The link between bipolar disorders and creativity: evidence from personality and temperament studies

Self-perceived relations between artistic creativity and mental illness: a study into lived experiences

Aim

To explore the self-perceived relationships between experiences of creativity and mental illness and to understand the meanings behind these relationships.

Background

The idea that mental illness and artistic creativity are somehow related dates back to ancient times. There is some evidence for an actual correlation, but many questions remain unanswered on the nature and direction of the relationship. Qualitative contributions to the debate are scarce, and mainly focus on the potential benefits of participation in the arts for people with mental illness.

Design

An explorative, interpretive study.

Methods

Twenty-four professional and semi-professional artists with self-reported experience with mental illness, were recruited purposively. Unstructured in-depth interviews were conducted and transcripts were subjected to interpretive analysis, guided by a hermeneutic phenomenological frame.

Results

Participants experience a range of interactions between artistic creativity and mental illness. Three constitutive patterns describe what these interactions look like: "flow as a powerful force"; "ambiguous self-manifestation"; and "narrating experiences of suffering."

Conclusion

The findings show that both the concept of creativity and the concept of mental illness, as well as their interrelationships, are layered and complex phenomena that can take on different meanings in people's lives. The findings provide starting points for further research that goes beyond the polarized academic debate. Understanding the experiences of artists with mental illness can help shape the role of art in public mental health and mental health care.

Bipolar spectrum traits and the space between Madness and Genius: The Muse is in the Dose

Creativity has long been associated with the bipolar spectrum, particularly among unaffected first-degree relatives and those with milder expressions of bipolar traits, suggesting that some aspects of the bipolar spectrum may confer advantages for creativity. Here we took a multifaceted approach to better define the shared vulnerability between creativity and bipolar disorder. We recruited 135 individuals with bipolar disorder, 102 creative controls, and 103 non-creative controls for a total of 340 participants. All participants completed a comprehensive assessment battery that included several self-report temperament and personality questionnaires, a computerized test of cognitive function across multiple domains, and an evaluation of creative performance and achievement. Significant group differences were observed for the hypothesized shared vulnerability traits of hypomanic personality, cyclothymic temperament, impulsivity, and positive schizotypy. While both the creative and bipolar groups demonstrated superior creative ability, the creative group alone revealed enhanced cognitive performance. Accounting for intercorrelations between traits, a combination of openness, hypomanic personality, divergent thinking, and reasoning ability emerged as the strongest predictors of creativity, collectively explaining 34% of the variance in creative achievement and correctly classifying 85% of individuals with high achievement irrespective of diagnosis. These results confirm and extend earlier observations of a shared vulnerability between creativity and bipolar disorder and suggest that mild to moderate expressions of bipolar spectrum traits are associated with enhanced cognitive functioning and creative expression. Further investigation of these traits is needed to clarify the nature of this shared vulnerability and suggest individualized treatment strategies to improve clinical outcomes in bipolar disorder.

Exploring Creative Entrepreneurs' IEO: Extraversion, Neuroticism and Creativity

In creative industries, entrepreneurs’ creativity is the source of entrepreneurial activities. Meanwhile, the key to the success of entrepreneurship lies in the strategic tendency of leaders, referred to the individual entrepreneurial orientation (IEO). This paper is aimed to explain the process from creativity to IEO and reveal the psychological process of entrepreneurs’ creativity. We proposed an integrated model of “individuality–creativity–IEO” by drawing on the theories of big five personality and entrepreneurship. Using a sample of 202 creative entrepreneurs from China, the research found that entrepreneurs’ creativity has a positive impact on IEO, and the individuality of neuroticism and extraversion exhibited a negative U-shaped relationship with creativity. Finally, implications for both theory and practice were presented.

Creativity and Bipolar Disorder: A Shared Genetic Vulnerability

Bipolar disorder is a lifelong mood disorder characterized by extreme mood swings between mania and depression. Despite fitness costs associated with increased mortality and significant impairment, bipolar disorder has persisted in the population with a high heritability and a stable prevalence. Creativity and other positive traits have repeatedly been associated with the bipolar spectrum, particularly among unaffected first-degree relatives and those with milder expressions of bipolar traits. This suggests a model in which large doses of risk variants cause illness, but mild to moderate doses confer advantages, which serve to maintain bipolar disorder in the population. Bipolar disorder may thus be better conceptualized as a dimensional trait existing at the extreme of normal population variation in positive temperament, personality, and cognitive traits, aspects of which may reflect a shared vulnerability with creativity. Investigations of this shared vulnerability may provide insight into the genetic mechanisms underlying illness and suggest novel treatments.

