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Basic Dimensions Defining Mania Risk: a Structural Approach Psychological Assessment © 2016 American Psychological Association 2017, Vol. 29, No. 3, 304–319 1040-3590/17/$12.00 http://dx.doi.org/10.1037/pas0000337 Basic Dimensions Defining Mania Risk: A Structural Approach Kasey Stanton June Gruber University of Notre Dame University of Colorado Boulder David Watson University of Notre Dame Mania is the core criterion for bipolar disorder, a chronic and severe psychiatric illness centrally associated with positive affective disturbance. Many self-report measures have been created to assess symptoms of, and risk for, mania but there are notable disparities in their length, scope, and content. Thus, the goal of this study was to determine the structure and correlates of a number of widely used “bipolar-relevant” (BR) measures (e.g., Hypomanic Personality Scale, Altman Self-Rating Mania Scale, General Behavior Inventory, Mood Disorder Questionnaire). Data from a community sample (Study 1, N ϭ 329) and a student sample assessed at two time points (Study 2; Ns ϭ 382 and 308, respectively) provided strong evidence that the BR measures were characterized by both (a) a well-defined common dimension when a single factor was extracted, and (b) a clear structure of Emotional Lability and Activated Positive Affect upon extracting two factors. The general factor showed a relatively nonspecific pattern of associations with personality and psychopathology. In contrast, the Emotional Lability factor showed its strongest relations with neuroticism and depressive symptoms, displaying comparatively weaker relations with measures of extraversion and positive emotionality. Conversely, although Acti- vated Positive Affect also associated positively with depressive symptoms and with neuroticism in some instances, its strongest relations were with measures of extraversion and high arousal positive emotion- ality. These findings suggest that measures defining Emotional Lability seem to assess mood volatility to a greater extent, whereas measures defining the Activated Positive Affect factor capture an intense, high arousal form of positive emotionality. Keywords: bipolar disorder, mania, positive affect, negative affect, five-factor model of personality The study of mood and affective experiences is broadly defined is known about how the positive affective system—which is using the dimensions of positive affect and negative affect (Wat- closely related to reward seeking and sensitivity (DeYoung, 2013; son, Wiese, Vaidya, & Tellegen, 1999). Positive affect is a term Quilty, DeYoung, Oakman, & Bagby, 2014)—may be a source of used to represent individual differences in positive feeling states dysfunction (Gruber, Dutra, Hay, & Devlin, 2014; Gruber, Kogan, such as joyfulness, attentiveness, and self-assurance, whereas neg- Quoidbach, & Mauss, 2013). Exploring positive affect’s relations ative affect is used to describe the tendency to experience negative with psychopathology is of interest not only because these asso- feelings of sadness, anxiety, guilt, and anger (Shiota, Keltner, & ciations have been understudied, but also because evidence sug- John, 2006; Watson, 2000). There is growing interest in under- gests that positive affect associates negatively with some forms of standing affective disturbance across a range of psychological psychopathology (e.g., depression, schizotypy) but positively with disorders (e.g., Dillon, Deveney, & Pizzagalli, 2011; Jazaieri, others (e.g., bipolar disorder, substance use); in contrast, negative Urry, & Gross, 2013). Although the role of negative affective affect demonstrates ubiquitous positive relations with psychopa- dysregulation in psychopathology is fairly well characterized, less thology (Gruber, 2011a; Gruber, Johnson, Oveis, & Keltner, 2008; This document is copyrighted by the American Psychological Association or one of its allied publishers. Watson & Naragon-Gainey, 2010). This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. In particular, elevated levels of positive affect appear to be a This article was published Online First June 2, 2016. particularly salient feature of bipolar disorder (BD; Gruber, Kasey Stanton, Department of Psychology, University of Notre Dame; 2011a), as individuals with BD show greater positive emotional June Gruber, Department of Psychology and Neuroscience, University of reactivity across a wide range of situations, suggesting that in- Colorado Boulder; David Watson, Department of Psychology, University creased positive affect is a trait-like feature of BD that is invariant of Notre Dame. across contexts (du Pont, Welker, Gilbert, & Gruber, in press; Informed consent was obtained from all individual participants included Gruber et al., 2014). Moreover, individuals