographic variables, Tables 2a and 2b the results of their clinical features. Psychiatric and medical comorbidities of the patients and medications used by them are shown in Table 3. The average values for global functioning and the level of personality functioning are provided in Table 4.
The correlation analyses assessing the relationships between global functioning and clinical
Discussion
The present study was designed to investigate the level of personality functioning in patients with BD during the euthymic phase and to determine factors that may impair global functioning across several domains and revealed that, even in the euthymic phase, patients with BD suffer from impairments in several domains of global functioning. Most notably, the presence of subclinical symptoms, psychiatric comorbidities, alcohol/substance use disorders, perceived social support and drug side
References (70)
- et al.
The impact of cognitive impairment, neurological soft signs and subdepressive symptoms on functional out come in bipolar disorder
J. Affect Disord.
(2015) - et al.
Social adjustment and self-esteem of bipolar patients: a multicentric study
J. Affect. Disord.
(2004) - et al.
Effects of stress and social support on recurrence in bipolar disorder
J. Affect. Disord.
(2004) - et al.
2-year course of bipolar disorder type I patients in outpatient care: factors associated with remission and functional recovery
Eur. Neuropsychopharmacol.
(2011) - et al.
Social functioning and personality of subjects at familial risk for affective disorder
J. Affect. Disord.
(2005) - et al.
The National Depressive and Manic-Depressive Association (DMDA) survey of bipolar members
J. Affect. Disord.
(1994) - et al.
Temperament and character traits in patients with bipolar disorder and associations with comorbid alcoholism or anxiety disorders
J. Psychiatr. Res.
(2008) - et al.
Influence of personality and neuropsychological ability on social functioning and self-management in bipolar disorder
Psychiatry Res.
(2015) - et al.
Psychometric properties of the Turkish version of the patient health questionnaire–somatic, anxiety, and depressive symptoms
Compr. Psychiatry
(2012) - et al.
Predictors of long-term work disability among patients with type I and II bipolar disorder: a prospective 18-month follow-up study
Bipolar Disord.
(2015)
Characterizing quality of life among patients with chronic mental illness: a critical examination of the self-report methodology
Am. J. Psychiatry
Bipolar bozuklukta işlevsellik ölçeğinin geliştirilmesi, güvenilirlik ve geçerliliği
Turk Psikiyatri Derg.
Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study
Neuropsychiatr. Dis. Treat
Toward a model for assessing level of personality functioning in DSM–5, part I: A review of theory and methods
J. Pers. Assess.
The psychological assessment of object representation
J. Pers. Assess.
The impact of repeated manic episodes and executive dysfunction on work adjustment in bipolar disorder
Eur. Arch. Psychiatry Clin. Neurosci.
A Secure Base. Clinical Applications of Attachment Theory
Recovery and functional outcomes following olanzapine treatment for bipolar I mania
Bipolar Disord.
The Temperament and Character Inventory-Revised
Clinical factors associated with treatment noncompliance in euthymic bipolar patients
J. Clin. Psychiatry
Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement
J. Clin. Psychiatry
The enduring psychosocial consequences of mania and depression
Am. J. Psychiatry
Bipolar bozukluğu olan hastalarda işlevsellik düzeyi ve içselleştirilmiş damgalanma arasındaki ilişkinin belirlenmesi
Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi
DSM IV Eksen I bozuklukları (SCID I) Icin Yapılandırılmış Klinik Görüşme-Klinik Versiyon
Health-related quality of life and functioning of middle-aged and elderly adults with bipolar disorder
J. Clin. Psychiatry
Life events and the course of bipolar disorder
Am. J. Psychiatry
Manual of the Eysenck Personality Questionnaire (Adult and Junior)
Personality, marital satisfaction, and divorce
Psychol. Rep.
Functional impairment in the remission phase of bipolar disorder
Bipolar Disord.
Bipolar disorder and comorbid personality psychopathology: a review of the literatüre
J. Clin. Psychiatry
Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version
The comorbidity of bipolar disorder and axis II personality disorders: prevalence and clinical correlates
Bipolar Disord.
Relapse and impairment in bipolar disorder
Am. J. Psychiatry
Course and outcome in bipolar affective disorder: a longitudinal follow-up study
Am. J. Psychiatry
Poor-outcome bipolar disorders
Cited by (7)
Effect of treatment adherence training given to patients with bipolar disorder on treatment adherence, social functioning and quality of life: A pilot study
2022, Complementary Therapies in Clinical PracticeCitation Excerpt :Significant impairments have been reported in 30–60% of bipolar patients in terms of both occupation and social functioning [5]. The World Health Organization (WHO) has recognized the disorder as one of the ten largest causes of disability worldwide, as it causes serious problems in the areas of the general functioning of individuals [6]. The WHO has reported that the rate of treatment adherence, which involves drug adherence, is approximately 50% in individuals with chronic diseases [7].
Social support among individuals with bipolar disorder during euthymic phase: A systematic review
2023, Clinical Psychology and PsychotherapyLong-term work disability due to type I and II bipolar disorder: findings of a six-year prospective study
2022, International Journal of Bipolar DisordersComplementary and alternative medicine use and its association with clinical features and functioning in patients with bipolar I disorder: A cross-sectional study
2022, Dusunen Adam - The Journal of Psychiatry and Neurological SciencesRole of personality functioning in predicting interpersonal and emotional problems
2020, Journal of Mazandaran University of Medical Sciences