Article

The expression of bipolar spectrum psychopathology in daily life

University of North Carolina at Greensboro, United States.
Journal of Affective Disorders (Impact Factor: 3.38). 11/2010; 130(1-2):166-70. DOI: 10.1016/j.jad.2010.10.025
Source: PubMed

ABSTRACT

Bipolar psychopathology has traditionally been defined by categorical diagnoses. However, these disorders may simply reflect the extremes of a broader spectrum of clinical and subclinical bipolar psychopathology.
The present study examined the validity of the Hypomanic Personality Scale (HPS) as a measure of bipolar spectrum psychopathology in 305 young adults using experience sampling methodology. The participants completed the HPS and were signaled randomly eight times daily for seven days to complete brief questionnaires on their current experiences.
High HPS scores were associated with elevated energetic-enthusiasm, irritability, dysphoria, flight of ideas, mild grandiose beliefs, and risky behavior, as well as increased variability in affect in daily life. High HPS scores were also associated with greater reactivity in negative affect and behavior in response to viewing themselves as unsuccessful in their activities.
It is not clear to what extent the participants had diagnosable bipolar disorders.
The findings support a broader spectrum of bipolar psychopathology and the validity of the HPS as a measure of this construct.

Full-text

Available from: Thomas Kwapil, Mar 14, 2014
Research report
The expression of bipolar spectrum psychopathology in daily life
Thomas R. Kwapil
a,
, Neus Barrantes-Vidal
a,b,c,d
, Molly S. Armistead
a
, Gena A. Hope
a
,
Leslie H. Brown
a
, Paul J. Silvia
a
, Inez Myin-Germeys
e
a
University of North Carolina at Greensboro, United States
b
Universitat Autònoma de Barcelona, Spain
c
Sant Pere Claver, Institució Sanitària, Spain
d
CIBER Salud Mental, Instituto de Salud Carlos III, Spain
e
Maastricht University, Netherlands
article info abstract
Article history:
Received 21 March 2010
Received in revised form 19 September 2010
Accepted 12 October 2010
Available online 5 November 2010
Background: Bipolar psychopathology has traditionally been defined by categorical diagnoses.
However, these disorders may simply reflect the extremes of a broader spectrum of clinical and
subclinical bipolar psychopathology.
Method: The present study examined the validity of the Hypomanic Personality Scale (HPS) as a
measure of bipolar spectrum psychopathology in 305 young adults using experience sampling
methodology. The participants completed the HPS and were signaled randomly eight times
daily for seven days to complete brief questionnaires on their current experiences.
Results: High HPS scores were associated with elevated energetic-enthusiasm, irritability,
dysphoria, flight of ideas, mild grandiose beliefs, and risky behavior, as well as increased
variability in affect in daily life. High HPS scores were also associated with greater reactivity
in negative affect and behavior in response to viewing themselves as unsuccessful in their
activities.
Limitations: It is not clear to what extent the participants had diagnosable bipolar disorders.
Conclusions: The findings support a broader spectrum of bipolar psychopathology and the
validity of the HPS as a measure of this construct.
© 2010 Elsevier B.V. All rights reserved.
Keywords:
Bipolar
Hypomania
Experience sampling methodology
Ecological momentary assessment
1. Introduction
1.1. A spectrum of bipolar psychopathology
Bipolar disorders have a lifetime prevalence of approxi-
mately 3% (Merikangas et al., 2007) and typically involve
recurring episodes that result in impairment, hospitalization,
and premature mortality (Osby et al., 2001; Calabrese et al.,
2003). However, empirical and clinical evidence supports the
existence of a wider spectrum of bipolar characteristics and
psychopathology (e.g., Akiskal, 2004; Angst et al., 2003; Judd
and Akiskal, 2003) that extends beyond the boundaries of
current diagnostic systems. People with subclinical symp-
toms who fall on this spectrum often experience impairment
and are at heightened risk for developing bipolar disorders
(Angst and Cassano, 2005). Therefore, identication of a
broader spectrum of bipolar psychopathology should en-
hance our understanding of the etiology and development of
such disorders. The present study examined the validity of
the Hypomanic Personality Scale (HPS; Eckblad and Chap-
man, 1986) as a measure of bipolar spectrum psychopathol-
ogy using experience sampling methodology (ESM).