Creativity and Mood Disorder: A Systematic Review and Meta-Analysis

Although the belief that creativity is related to psychopathology is prevalent, empirical evidence is limited. Research findings relating to mood disorder in particular are mixed, possibly as a result of differing research approaches (e.g., assessing the creativity of individuals with versus without mood disorder opposed to the prevalence of mood disorder in creative versus noncreative individuals). Therefore, a systematic review and meta-analysis were conducted to investigate prior research examining the link between mood disorder and creativity from three distinct research approaches. Multilevel random effects models were used to calculate the overall effect size for studies that assessed (a) creativity in a clinical versus nonclinical sample ( k = 13), (b) mood disorder in a creative versus noncreative sample ( k = 10), and (c) the correlation between dimensional measures of creativity and mood disorder symptoms ( k = 15). Potential moderators were examined using meta-regression and subgroup analyses, as significant heterogeneity was detected among the effects in all three analyses. Results reveal a differential strength and pattern of effects across the three analyses, suggesting that the relationship between creativity and mood disorder differs according to the research approach. The theoretical implications of results and potential mechanisms responsible for the relationship between creativity and mood disorder are discussed.

Positive Traits in the Bipolar Spectrum: The Space between Madness and Genius

Bipolar disorder is a severe, lifelong mood disorder for which little is currently understood of the genetic mechanisms underlying risk. By examining related dimensional phenotypes, we may further our understanding of the disorder. Creativity has a historical connection with the bipolar spectrum and is particularly enhanced among unaffected first-degree relatives and those with bipolar spectrum traits. This suggests that some aspects of the bipolar spectrum may confer advantages, while more severe expressions of symptoms negatively influence creative accomplishment. Creativity is a complex, multidimensional construct with both cognitive and affective components, many of which appear to reflect a shared genetic vulnerability with bipolar disorder. It is suggested that a subset of bipolar risk variants confer advantages as positive traits according to an inverted-U-shaped curve with clinically unaffected allele carriers benefitting from the positive traits and serving to maintain the risk alleles in the population. The association of risk genes with creativity in healthy individuals (e.g., NRG1), as well as an overall sharing of common genetic variation between bipolar patients and creative individuals, provides support for this model. Current findings are summarized from a multidisciplinary perspective to demonstrate the feasibility of research in this area to reveal the mechanisms underlying illness.

Creativity and Bipolar Disorder: Igniting a Dialogue

Bipolar disorder (BD) has been related to heightened creativity, yet core questions remain unaddressed about this association. We used qualitative methods to investigate how highly creative individuals with BD understand the role of symptoms and treatment in their creativity, and possible mechanisms underpinning this link. Twenty-two individuals self-identified as highly creative and living with BD took part in focus groups and completed quantitative measures of symptoms, quality of life (QoL), and creativity. Using thematic analysis, five themes emerged: the pros and cons of mania for creativity, benefits of altered thinking, the relationship between creativity and medication, creativity as central to one's identity, and creativity's importance in stigma reduction and treatment. Despite reliance on a small sample who self-identified as having BD, findings shed light on previously mixed results regarding the influence of mania and treatment and suggest new directions for the study of mechanisms driving the creative advantage in BD.

Creativity is linked to ambition across the bipolar spectrum

OBJECTIVE

Beyond evidence for an association, little is known about the mechanism linking creativity bipolar spectrum conditions. Theory suggests that ambition, which is heightened in bipolar disorder (BD) and associated with creativity in the general population, might be an important variable. The overarching aim of this project was to evaluate whether ambition is related to creativity among those with bipolar spectrum conditions.

METHOD

Across two studies, we examined correlations between a validated self-report measure of ambition, the WASSUP, and creativity. In Study One, 22 individuals diagnosed with BD who self-identified as highly creative completed the WASSUP and a measure of lifetime creative accomplishment. In Study Two, 221 undergraduates completed the WASSUP, a measure of mania risk (the Hypomanic Personality Scale, HPS) and a measure designed to assess creativity in business projects and tasks.

RESULTS

In Study One, WASSUP scores were significantly elevated compared to normative levels in BD, and WASSUP scores were correlated with lifetime creative accomplishment within the artistic sample. In Study Two, mania risk was related to greater ambition and creativity, and ambition was also directly related to greater creativity.

