Antioch University AURA - Antioch University Repository and Archive Student & Alumni Scholarship, including Dissertations & Theses Dissertations & Theses 2018 Differences Between Introverts and Extraverts with Bipolar Disorder Ray E. McHale Antioch University, New England Follow this and additional works at: https://aura.antioch.edu/etds Part of the Clinical Psychology Commons Recommended Citation McHale, Ray E., "Differences Between Introverts and Extraverts with Bipolar Disorder" (2018). Dissertations & Theses. 448. https://aura.antioch.edu/etds/448 This Dissertation is brought to you for free and open access by the Student & Alumni Scholarship, including Dissertations & Theses at AURA - Antioch University Repository and Archive. It has been accepted for inclusion in Dissertations & Theses by an authorized administrator of AURA - Antioch University Repository and Archive. For more information, please contact [email protected], [email protected]. Running head: INTROVERTS WITH BIPOLAR DISORDER 1 Differences Between Introverts and Extraverts with Bipolar Disorder by Ray McHale B.A., Hartwick College, 2013 M.S., Antioch University New England, 2016 DISSERTATION Submitted in partial fulfillment for the degree of Doctor of Psychology in the Department of Clinical Psychology at Antioch University New England, 2018 Keene, New Hampshire INTROVERTS WITH BIPOLAR DISORDER ii Department of Clinical Psychology DISSERTATION COMMITTEE PAGE The undersigned have examined the dissertation entitled: DIFFERENCES BETWEEN INTROVERTS AND EXTRAVERTS WITH BIPOLAR DISORDER presented on August 23, 2018 by Ray McHale Candidate for the degree of Doctor of Psychology and hereby certify that it is accepted*. Dissertation Committee Chairperson: Martha B. Straus, PhD Dissertation Committee members: Vince Pignatiello, PsyD Christine Chamberlin, PhD Accepted by the Department of Clinical Psychology Chairperson George Tremblay, PhD on 8/23/18 * Signatures are on file with the Registrar’s Office at Antioch University New England. INTROVERTS WITH BIPOLAR DISORDER iii Table of Contents List of Tables .................................................................................................................................. v List of Figures………………………………………………………………………………….…vi Abstract ........................................................................................................................................... 1 Introduction ..................................................................................................................................... 2 Significance of the Knowledge Gap to the Field ............................................................................ 2 Bipolar Disorder and Possible Misdiagnosis of Introverts ..................................................... 2 Importance for Clinicians and for Clients with Bipolar Disorder........................................... 5 Conceptual Framework ................................................................................................................... 6 Social Constructionism ........................................................................................................... 6 Introversion/Extraversion ....................................................................................................... 9 Literature Review.......................................................................................................................... 11 Individual Differences and the Nature of Introversion ................................................................. 11 Known Factors That Contribute to Misdiagnosis ......................................................................... 13 Classification of symptoms. .................................................................................................. 13 Cultural factors……………………………………………………………………………...14 Impact of cultural factors on personality differences……………………….……………...15 Gender and bipolar symptoms……………………………………………………………...16 Ethical Concerns Related to Misdiagnosis ................................................................................... 16 Objective of the Study and Research Questions ........................................................................... 17 Methods......................................................................................................................................... 18 Participants ............................................................................................................................ 18 Materials ............................................................................................................................... 18 Procedure .............................................................................................................................. 20 Ethical Considerations .......................................................................................................... 21 Results ........................................................................................................................................... 22 Methods of Analysis ............................................................................................................. 22 Common Symptoms Reported .............................................................................................. 26 Atypical Experiences ............................................................................................................ 26 Awareness of Symptoms ....................................................................................................... 27 Negative Experiences of Symptoms ..................................................................................... 27 Positive Experiences of Symptoms ....................................................................................... 28 Effects on Social Interactions ............................................................................................... 28 Coping Strategies .................................................................................................................. 29 Effect on Identity .................................................................................................................. 30 Additional Findings .............................................................................................................. 31 Discussion ..................................................................................................................................... 31 Commonalities Among Participants ..................................................................................... 32 Implications of Identified Themes ........................................................................................ 34 Common symptoms…………………………………………………….…………………..34 Atypical experiences………………………………………………………..………………34 Initial awareness of manic episode………………………..………………..………………35 Negative effects of symptoms…..…………………………………………..………………36 Positive experiences of symptoms...………………………………………..………………37 Seeking support………………………………………………………..……………………38 Most and least helpful coping mechanisms………………………………..…………….…39 INTROVERTS WITH BIPOLAR DISORDER iv Effect on identity………………………………………………………..………………..…42 The Extraversion Bias…………………………………………………..………………..…42 Limitations ............................................................................................................................ 43 Future Research .................................................................................................................... 47 Clinical Implications ............................................................................................................. 47 References ..................................................................................................................................... 51 Appendix A: NEO-PI-3 Extraversion Scale ................................................................................. 55 Appendix B: Altman Self-Rating Mania Scale ............................................................................. 58 Appendix C: Demographics Questionnaire .................................................................................. 60 Appendix D: Qualitative Questionnaire........................................................................................ 61 Appendix E: Recruitment Letter and Description of Research .................................................... 62 Appendix F: Consent Form ........................................................................................................... 63 Appendix G: Debriefing Statement .............................................................................................. 65 Appendix H: Permissions………………………………………………………………………..66 INTROVERTS WITH BIPOLAR DISORDER v List of Tables Table 1. Level of Extraversion and ASRM Scores……………………………………………76 Table 2. Participants’ Responses and Thematic Codes ……………………………………….77 INTROVERTS WITH BIPOLAR DISORDER vi List of Figures Figure 1. Themes and Clusters of Themes Identified…………………………………………86 Running head: INTROVERTS WITH BIPOLAR DISORDER 1 Abstract People living with bipolar disorder have vastly different presentations and experiences despite sharing a common diagnosis. While some research has explored the role of temperament in these different presentations (Azorin, Adida, & Belzeaux, 2015; Graham, Parker, Breakspear, & Mitchell, 2015; Iasevoli et al., 2013), little is currently known about whether