Whether dened narrowly or broadly, bipolar spectrum
psychopathology involves dysregulation in mood, cognition,
and behavior. It is characterized by periods of euphoria,
dysphoria, and irritability, as well as labile affect. Disruptions
in cognition involve form of thought (e.g., racing thoughts)
and content of thought (e.g., grandiosity and unrealistic
plans). Behavioral and somatic changes include increased
Journal of Affective Disorders 130 (2011) 166170
Corresponding author.
E-mail address: t_kwapil@uncg.edu (T.R. Kwapil).
0165-0327/$ see front matter © 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.jad.2010.10.025
Contents lists available at ScienceDirect
Journal of Affective Disorders
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Page 1
energy, sociability, and impulsivity, as well as decreased need
for sleep.
Eckblad and Chapman (1986) developed the self-report
HPS to assess trait-like hypomanic functioning. They reported
that 77% of college students identied by high scores on the
HPS met criteria for a hypomanic episode. A thirteen-year
follow-up of their sample found that 28% of the HPS group
met criteria for a hypomanic episode within the past 2 years,
compared to 3% of controls (Kwapil et al., 2000). Therefore,
the HPS appears to be a promising measure of bipolar
spectrum psychopathology in nonclinical populations.
1.2. Bipolar spectrum psychopathology in daily life
Researchers are increasingly using ESM to examine
clinical and subclinical psychopathology in daily life (e.g.,
Brown et al., 2007; Myin-Germeys et al., 2009). ESM is a
widely used, within-day sel f-assessment technique that
prompts participants at random intervals to complete brief
questionnaires. ESM offers several advantages over tradition-
al laboratory assessments (e.g., Csikszentmihalyi and Larson,
1987; Reis and Gable, 2000). Specically, ESM: (1) repeatedly
assesses participants in their daily environment, thereby
enhancing ecological validity; (2) assesses experiences at
the signal, thereby minimizing retrospective bias; and
(3) examines the context of participants' experiences. A few
studies have used ESM with patients with bipolar disorder
(e.g., Havermans et al., 2007; Myin-Germeys et al., 2003).
However, ESM has not been used to examine the expression
of the broader bipolar spectrum in daily life.
1.3. Goals and hypotheses
This study examined the validity of the HPS as a measure
of bipolar spectrum psychopathology in daily life using
ESM in a large non-clinically ascertained sample of college
students. Based upon Eckblad and Chapman's (1986) nd-
ings, students appear to be an appropriate group for assessing
subclinical bipolar characteristics. It is hypothesized that the
HPS will be positively associated with energetic-enthusiasm,
irritability, ight of ideas, condence/grandiosity, sociability,
and risky/excitement-seeking behavior, as well as greater
variability in mood. It is expected that high HPS scorers will
be more reactive to cues of success/failure in daily life (i.e.,
HPS will moderate the relation of perceived success/failure
with affect, cognition, and behavior) . Finally, the study
examined whether HPS scores moderate the change in affect
and cognition across the day.
2. Method
2.1. Participants
Approximately 1400 undergraduates completed the HPS
as part of screening sessions and 321 of these participants
completed the ESM assessment. Sixteen participants were
dropped from the analyses due to completing fewer than 20
ESM questionnaires. The nal sample consisted of 2 40
women and 65 men (mean age=19.6 years, SD = 2.8).
2.2. Materials and procedures
Participants completed a demographic questionnaire, the
HPS, and an infrequency scale (Chapman and Chapman,
1983) during the screening sessions. Participants with scores
N 2 on the infrequency scale were not eligible for the ESM
assessment. Participants volunteered to take part in the ESM
study. In addition, participants who scored more than 1.5 SD
above the mean on the HPS were recruited to ensure that
there were an adequate number of high scorers. Coefcient
alpha was .87 for the HPS in the ESM sample and standardized
scores ranged from 1.91 to 3.01 (based on norms from 2217
UNCG students) with a unimodal distribution.
