Predicting Affective States of Bipolar Disorder by the Chinese Adjective Descriptors of Personality

  • Bingren Zhang
  • Junpeng Zhu
  • Wei WangEmail author


In Chinese culture, people appreciate social harmony, which might lead to an emotional fluctuation in bipolar disorder when discordance exists (Chapter “ Bipolar Disorders in Chinese Culture: From a Perspective of Harmony”). Chinese patients’ emotional variations might have their cultural-related personality bases. We have tested the Chinese Adjective Descriptors of Personality (CADP), and the scales measuring affective states, namely the Mood Disorder Questionnaire (MDQ), the Hypomanic Checklist-32 (HCL-32), as well as the Plutchik-van Praag Depression Inventory (PVP) in bipolar I (BD I) and II (BD II) disorder patients, and healthy volunteers. We found that both BD I and BD II groups got higher scores on the mood scales; BD II scored lower on the MDQ, but higher on the HCL-32 and PVP compared with BD I. Interestingly, in BD I, the CADP Intelligent trait predicted MDQ; Agreeable, Emotional and Intelligent traits predicted PVP. While in BD II, Agreeable, Unsocial and Intelligent traits predicted MDQ; Agreeable, Emotional and Intelligent traits predicted HCL-32. Four out of five CADP personality traits were linked with the affective states in patients, but they demonstrated different connections in the two types of bipolar disorder; and a Chinese culture featured similar influence of Intelligent trait on affective states of patients was found.


Affective states Bipolar I disorder Bipolar II disorder Chinese adjective descriptors of personality Chinese culture 


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorder (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Angst, J., Adolfsson, R., Benazzi, F., Gamma, A., Hantouche, E., Meyer, T. D., Skeppar, P., Vieta, E., & Scott, J. (2005). The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients. Journal of Affective Disorders, 88, 217–233.CrossRefGoogle Scholar
  3. Bagby, R. M., Bindseil, K. D., Schuller, D. R., Rector, N. A., Trevor, Y. L., Cooke, R. G., Seeman, M. V., McCay, E. A. T., & Joffe, R. (1997). Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients. Psychiatry Research, 70, 83–94.CrossRefGoogle Scholar
  4. Barnhill, G. P. (2001). Social attributions and depression in adolescents with Asperger syndrome. Focus on Autism and Other Developmental Disabilities, 16, 46–53.CrossRefGoogle Scholar
  5. Benazzi, F. (2007). Bipolar disorder-focus on bipolar II disorder and mixed depression. Lancet, 369, 935–945.CrossRefGoogle Scholar
  6. Ben-Porath, Y. S., & Tellegen, A. (2011). MMPI-2RF: Manual for administration, scoring, and interpretation. Minneapolis: University of Minnesota Press.Google Scholar
  7. Bond, M. H., & Pang, M. K. (1991). Trusting to the Tao: Chinese values and the re-centering of psychology. Bulletin of the Hong Kong Psychological Society, 26(27), 5–27.Google Scholar
  8. Bowins, B. (2008). Hypomania: A depressive inhibition override defense mechanism. Journal of Affective Disorders, 109, 221–232.CrossRefGoogle Scholar
  9. Bush, T., & Qiang, H. (2000). Leadership and culture in Chinese education. Asia Pacific Journal of Education, 20, 58–67.CrossRefGoogle Scholar
  10. Castagnini, A., & Berrios, G. E. (2009). Acute and transient psychotic disorders (ICD-10 F23): A review from a European perspective. European Archives of Psychiatry and Clinical Neuroscience, 259, 433–443.CrossRefGoogle Scholar
  11. Cerimele, J. M., Chwastiak, L. A., Dodson, S., Dodson, S., & Katon, W. J. (2014). The prevalence of bipolar disorder in general primary care samples: A systematic review. General Hospital Psychiatry, 36, 19–25.CrossRefGoogle Scholar
  12. Chen, M. J. (1994). Chinese and Australia concepts of intelligence. Psychology and Developing Societies, 6, 103–117.CrossRefGoogle Scholar
  13. Chien, I. C., Chang, K. C., Lin, C. H., Chou, Y. J., & Chou, P. (2010). Prevalence of diabetes in patients with bipolar disorder in Taiwan: A population-based national health insurance study. General Hospital Psychiatry, 32, 577–582.CrossRefGoogle Scholar
