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Section 8
Track #8 - Temperamental Disturbances

Question 8 found at the bottom of this page
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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 PMS on bipolar and unipolar women; and mania in men.

On this track, we will present three temperamental disturbances and how these affect a client’s vulnerability for bipolar disorder:  hyperthymic, cyclothymic, and dysthymic.

#1 Hyperthymic Temperament
The first temperament as you know is the hyperthymic temperament.  Clients who exhibit this temperament in adolescence exhibit chronic cheerfulness, overly optimistic outlooks, exuberance, tend to be extraverted, seek stimuli, overconfidence, and pushiness.  Those exhibiting hyperthymic temperament are 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 hyperthymic are not nearly as severe as a hypomanic episode.

Technique:  Personality Checklist
Maxine, age 42, was a bipolar I 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 big deal.  You tell me I’m bipolar.  Fine.  But I know I can’t tell the difference between my manic episodes and my regular personality.”  To help Maxine with her confusion, I asked her to complete “Personality Checklist”. 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 included, but was not limited to, the following:
Reliable
Conscientious
Dependable
Indecisive
Assertive
Open

Maxine checked off the following traits:  optimistic, affectionate, talkative, ambitious.  Next, I asked Maxine to check off the symptoms that characterized her manic episodes.  This list included, but was not limited to, the following:
Full of energy
Doing too many things
Highly distractible
Irritable
Wired
Sped up

Maxine checked off the following symptoms  euphoric, grandiose, sleeping too 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 who suffer 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 was 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 are susceptible to major depressive episodes.  However, as with hyperthymic temperament, the line between personality traits and actual bipolar disorder is foggy.  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 asked Carol to complete the "Personality Checklist” except instead of manic symptoms, I gave Carol a list of depressive symptoms.  The personality 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.

QUESTION 8
What are three temperamental disturbances that affect a client’s vulnerability for bipolar disorder? To select and enter your answer go to Answer Booklet.