ESM data were collected on PDAs using iESP software
(Intel, 2004). Table 1 presents the ESM items and indices. The
PDAs signaled participants, administered questionnaires, and
time-stamped and recorded responses. Participants were
signaled to complete eight questionnaires daily between
noon and midnight for seven days.
ESM data have a hierarchical structure in which ratings in
daily life (level 1 data) are nested within participants (level 2
data). Hierarchical linear modeling is the appropriate method
for analyzing nested data (Schwartz and Stone, 1998). Initial
analyses assessed the effects of the level 2 predictor (HPS
score) on level 1 dependent measures (ESM daily life ratings).
Cross-level interactions (Kreft and de Leeuw, 1998) examined
whether level 1 associations (e.g., association between
success and irritability in daily life) varied as a function of
HPS scores. Analyses were conducted using HLM 6 (Rauden-
bush et al., 2004). Following Luke (2004), level 1 predictors
were group mean centered and the level 2 predictor was
grand mean centered. Parameter estimates were calculated
using robust standard errors (Hox, 2002).
3. Results
Participants completed an average of 41 ESM question-
naires (SD =10). HPS scores were unassociated with the
number of completed ESM questionnaires. Table 2 displays
the associations of HPS scores with experiences in daily life.
1
HPS scores were positively associated with positive and
negative affect in daily life. High HPS scorers also exhibited
greater variability in affect in daily life than low HPS scorers.
HPS scores correlated signicant ly with the variance of
participants' daily ratings of energetic-enthusiasm (r = .33,
pb .001), happiness (r =.16, p b .01), irritab ility (r = .27,
pb .001), dysphoria (r=.29, pb .001), and anxiety (r =.36,
pb .001).
As hypothesized, HPS scores were positively associated
with feeling condent, superior to others, like the center of
attention, and that their behavior could get them into trouble.
HPS scores were positively associated with ight of ideas and
difculty concentrating, but unassociated with time spent
1
Note that all of the effects were recomputed with sex and the HPS × sex
interaction entered as additional level 2 variables. The statistical signicance
of the main effects for HPS did not change for any of the analyses after the
entry of sex into the regressions, and none of the interaction terms were
signicant (indicating that HPS was not differentially expressed in daily life
for men and women).
167T.R. Kwapil et al. / Journal of Affective Disorders 130 (2011) 166170
Page 2
with others, feeling close with others and liking or feeling
successful in current activities.
Cross-level analyses examined whether participants high
in HPS were more reactive to success/failure in daily life. HPS
scores moderated the relation of success with irritability and
the likelihood of getting into trouble, indicating that the
impact of success/failure was greater on high HPS scorers.
However, HPS did not moderate the relation of success with
ight of ideas, although as noted above, there was a main
effect of the HPS on ight of ideas. Participants reported
experiencing more energetic-enthusiasm when successful,
although the HPS did not moderate this relation.
Finally, cross-level interactions examined whether changes
in affect and cognition across the day differed across levels of
HPS scores. Overall, reports of energetic-enthusiasm dimin-
ished across the day; however, a signicant cross-level
interaction indicated that this decline was not reported by
high-scoring HPS participants, as their ratings of energetic-
enthusiasm remained constant across the day. None of
the other cross-level interactions of time and affect were mod-
erated by HPS. Overall, ratings of irritability and dysphoria
demonstrated linear increases across the day, although ratings
of happiness did not vary signicantly. Note that there
were no signicant cross-level interactions with nonlinear
(quadratic and cubic) representations of time.
Difculty concentrating increased across the day for the
entire sample; that is there was a main effect of higher
concentration problems in the high HPS participants relative
to the low HPS participants, but their increases across the day
in concentration difculties were comparable. However,
ight of ideas, which presumably is more specic to bipolar
psychopathology than concentration problems, demonstrat-
ed a different pattern. As noted above, there was a main effect
of greater ight of ideas in high HPS scorers. However, ight
of ideas remained constant across the day for both high and
low HPS scorers. In other words, participants with low HPS
scores reported minimal ight of ideas that did not increase
during the day (as concentration difculties did). High HPS
scorers reported heightened levels of ight of ideas that
remained constant across the day. Thus, concentration dif-
culties increased as the day progressed, but elevated ight of
ideas were specically associated with the bipolar spectrum
and remained constant throughout the day.