  14. Costa, P. T., Jr., & McCrae, R. R. (1997). Stability and change in personality assessment: The revised NEO personality inventory in the year 2000. Journal of Personality Assessment, 68, 86–94.CrossRefGoogle Scholar
  15. Coulston, C. M., Bargh, D. M., Tanious, M., Cashman, E. L., Tufrey, K., Curran, G., Kuiper, S., Morgan, H., Lampe, L., & Malhi, G. S. (2013). Is coping well a matter of personality? A study of euthymic unipolar and bipolar patients. Journal of Affective Disorders, 145, 54–61.CrossRefGoogle Scholar
  16. de Fruyt, F., van Leeuwen, K., Bagby, R. M., Rolland, J., & Rouillon, F. (2006). Assessing and interpreting personality change and continuity in patients treated for major depression. Psychological Assessment, 8, 71–80.CrossRefGoogle Scholar
  17. Dervic, K., Garcia-Amador, M., Sudol, K., Freed, P., Brent, D. A., Mann, J. J., Harkavy-Friedman, J. M., & Oquendo, M. A. (2015). Bipolar I and II versus unipolar depression: Clinical differences and impulsivity/aggression traits. European Psychiatry, 30, 106–113.CrossRefGoogle Scholar
  18. Eysenck, H. J., & Eysenck, S. B. G. (1992). Manual of the Eysenck Personality Questionnaire-Revised. San Diego: Education and Industrial Testing Service.Google Scholar
  19. Guo, Z. (1995). Chinese Confucian culture and the medical ethical tradition. Journal of Medical Ethics, 21, 239–246.CrossRefGoogle Scholar
  20. Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6, 278–296.CrossRefGoogle Scholar
  21. Heine, S. J., & Buchtel, E. E. (2009). Personality: The universal and the culturally specific. Annual Review of Psychology, 60, 369–394.CrossRefGoogle Scholar
  22. Hirschfeld, R. M. A., Williams, J. B. W., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck, P. E., Lewis, L., McElroy, S. L., Post, R. M., Rapport, D. J., Russell, J. M., Sachs, G. S., & Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The Mood Disorder Questionnaire. American Journal of Psychiatry, 157, 1873–1875.CrossRefGoogle Scholar
  23. Hui, L. (2005). Chinese cultural schema of Education: Implications for communication between Chinese students and Australian educators. Issues in Educational Research, 15, 17–36.Google Scholar
  24. Isometsä, E., Suominen, K., Mantere, O., Valtonen, H., Leppämäki, S., Pippingsköld, M., & Arvilommi, P. (2003). The Mood Disorder Questionnaire improves recognition of bipolar disorder in psychiatric care. BMC Psychiatry, 3, 8.CrossRefGoogle Scholar
  25. Jain, U., Blais, M. A., Otto, M. W., Hirshfeld, D. R., & Sachs, G. S. (1999). Five-factor personality traits in patients with seasonal depression: Treatment effects and comparisons with bipolar patients. Journal of Affective Disorders, 55, 51–54.CrossRefGoogle Scholar
  26. Jamison, K. R. (1995). Manic-depressive illness and creativity. Scientific American, 272(2), 62–67.CrossRefGoogle Scholar
  27. Jorm, A. F. (2001). History of depression as a risk factor for dementia: An updated review. Australian and New Zealand Journal of Psychiatry, 35, 776–781.CrossRefGoogle Scholar
  28. Judd, L. L., Akiskal, H. S., Schettler, P. J., Coryell, W., Maser, J., Rice, J. A., Solomon, D. A., & Keller, M. B. (2003). The comparative clinical phenotype and long term longitudinal episode course of bipolar I and II: A clinical spectrum or distinct disorders. Journal of Affective Disorders, 73, 19–32.CrossRefGoogle Scholar
  29. Kahn, J., Coyne, J. C., & Margolin, G. (1985). Depression and marital disagreement: The social construction of despair. Journal of Social and Personal Relationships, 2, 447–461.CrossRefGoogle Scholar
  30. Kim, B., Lim, J. H., Kim, S. Y., & Joo, Y. H. (2012). Comparative study of personality traits in patients with bipolar I and II disorder from the five-factor model perspective. Psychiatry Investigation, 9, 347–353.CrossRefGoogle Scholar
  31. Krone, K. J., & Morgan, J. M. (2000). Emotion metaphors in management: The Chinese. In S. Fineman (Ed.), Emotion in organizations (2nd ed., pp. 83–100). London: Sage.CrossRefGoogle Scholar
