Temperament and character as predictors of occupational disability in bipolar disorder

The purpose of this study was: (1) to assess whether bipolar spectrum patients exhibit unique personality profiles compared to non-ill individuals and; (2) to examine whether personality traits and related illness features (i.e., a history of psychosis and a history substance abuse) are predictive of work functioning. Participants were 72 patients diagnosed with bipolar I (83%), bipolar II (6%), bipolar NOS (10%), or cyclothymic disorder (1%) who had been hospitalized for an acute exacerbation of illness. Cloninger\u27s Temperament and Character Inventory (TCI) was administered when participants symptoms\u27 had remitted to within the mild range as defined by scores on the Hamilton Rating Scale for Depression (\u3c18) and the Clinician-Administered Rating Scale for Mania (\u3c15). Work functioning was measured retrospectively by the number of months employed in the past 5 years and the number of months employed in the longest job held in the past 5 years. Prospective work functioning was assessed over a 6 to 14 month follow-up period with the Multidimensional Scale of Independent Functioning. Bipolar patients exhibited significantly higher Harm Avoidance, lower Self-Directedness, lower Cooperativeness and higher Self-Transcendence scores compared to age and gender-matched controls. Depressive symptoms were correlated with Harm Avoidance and Self-Directedness, and manic symptoms were correlated with Persistence and Self-Transcendence. Regression analyses failed to demonstrate significant predictive relationships between select TCI traits (i.e., Novelty Seeking, Persistence, and Self-Directedness), a history of psychosis, a history of substance abuse and work functioning. Demographic and course of illness variables (i.e., educational attainment, number of psychiatric hospitalizations) were found instead to be significant predictors of functioning. This study suggests that bipolar patients do exhibit unique temperament and character profiles, although residual affective symptoms may have influenced the findings. Sample characteristics, limitations of the instruments, and alternative predictors of functioning to be examined in future research are discussed