4. Discussion
The present ndings supported the validity of the HPS as a
measure of bipolar spectrum psychopathology in a nonclin-
ical sample of young adults. Unlike traditional validation
strategies, the use of ESM allowed the examination of HPS
correlates at multiple points during daily life. This allowed us
to examine, for example, not only affective tone and intensity,
but affective reactivity and variability in daily life.
Table 1
Experience sampling protocol items and indices.
Affect in the moment
Energetic-Enthusiasm index (alpha =.95)
Item 10 I feel enthusiastic right now
Item 14 I feel excited right now
Item 17 I feel energetic right now
Irritability index (alpha=.93)
Item 07 I feel irritable right now
Item 12 I feel frustrated right now
Item 15 I feel angry right now
Dysphoria index (alpha =.93)
Item 08 I feel sad right now
Item 11 I feel gloomy right now
Item 06 I feel happy right now
Item 13 I feel anxious right now
Thought disruption in the moment
Flight of Ideas index (alpha=.94)
Item 03 My thoughts are racing right now
Item 05 I am thinking about a lot of things right now
Item 04 I have trouble concentrating right now
Sense of self in the moment
Item 01 I feel condent right now
Item 18 I feel like I am better than most people right now
Item 23 I am the center of attention right now
Social functioning in the moment
Item 19 Are you alone at this time?
Social Closeness index (alpha = .95)
Item 20 I like this person (these people)
Item 21 I am important to this person (these people)
Item 22 I feel close to this person (these people)
Current activity
Item 24 I like what I am doing right now
Item 28 I am successful in my current activity
Other
Item 02 I feel tired right now
Item 29 My behavior right now could get me in trouble
Note: All items rated from 1 (not at all) to 7 (very much) except item 19 (yes/
no). Coefcient alpha for indices are based upon aggregate scores on subjects.
Table 2
Relation of scores on the Hypomanic Personality Scale with experiences in
daily life.
Level 1 (ESM daily life) criterion
Level 2 predictor
Hypomanic Personality
Scale score
γ
01
(df=303)
Affect in the moment
Energetic-enthusiasm index 0.041 (SE = 0.006)
Happiness 0.017 (SE = 0.005)
Irritability index 0.033 (SE = 0.005)
Dysphoria index 0.022 (SE = 0.005)
Anxiety 0.048 (SE = 0.007)
Thought disruption
Flight of ideas index 0.044 (SE = 0.006)
Difculty concentrating 0.046 (SE = 0.006)
Sense of Self
Condent 0.023 (SE = 0.005)
Better than most people 0.034 (SE = 0.009)
Center of attention 0.033 (SE = 0.005)
Social functioning
With others at signal 0.001 (SE = 0.001)
Social closeness index 0.003 (SE = 0.005)
Current activities
Like activity 0.008 (SE = 0.005)
Successful at activity 0.001 (SE = 0.004)
Tired 0.004 (SE = 0.006)
Behavior gets me into trouble 0.016 (SE = 0.004)
Raw multilevel regression coef cients indicating the relation of the level 2
predictor (HPS) with the level 1 (daily life experience) criteria.
pb .001.
168 T.R. Kwapil et al. / Journal of Affective Disorders 130 (2011) 166170
Page 3
High HPS scores were associated with elevated intensity
of positive and negative affect. Consistent with the notion that
mood dysregulation is a core feature of the bipolar spectrum,
high HPS scorers exhibited greater variability in affect in daily
life. HPS scores were positively associated with condence,
feeling superior, and being the center of attention capturing
the grandiose aspect of the bipolar spectrum. As expected, the
HPS was associated with increased difculty concentrating and
ight of ideas. Engagement in risky behavior was associated
with high HPS scores, but hypersociability was not. It may be
that the social environmen t of college students limited
detection of wide variability in social contact.