LIMITATIONS

Both studies were limited by the reliance on self-reported ambition.

CONCLUSION

Ambition could be one important component of creative success across the bipolar spectrum.

Pictionary-based fMRI paradigm to study the neural correlates of spontaneous improvisation and figural creativity

A novel game-like and creativity-conducive fMRI paradigm is developed to assess the neural correlates of spontaneous improvisation and figural creativity in healthy adults. Participants were engaged in the word-guessing game of Pictionary(TM), using an MR-safe drawing tablet and no explicit instructions to be "creative". Using the primary contrast of drawing a given word versus drawing a control word (zigzag), we observed increased engagement of cerebellum, thalamus, left parietal cortex, right superior frontal, left prefrontal and paracingulate/cingulate regions, such that activation in the cingulate and left prefrontal cortices negatively influenced task performance. Further, using parametric fMRI analysis, increasing subjective difficulty ratings for drawing the word engaged higher activations in the left pre-frontal cortices, whereas higher expert-rated creative content in the drawings was associated with increased engagement of bilateral cerebellum. Altogether, our data suggest that cerebral-cerebellar interaction underlying implicit processing of mental representations has a facilitative effect on spontaneous improvisation and figural creativity.

Prevalence, chronicity, burden and borders of bipolar disorder

Bipolar disorder (BD) has traditionally been thought of as an episodic condition, characterized by periods of hypomania/mania and depression. However, evidence is accumulating to suggest that this condition is associated with significant chronicity. For a large proportion of patients with BD, residual, sub-syndromal symptoms persist between major syndromal episodes, and studies have shown that many patients with bipolar disorder are symptomatic for approximately 50% of the time over follow-up periods of greater than 10 years. Moreover, while the prevalence of BD has been estimated to be around 1-2%, there is growing evidence that this may be a substantial underestimation. There are a number of reasons for this potential underestimation, including difficulties in diagnosis. Adding to the burden of BD is the issue of comorbidity, with an increased prevalence of many chronic conditions in those with a primary diagnosis of BD. Conversely, for many patients with chronic conditions, both medical and psychiatric, BD frequently exists as a comorbid secondary diagnosis. This issue of comorbidity complicates estimates of use of pharmaceutical agents for BD, such as mood stabilizers, which are known to be used off-label in conditions such as borderline personality or substance use disorder. We speculate that such off-label prescribing may not be truly off-label but may be instead fully justified by an overlooked secondary diagnosis of BD. Finally, we discuss the association of bipolar disorder with a significant economic burden, to the individual and to society, both due to the direct costs of medical expenditure and indirect costs such as loss of productivity and increased mortality.

TEMPS-A[P] temperament profile related to professional choice. Differences between applicants to become a cadet officer in the Italian Air Force or Navy

BACKGROUND

Temperament appears to be a factor involved in professional attitudes. The most impressive findings are those on the importance of cyclothymia in art and of hyperthymia in leadership.

AIM

In this study we raise the issue of whether the relationship between hyperthymic temperament and the choice of a military career, previously reported among Italian Air Force applicants, can be extended to another military service such as the Italian Navy.

METHODS

We compared temperaments between those who had applied to become a cadet officer in the Italian Air Force or in the Italian Navy, with special reference to gender differences and the ability of the two types of applicants to pass the psychiatric examination for admission that we had recently assessed in the Italian Air Force.

RESULTS

Hyperthymic traits were well represented in both these armed services. Navy applicants differed from air-force applicants in obtaining higher depressive, cyclothymic and irritable scores. Navy applicants who passed the psychiatric entrance examination (PEE) showed the same incidence of hyperthymic temperament as their Air Force counterparts, but higher depressive, cyclothymic and irritable scores. Considering gender, among Air Force applicants depressive traits were better represented in males; conversely, among Navy applicants they were better represented in females. If we consider gender together with PEE results, the highest hyperthymic scores were more frequently found among males who passed and females who failed to pass the PEE. On the other hand, a greater number of cyclothymic traits were found in females who passed and males who failed to pass the PEE.

CONCLUSIONS

It was confirmed that hyperthymic temperament represents the temperamental profile of those who aim to become a cadet officer in the Italian armed forces. This study further supports the idea that hyperthymic traits bring distinct advantages in a professional field, such as a military career, which is closely related to leadership.

