Complex Bipolarity: Focus on Temperament and Mixed States

Notes from a presentation by Dr. Akiskal

  • This is a “translation” for non-psychiatrists out there.
  • All responsibility for error in translation is mine.
  • Here are his main points as I understand them:

A. There is a complex interaction between a person’s usual mood style and the kind of mood episodes they’ll have. Call their usual mood style “temperament”. A gregarious, dramatic, outgoing type (“hyperthymic temperament”) is more likely to have a “euphoric” manic phase – that is, a relatively pure manic phase without depressive features: i.e. not “mixed state”. By contrast, a person whose usual style is more negative in outlook (“depressive temperament”) is more likely to have anxiety and despair as part of their “manic” episodes: i.e. what we have been calling “mixed state”.

B. Women are more likely to have “depressive temperament”. If that conclusion sounds sexist, remember, you can read the article and get references directly to the research on which this is based. In Akiskal’s view, this is part of the reason why women are more likely to have mixed states than men (a common observation — as much as 4-5 times more).

C. So finally, here is the model for the interaction of temperament and form-of-mixed-state, quoting the article:

“hyperthymic temperament gives rise to pure mania, irritable
temperament to mixed mania (which of all mixed states probably best deserves the designation of “dysphoric mania”), the depressive temperament gives rise to anxious-depressive (despairing) mania, and the cyclothymic temperament to an unstable-labile mixed state.”