HPS scores moderated reactivity to success/failure in daily
life. Given that hypomania and mania are characterized by
exaggerated self-assessment, it was hypothesized that sub-
jective appraisals of s uccess/failureinreallifewould
constitute a potent cue for eliciting affective and cognitive
characteristics associated with the bipolar spectrum. Indeed,
as Henry et al. (2008) proposed, the assessment of affective
reactivity is an important and overlooked component in the
study of mood disorders and dysregulation that is as relevant
as the tone and intensity of affect. As expected, high HPS
scorers experienced more irritability and risky behaviors
when unsuccessful. However, they did not experience more
racing thoughts or energetic-enthusiasm than others when
feeling successful. It may be that high HPS scorers do not
show cognitive and motivational reactivity to success because
the appraisal of success is congruent with their internal
representation of the self. However, consistent with current
cognitive theories of the bipolar spectrum (Colom et al., 2001;
Newman et al., 2002), when confronted with failure, the lack
of congruence with their internal s elf might activate
irritability and acting-out behaviors. On the other hand, the
two non-reactive features, high energy and ight of ideas,
were elevated in high HPS scorers, but relatively stable across
the day. High energy and a cognitive style dened by
disrupted and divergent thinking are closer to trait-like
features of the bipolar spectrum, which would not be so
highly variable or reactive to environmental cues. In contrast,
negative affect and acting-out behavior would be more
susceptible to reactivity.
The results of this study must be interpreted in light of two
limitations. First, ESM data collection occurred as much as
12 weeks after the administration of the HPS. However, the
HPS was designed to measure stable characteristics and has
good testretest reliability across this time frame (Eckblad
and Chapman, 1986). Secondly, p articipants were not
assessed for bipolar disorders (although the focus was not
specically on disorders). Nevertheless, the ndings are
consistent with a broader spectrum of bipolar characteristics
that is identiable in nonclinical samples and provide further
support for the HPS as a measure of this construct. Note that
we are currently examining the expression of Akiskal's (e.g.,
Akiskal and Akiskal, 2005) affective temperaments, as these
appear central to understanding the bipolar spectrum.
Examining a broader spectrum of bipolar psychopathology
should enhance our und erstanding of the etiology and
development of bipolar disorders, facilitate identication of
vulnerable individuals, and promote early interventions
(Angst and Cassano, 2005; Barrantes-Vidal et al., 2002).
Greater attention to subclinical bipolar symptoms in clinical
practice should increase the likelihood that patients receive
appropriate diagnoses and treatment.
Role of funding source
Neus Barrantes-Vidal and Thomas R. Kwapil are supported by the
Generalitat de Catalunya (2009SGR672). The Generalitat de Catalunya had
no further role in study design; in the collection, analysis and interpretation
of data; in the writing of the report; and in the decision to submit the paper
for publication.
Conict of interest
None of the authors had any conicts of interest.
Acknowledgements
The authors thank Jason Mesner and Amethyst Royal for
their assistance with data collection.
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  • Source
    • "The PDAs signaled participants to complete questionnaires eight times a day between the hours of noon and midnight for 7 days. The ESM items and indices used were developed to tap affect, behavior, and cognitions in daily life and have been validated in previous studies (e.g., Kwapil et al., 2011). Items and coefficient alpha for indices are presented inTable 1. Participants were instructed to rate items based upon how they felt at the moment they were signaled on a scale from 1 (not at all) to 7 (very much). "
    [Show abstract] [Hide abstract] ABSTRACT: Impulsivity is a key personality and psychopathology construct that is best conceptualized as multidimensional. The UPPS model is a comprehensive multidimensional framework which defines four impulsivity facets: negative urgency, lack of premeditation, lack of perseverance, and sensation seeking. Although these facets have unique predictive value in laboratory based correlational studies, the validity and expression of these facets have not been examined in daily life. The present study employed experience sampling methodology (ESM) to examine associations of UPPS impulsivity facets with affect, cognition, and behavior in daily life in a non-clinical sample of 299 young adults. The impulsivity facets were differentially expressed in daily life. Negative urgency was associated with negative affect, poor sense of self, and thought disruption; lack of premeditation was associated with negative but energetic affect; lack of perseverance was characterized by difficulty putting forth effort and completing activities; and sensation seeking was associated with positive affect and enjoying oneself. All UPPS facets with the exception of sensation seeking were associated with increased troublesome behavior in daily life. Overall, these results support the validity of the multidimensional UPPS model of impulsivity in daily life and suggest that ESM is a useful tool for examining the expression of impulsivity.