  32. Lan, Y. C., Zelman, D. C., & Chao, W. T. (2018). Angry characters and frightened souls: Patients and family explanatory models of bipolar disorder in Taiwan. Transcultural Psychiatry, 55, 317–338.CrossRefGoogle Scholar
  33. Látalová, K. (2012). Insight in bipolar disorder. Psychiatric Quarterly, 83, 293–310.CrossRefGoogle Scholar
  34. Leao, I. A., & del Porto, J. A. (2012). Cross validation with the mood disorder questionnaire (MDQ) of an instrument for the detection of hypomania in Brazil: The 32 items hypomania check-list, first revision (HCL-32-R1). Journal of Affective Disorders, 140, 215–221.CrossRefGoogle Scholar
  35. Leung, K. (2008). Chinese culture, modernization, and international business. International Business Review, 17, 184–187.CrossRefGoogle Scholar
  36. Levy, K. N., Edell, W. S., & McGlashan, T. H. (2007). Depressive experiences in inpatients with borderline personality disorder. Psychiatric Quarterly, 78, 129–143.CrossRefGoogle Scholar
  37. Li, Y., Wang, M., Wang, C., & Shi, J. (2010). Individualism, collectivism, and Chinese adolescents’ aggression: Intracultural variations. Aggressive Behavior, 36, 187–194.CrossRefGoogle Scholar
  38. Lin, N. (2001). Social capital: A theory of social structure and action. New York: Cambridge University Press.CrossRefGoogle Scholar
  39. Liu, X., & Tein, J. (2005). Life events, psychopathology, and suicidal behavior in Chinese adolescents. Journal of Affective Disorders, 86, 195–203.CrossRefGoogle Scholar
  40. Lozano, B. E., & Johnson, S. L. (2001). Can personality traits predict increases in manic and depressive symptoms. Journal of Affective Disorders, 63, 103–111.CrossRefGoogle Scholar
  41. Maisel, E. (2013). Why smart people hurt: A guide for the bright, the sensitive, and the creative. Newburyport: Conari Press.Google Scholar
  42. Merikangas, K. R., Jin, R., He, J. P., He, J., Kessler, R. C., Lee, S., Sampson, N. A., Viana, M. C., Andrade, L. H., Hu, C., Karam, E. G., Ladea, M., Medina-Mora, M. E., Ono, Y., Posada-Villa, J., Sagar, R., Wells, J. E., & Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of General Psychiatry, 68, 241–251.CrossRefGoogle Scholar
  43. Müller-Oerlinghausen, B., Berghöfer, A., & Bauer, M. (2002). Bipolar disorder. Lancet, 359, 241–247.CrossRefGoogle Scholar
  44. Ng, E. (2009). Heartache of the state, enemy of the self: Bipolar disorder and cultural change in urban China. Culture, Medicine and Psychiatry, 33, 421–450.CrossRefGoogle Scholar
  45. Parker, G., Gladstone, G., & Chee, K. T. (2001). Depression in the Planet’s largest ethnic group: The Chinese. American Journal of Psychiatry, 158, 857–864.CrossRefGoogle Scholar
  46. Phillips, M. L., & Kupfer, D. J. (2013). Bipolar disorder diagnosis: Challenges and future directions. Lancet, 381, 1663–1671.CrossRefGoogle Scholar
  47. Plutchik, R., & van Praag, H. M. (1987). Interconvertability of five self-report measures of depression. Psychiatry Research, 22, 243–256.CrossRefGoogle Scholar
  48. Quilty, L. C., Sellborm, M., Tackett, J. L., & Bagby, R. M. (2009). Personality trait preditors of bipolar disorder symptoms. Psychiatry Research, 169, 159–163.CrossRefGoogle Scholar
  49. Quilty, L. C., Pelletier, M., de Young, C. G., & Michael, B. R. (2013). Hierarchical personality traits and the distinction between unipolar and bipolar disorders. Journal of Affective Disorders, 147, 247–254.CrossRefGoogle Scholar
  50. Redding, G., & Wong, G. Y. Y. (1986). The psychology of Chinese organizational behavior. In M. H. Bond (Ed.), The psychology of the Chinese people (pp. 267–295). London: Oxford University Press.Google Scholar
  51. Saddichha, S., & Schutz, C. (2014). Is impulsivity in remitted bipolar disorder a stable trait? A meta-analytic review. Comprehensive Psychiatry, 55, 1479–1484.CrossRefGoogle Scholar