An association between affective lability and executive functioning in bipolar disorder

Studies suggest altered affect regulation manifested by affective lability in manic/mixed and euthymic states in patients with bipolar disorder (BD). Altered affect regulation may arise from disturbances in interactions between the cognitive and the emotional brain networks. However, the relationship between affective lability and executive function has not previously been studied. Our aim was to investigate affective lability, as measured with the Affective Lability Scale (ALS) in patients with BD (N=32) compared to healthy controls (HC) (N=60), and its relationship to executive functioning. We found significantly higher ALS scores in the BD than in the HC group, indicating a higher degree of affective lability in patients with BD. Sub-sample analysis revealed a significant positive relationship between affective lability and semantic set shifting abilities in BD only. These findings suggest that higher levels of affective lability compared with controls are a trait as well as state dependent in BD, and that disturbed affective lability may arise from an aberrant interaction between cognitive and emotional brain networks.

Creativity and executive function across manic, mixed and depressive episodes in bipolar I disorder

INTRODUCTION

Creativity is a complex construct involving affective and cognitive components. Bipolar Disorder (BD) has been associated with creativity and is characterized by a wide range of affective and cognitive symptoms. Although studies of creativity in BD have tended to focus on creativity as a trait variable in medicated euthymic patients, it probably fluctuates during symptomatic states of BD. Since creativity is known to involve key affective and cognitive components, it is plausible to speculate that cognitive deficits and symptoms present in symptomatic BD could interfere with creativity.

MATERIAL AND METHODS

Sixty-seven BD type I patients medication free, age 18-35 years and experiencing a maniac, mixed, or depressive episodes, were assessed for creativity, executive functioning, and intelligence.

RESULTS

Manic and mixed state patients had higher creativity scores than depressive individuals. Creativity was influenced by executive function measures only in manic patients. Intelligence did not influence creativity for any of the mood episode types.

CONCLUSION

We propose that creativity in BD might be linked to the putative hyperdopaminergic state of mania and be dependent on intact executive function. Future studies should further explore the role of dopaminergic mechanisms in creativity in BD.

Creativity and affective temperaments in non-clinical professional artists: an empirical psychometric investigation

OBJECTIVE

Manic-depression/bipolar disorder was linked to creativity, with affective temperaments allegedly favoring creative expression and achievement, but a few studies only empirically tested the link.

METHODS

152 undergraduate students attending preparatory courses for creative artistic professions and 152 students in areas expected to lead to a profession mostly requiring the application of the learned rules were invited to fill in the TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego - Autoquestionnaire), the General Health Questionnaire (GHQ) and the Creative Achievement Questionnaire (CAQ). Latent class analysis (LCA) was used to investigate the links between creativity scores and measures of psychopathology.

RESULTS

Creative participants and controls did not differ in terms of sex (males=47%), age (24.5 years, SD=3.8), or socioeconomic status. Creative people scored higher than controls on the CAQ and on the cyclothymic, hyperthymic and irritable subscales of the TEMPS-A, but not on the GHQ. Greater involvement in creative activities rather than being a creative achiever best differentiated those into the "risk for bipolar spectrum" class from the other two classes extracted by the LCA from the TEMPS-A.

LIMITATIONS

The use of self-report measures to evaluate both creative involvement and the risk of psychopathology, and the exclusive focus on artistic creativity limit the generalizability of the findings.

CONCLUSIONS

This study confirms that the cyclothymic dimension of the bipolar spectrum is linked to creativity, and this link is likely to result from increased involvement into pleasurable activities, including creative ones.

Creativity and bipolar disorder: touched by fire or burning with questions?

Substantial literature has linked bipolar disorder with creative accomplishment. Much of the thinking in this area has been inspired by biographical accounts of poets, musicians, and other highly accomplished groups, which frequently document signs of bipolar disorder in these samples. A smaller literature has examined quantitative measures of creativity among people with bipolar disorder or at risk for the disorder. In this paper, we provide a critical review of such evidence. We then consider putative mechanisms related to the link of bipolar disorder with creativity, by drawing on literature outside of bipolar disorder on personality, motivational, and affective predictors of creativity. Because so little research has directly evaluated whether these factors could help explain the elevations of creativity in bipolar disorder, we conclude with an agenda for future research on the theoretically and clinically compelling topic of creativity in bipolar disorder.