    Full-text · Article · Nov 2016 · Personality and Individual Differences
  • Source
    • "Thus, ESM allows in vivo, in situ ( " real time, real world " ) ambulatory assessment of experiences with limited need for long-term memory input. In recent years, ESM has been successfully used with many psychiatric populations, including individuals with schizophrenia (Swendsen et al., 2011; Kimhy et al., 2012), bipolar disorder (Kwapil et al., 2011), depression (Ben-Zeev et al., 2012a), schizotypy (Kwapil et al., 2012), as well as individuals at high-risk for psychosis (Kimhy and Corcoran, 2008). While an extensive literature suggests that many individuals with schizophrenia experience depressed mood, a number of important gaps in the literature remain unaddressed. "
    [Show abstract] [Hide abstract] ABSTRACT: Depressed mood is prevalent among individuals with schizophrenia, leading to difficulties in functioning. Typically, depressed mood is evaluated using retrospective assessments during which individuals are asked to recall their mood during the past week or month. However, as individuals with schizophrenia may display memory difficulties, the results of such assessments may be biased, potentially leading to inaccurate clinical characterizations and/or suboptimal treatment. Our aim was to assess the potential impact of long-term memory on depressed mood in individuals with schizophrenia. Employing an Experience Sampling Method (ESM) approach, 51 individuals with schizophrenia and 22 healthy controls rated their momentary emotions up to 10 times/day over a two-day period, along with retrospective measures of depressed mood, long-term memory, quality of life, social functioning, and symptoms. ESM assessment of real-time depressed mood demonstrated discriminant and convergent validity. Among the schizophrenia group, there was a significant correlation between the real-time and retrospective measures of depressed mood. However, once variance due to long-term memory was controlled, the relationship between the real-time and retrospective measure was no longer significant. The findings suggest that a real-time measure of depressed mood may allow overcoming some of the limitations associated with long-term memory difficulties common among individuals with schizophrenia. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Jun 2015 · Psychiatry Research
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    • "This spectrum includes subclinical symptoms of dysregulated mood, cognition, behavior, and sense of self (Angst et al., 2003; Walsh, Royal, Brown, Barrantes-Vidal, & Kwapil, 2012). For example, Kwapil et al. (2011) assessed the expression of subclinical bipolar spectrum traits in daily life and found associations with elevated energy-enthusiasm, irritability, dysphoria, flight of ideas, mild grandiose beliefs, risky behavior, and variability in affect. Those who experience subclinical symptoms may suffer impairment and distress (Angst et al., 2003) and are at heightened risk for the development of clinical bipolar disorders (Kwapil et al., 2000). "
    [Show abstract] [Hide abstract] ABSTRACT: The Hypomanic Personality Scale (HPS) is used to investigate hypomanic traits and risk for bipolar spectrum disorders; however, the length of the HPS (48 items) may be prohibitive for clinical research and screening purposes. Meads and Bentall (2008) developed a promising 20-item version of the HPS; however, the psychometric properties and validity of the short form have not been thoroughly examined. The present study investigated the construct validity and psychometric properties of the short HPS. A sample of 2713 non-clinically ascertained young adults was used to assess psychometric properties of the short form relative to the original scale. Two non-overlapping subsamples (n = 522; n = 145) were used to investigate the validity of the short HPS using personality and temperament questionnaires and clinical interviews of bipolar psychopathology and diagnoses. The short and original HPS generally had comparable correlations with measures of temperament, personality, impulsivity, borderline personality, grandiosity, psychosocial functioning, and alcohol use, and comparably predicted DSM bipolar and bipolar spectrum diagnoses. Overall, the short HPS was found to be both reliable and valid. However, the short HPS tended to be more strongly correlated with pathological components of hypomanic personality and less strongly correlated with exuberant and potentially adaptive aspects of the construct.
    Full-text · Article · Mar 2015 · Personality and Individual Differences
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