  52. Schrijvers, D. L., de Bruijn, E. R., Destoop, M., Hulstijn, W., & Sabbe, B. G. C. C. (2010). The impact of perfectionism and anxiety traits on action monitoring in major depressive disorder. Journal of Neural Transmission, 117, 869–880.CrossRefGoogle Scholar
  53. Serpell, R. (2000). Intelligence and culture. In R. J. Sternberg (Ed.), Handbook of intelligence (pp. 549–578). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  54. Serretti, A., & Olgiati, P. (2007). Profiles of “manic” symptoms in bipolar I, bipolar II and major depressive disorders. Journal of Affective Disorders, 84, 159–166.CrossRefGoogle Scholar
  55. Stringer, D., Marshall, D., Pester, B., Baker, A., Langenecker, S. A., Angers, K., Frazier, N., Archer, C., Kamali, M., McInnis, M., & Ryan, K. A. (2014). Openness predicts cognitive functioning in bipolar disorder. Journal of Affective Disorders, 168, 51–57.CrossRefGoogle Scholar
  56. Sugaya, N., Yoshida, E., Yasuda, S., Tochigi, M., Takei, K., Otani, T., Otowa, T., Minato, T., Umekage, T., Konishi, Y., Sakano, Y., Chen, J., Nomura, S., Okazaki, Y., Kaiya, H., Sasaki, T., & Tanii, H. (2013). Prevalence of bipolar disorder in panic disorder patients in the Japanese population. Journal of Affective Disorders, 147, 411–415.CrossRefGoogle Scholar
  57. Tjosvold, D., & Su, F. (2007). Managing anger and annoyance in organizations in China: The role of constructive controversy. Group and Organization Management, 32, 260–289.CrossRefGoogle Scholar
  58. Triandis, H. C., & Suh, E. M. (2002). Cultural influences on personality. Annual Review of Psychology, 53, 133–160.CrossRefGoogle Scholar
  59. Tsai, S. Y., Chen, C. C., & Yeh, E. K. (1997). Alcohol problems and long-term psychosocial outcome in Chinese patients with bipolar disorder. Journal of Affective Disorders, 46, 143–150.CrossRefGoogle Scholar
  60. Tse, S., Yuen, Y. M., & Suto, M. (2014). Expected possible selves and coping skills among young and middle-aged adults with bipolar disorder. East Asian Arch Psychiatry, 24, 117–124.Google Scholar
  61. Weintraub, M. (2012). Prosocial personality and cognitive buffers for partners of manic individuals. Undergraduate Journal of Psychology at Berkeley, 5, 20–28.Google Scholar
  62. White, H. C. (1992). Identity and control: A structural theory of social action. Princeton: Princeton University Press.Google Scholar
  63. Xu, S., Gao, Q., Ma, L., Fan, H., Mao, H., Liu, J., & Wang, W. (2015). The Zuckerman-Kuhlman Personality Questionnaire in bipolar I and II disorders: A preliminary report. Psychiatry Research, 226, 357–360.CrossRefGoogle Scholar
  64. Yang, K. S. (1990). Chinese personality and its change. In M. H. Bond (Ed.), The psychology of the Chinese people (pp. 106–170). Hong Kong: Oxford University Press.Google Scholar
  65. Yang, S. Y., & Sternberg, R. J. (1997). Conceptions of intelligence in ancient Chinese philosophy. Journal of Theoretical and Philosophical Psychology, 17, 101–119.CrossRefGoogle Scholar
  66. Yao, J., Xu, Y., Qin, Y., Liu, J., Shen, Y., Wang, W., & Chen, W. (2015). Relationship between personality disorder functioning styles and the emotional states in bipolar I and II disorders. PLoS One, 10, e0117353.CrossRefGoogle Scholar
  67. Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429–435.CrossRefGoogle Scholar
  68. Yu, E., Li, H., Fan, H., Gao, Q., Tan, Y., Lou, J., Zhang, J., & Wang, W. (2015). Relationship between Chinese adjective descriptors of personality and emotional symptoms in young Chinese patients with bipolar disorders. Journal of International Medical Research, 43, 790–801.CrossRefGoogle Scholar
  69. Zimmerman, M., & Galione, J. N. (2011). Screening for bipolar disorder with the Mood Disorder Questionnaire: A review. Harvard Review of Psychiatry, 19, 219–228.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Clinical Psychology and Psychiatry/School of Public HealthZhejiang University College of MedicineHangzhouChina
  2. 2.Department of PsychiatryZhejiang Provincial People’s HospitalHangzhouChina
  3. 3.Department of PsychiatryPeople’s Hospital of Hangzhou Medical CollegeHangzhouChina

Personalised recommendations