with BD struggle to in the study. The above authors declare that they have no conflict of interest downregulate positive emotion intensity and engage in emotion (financial or non-financial), and APA ethical standards were followed in regulation strategies that prolong and intensify problematic posi- the conduct of this study. All of the reported research was approved by the Institutional Review Board at the University of Notre Dame. tive mood states (Gruber, 2011a, 2011b; Gruber et al., 2013, 2014; Correspondence concerning this article should be addressed to Kasey Watson & Naragon-Gainey, 2010). Despite this compelling evi- Stanton, Department of Psychology, University of Notre Dame, 118 Hag- dence that positive emotionality is strongly implicated in BD, gar Hall, Notre Dame, IN 46556. E-mail: [email protected] important gaps in assessing positive affective disturbance in BD 304 DIMENSIONS DEFINING MANIA RISK 305 remain, as measures of BD traits and symptoms include content and the Social Vitality scale associate positively with extraversion assessing positive emotional dysregulation to widely varying de- (Stanton et al., 2016; Watson & Naragon-Gainey, 2014). In con- grees (Gruber, 2011b; Gruber et al., 2008). trast, the HPS Mood Volatility scale correlates weakly with extra- version but demonstrates strong relations with neuroticism. The Present Investigation: The Temperament Evaluation of the Memphis, Pisa, Paris, and Assessment Issues in BD Research San Diego Autoquestionnaire (TEMPS-A; 50 items; Akiskal, Ak- iskal, Haykal, Manning, & Connor, 2005) is similar to the HPS in There are notable disparities in how BD and bipolar-relevant that it assesses characteristics conferring risk for BD. More spe- (BR) traits are assessed via self-report measures. We focus on cifically, the TEMPS-A—which includes content tapping emo- self-report measures here given that (a) BD symptoms and affect tional lability, elevated positive emotionality, and dysthymia— are frequently assessed using this method, (b) BD measures vary assesses temperamental styles associated with increased risk for widely in their length, format, and content, and (c) self-report disorders characterized by mood lability, including BD (Akiskal et provides a valid format of assessment for ratings of affect and of al., 2005). traits and symptoms related to BD (Miller, Johnson, & Eisner, The expanded version of the Inventory of Depression and Anx- 2009; Pendergast et al., 2015; Watson, 2000). As noted earlier, iety Symptoms (IDAS-II; Watson et al., 2012) is a recently devel- although affective dysfunction and BD are closely intertwined, oped instrument that contains content related to BD. More specif- widely used measures of BD and mania incorporate assessment of ically, the IDAS-II includes a Euphoria (five items; e.g., “felt positive and negative affective dysregulation to varying degrees: elated for no reason”) scale tapping elevated mood and a Mania Some include little measurement of mood, some focus solely on scale (five items; e.g., “thoughts jumped rapidly”) assessing racing assessing either positive or negative affect, and others assess both thoughts characteristic of hypomanic and manic episodes. Al- types of affect. though IDAS-II Euphoria and Mania tap distinct sets of content, For instance, the five items in the Altman Self-Rating Mania they are substantially intercorrelated and both show strong con- Scale (ASRM; Altman, Hedeker, Peterson, & Davis, 1997) pri- vergence with interview ratings of mania (Watson et al., 2012). marily seem to assess high arousal positive affect (e.g., activity In addition to these measures, several widely used omnibus level, happiness). The Hypomania Checklist-32 (HCL-32; Angst et personality instruments such as the Personality Assessment Inven- al., 2005) instructs respondents to describe how they felt during “a tory (PAI; Morey, 2007) and the Minnesota Multiphasic Person- period when you were in a ‘high’ state,” and a significant portion ality Inventory-2 (MMPI-2; Butcher et al., 2001) also include of its item content also assesses elevated positive affect (e.g., “feel scales assessing BR traits and symptoms. The PAI includes a more energetic”); however, unlike the ASRM, the HCL-32 also Mania scale assessing increased levels of energy and excitement, includes content assessing risk-taking and irritability. Similar to whereas the MMPI-2 includes a Hypomania scale tapping content the HCL-32, the Mood Disorder Questionnaire (MDQ; 13 items; related to elated mood, irritability, and racing thoughts. In addi- Hirschfeld et al., 2000) appears to include content measuring tion, the MMPI-2–Restructured Form (MMPI-2–RF; Ben-Porath euphoric mood, risk taking, and irritability. & Tellegen, 2008) includes both a Hypomanic Activation
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