Depression, anxiety, and personality disorders are associated with a set of hereditarily determined temperamental traits of a high order, that is, a tendency to search for novelty, avoid harm and depend on rewards. Each of them is associated with a specific neurobiological system such as dopaminergic, serotonergic, and noradrenergic. The interactions of these three traits determine the development of personality with characteristic patterns of learning, information processing, mood, reactivity to stress, and adaptation throughout life.
Each of the traits and associated neurobiological systems underlies various types of anxiety and dysphoria. Somatic anxiety is associated with high values of the novelty search parameter, cognitive anxiety is associated with harm avoidance, and dysphoria or depression is associated with the highest level of reward dependence. The model will be able to predict that affective disorders will be more frequent in those personality types where there are no buffers against addiction to reinforcements such as cycloid, histrionic, passively aggressive, and dependent.
Statement of the Problem
The bipolar affective disorder is one of the leading causes of impaired functioning and disability of the population. Two types of this disorder are distinguished, such as type 1 BAD and type 2 BAD, the differences between which are the duration and severity of the affective phases. In reality, the procedural mechanism of bipolar affective disorder is complex and heterogeneous and includes mixed phases of mood, constant emotional instability, and cognitive dysfunction.
The reason why the given study is relevant and important is due to the fact that assessing and analyzing risk factors of bipolar complications will allow taking preliminary measures during treatment and counseling. The study of risk factors for the development of bipolar affective disorder requires an integrated approach taking into account the premorbid background, clinical and psychological characteristics, the influence of external psychosocial influences, which in general can affect both the general course of the disease, complications and the prognosis as a whole.
The paradigm of premorbid background, the ratio of affective phases, and constitutional properties, including personality characteristics, is essential for identifying risk factors. Depressive temperament can transform into melancholy and act as a vestige of outlined depressive phases. It is important to understand that a sub-affective disorder scheme should be proposed where three types of pre-pain conditions, such as sub-affective dysthymic disorder, sub-affective cyclothymic disorder, and sub-affective borderline disorder are indicated.
In addition, it is necessary to identify a complex multicausal scheme, where the described affective personality traits will be considered as disorders of temperament, mediating biological risk factors for the clinical forms of affective disorders (Swartz & Suppes, 2019). Taking into account the characteristics of temperament can contribute to a more accurate prediction of the course of affective disorders, the determination of their types, and the selection of the optimal therapeutic strategy. In addition, extraversion and a tendency to express positive emotions, a significant level of neuroticism in premorbid, are characteristic of patients with BAD II.
It is also important to consider the fact that there is a significant relationship between depression, as with common personality traits, in particular, a high level of neuroticism or negative emotionality, a low level of extraversion or positive emotionality, and good faith. In addition, there is a connection with various additional traits, such as harm avoidance, rumination, and self-criticism (Beyer, 2016). Most personality traits associated with depression are also associated with other forms of psychopathology, especially anxiety disorders. The likelihood of depressive episodes on characterological features is unlikely, but personality traits can have predictive value and affect the course of depression and the therapeutic response.
Purpose of the Study
The purpose of this study is to analyze and identify risk factors for the development of the bipolar affective disorder and its complications and opportunities for early diagnosis of the disease. It is important because preliminary preventative actions will be less resource intensive and set the direction for new researches, and the unit of analysis is observational studies. The factor of hereditary predisposition to bipolar affective disorder is studied from various perspectives.
One of the positions is that abnormal expression of the neurotrophic factor of the peripheral brain can represent the endophenotype of the disease, that is, a quantitative characteristic that is intermediate between the phenotype of the disease and its main biological process. Despite the conclusion of the results, the concept of the study of endophenotypes can be used as a strategy to overcome the methodological difficulties inherent in the classical study of complex heterogeneous disorders, such as BAD.
In addition, a study of first-line relatives can provide an ideal basis for the analysis of diathesis, which in itself acts as a risk factor for the development of the bipolar disorder (Parker, Romano, Graham, & Ricciardi, 2018). Identification of biomarkers and environmental factors can act as prognostic signs and identify the most significant prodromal symptoms.
Adverse conditions of education in childhood can act as factors provoking the development of affective pathology. Children exposed to stressful factors, such as financial difficulties in the family, abuse, sexual abuse, are more likely to develop bipolar disorder.
There is the role of stressful events, violence, excessive use of permitted or prohibited psychoactive substances, economic and emotional stress, family problems, as the main risk factors for bipolar disorder in adolescence (Swartz & Suppes, 2019). Among the risk factors for the development of a bipolar affective disorder, there are problems like the family burden of this disease in first-line relatives and existing anxiety disorders. The adverse factors of life that are significant for the patient may be provoking factors in the development of the bipolar disorder, both for the development of depressive and for the development of manic states.
The Social Significance of the Study
Analysis of this problem will reveal the significance of studying hereditary-constitutional features in the form of hereditary burden, temperamental characteristics, the influence of adverse family factors such as abuse and domestic violence, the age of onset of the disease. The research will also help to identify the risks of developing suicidal behavior, which cause significant differences in the clinical manifestations of the first episodes of bipolar disorder and the path of the disease as a whole. The search for optimal therapeutic targets for early intervention requires further comprehensive study using diagnostic tools. They will overcome the difficulties of identifying the initial symptoms of the disease, ethical and practical limitations associated with the heterogeneity of the manifestations of bipolar disorder.
- What set of factors plays a significant role in the early development of bipolar disorder?
- What preliminary preventative counseling approaches can stop or slow down the development of bipolar disorder?
- Will the hereditary factor play a bigger role in being the major risk factor in comparison to one’s ontogenesis?
The hypothesis is that hereditary burden, and adverse psychosocial effects are two major risk factors of bipolar disorder.
Definition of Key Terms
- Bipolar affective disorder–can be identified as “a potentially life-long psychiatric illness that is characterised by episodic disturbances in mood between symptoms of mania and depression” (Leung, 2014).
- Suicidal behavior–one’s a behavioral pattern that leads to self-harm and suicide (López-Díaz, Fernández-González, Luján-Jiménez, Galiano-Rus, & Gutiérrez-Rojas, 2017).
Beyer, J. L. (2016). Bipolar depression, an issue of psychiatric clinics of North America. Philadelphia, PA: Elsevier.
Leung, R. (2014). Bipolar affective disorder. InnovAiT, 7(12), 723-728.
López-Díaz, Á., Fernández-González, J. L., Luján-Jiménez, J. E., Galiano-Rus, S., & Gutiérrez-Rojas, L. (2017). Use of repeated intravenous ketamine therapy in treatment-resistant bipolar depression with suicidal behaviour: A case report from Spain. Therapeutic Advances in Psychopharmacology, 7(4), 137–140.
Parker, G. B., Romano, M., Graham, R. K., & Ricciardi, T. (2018). Comparative familial aggregation of bipolar disorder in patients with bipolar I and bipolar II disorders. Australasian Psychiatry, 26(4), 414-416.
Swartz, H. A., & Suppes, T. (2019). Bipolar II Disorder: Recognition, understanding, and treatment (1st ed.). Washington, DC: American Psychiatric Association Publishing.