Am J Psychiatry 1995; 152:232-238
Copyright © 1995 by American Psychiatric Association
Relationship between hypomania and personality disorders before and after successful treatment
ED Peselow, MP Sanfilipo and RR Fieve
Foundation for Depression/Manic Depression, New York.
OBJECTIVE: To examine the effect of hypomanic states on maladaptive
personality traits and personality disorders, the authors evaluated
personality traits and disorders of patients during an episode of hypomania
and after successful somatic treatment. METHOD: The authors used the
Structured Interview for DSM-III Personality Disorders to study 66
outpatients who had a lifetime diagnosis of bipolar disorder and who met
the minimum Research Diagnostic Criteria for hypomania. All patients had a
knowledgeable informant separately undergo the Structured Interview for
DSM-III Personality Disorders during the patient's hypomanic state.
Outpatients who successfully recovered from the hypomanic episode (N = 47)
and their informants were read- ministered the interview 4-8 weeks after
the initial assessment. RESULTS: During the hypomanic state, informants
generally reported higher levels of maladaptive personality traits among
patients than patients themselves. For the patients who recovered
successfully from the hypomanic episode, a reduction in all maladaptive
personality traits except schizoid and dependent traits was reported by
both patients and their informants; however, the decrease reported by
patients generally was much greater than that reported by informants. In
addition, schizoid traits actually increased after successful treatment
according to patient reports but were unchanged according to informant
reports. CONCLUSIONS: Hypomania may be associated with an exacerbation of
maladaptive personality traits, which may be attenuated after successful
treatment. Even with the attainment of euthymic mood, however, about 50% of
the cohort had at least one personality disorder, which suggests that a
high degree of comorbidity may exist between bipolar disorders and
maladaptive personality traits or personality disorders.
