Positive Traits in the Bipolar Spectrum: The Space between Madness and Genius

Abstract

Bipolar disorder is a severe, lifelong mood disorder for which little is currently understood of the genetic mechanisms underlying risk. By examining related dimensional phenotypes, we may further our understanding of the disorder. Creativity has a historical connection with the bipolar spectrum and is particularly enhanced among unaffected first-degree relatives and those with bipolar spectrum traits. This suggests that some aspects of the bipolar spectrum may confer advantages, while more severe expressions of symptoms negatively influence creative accomplishment. Creativity is a complex, multidimensional construct with both cognitive and affective components, many of which appear to reflect a shared genetic vulnerability with bipolar disorder. It is suggested that a subset of bipolar risk variants confer advantages as positive traits according to an inverted-U-shaped curve with clinically unaffected allele carriers benefitting from the positive traits and serving to maintain the risk alleles in the population. The association of risk genes with creativity in healthy individuals (e.g., NRG1), as well as an overall sharing of common genetic variation between bipolar patients and creative individuals, provides support for this model. Current findings are summarized from a multidisciplinary perspective to demonstrate the feasibility of research in this area to reveal the mechanisms underlying illness.

Keywords: Bipolar disorder; Creativity; Genetics; Personality; Polygenic; Psychosis; Temperament.

Fig. 1

Positive traits within the bipolar spectrum and a shared vulnerability. According to the inverted-U model, creativity and other positive traits would be expected to increase with genetic loading up to a threshold, beyond which they would start to diminish with the increasing impairment of illness [42,48,49]. Polygenic risk indicates genetic vulnerability due to common variation in aggregate, which is maintained in the population by clinically unaffected individuals, who benefit from the positive traits. BD, bipolar disorder.

Fig. 2

The space between madness and genius. Adaptation of Carson's model of the shared vulnerability between creative genius and psychopathology [49] summarizing the temperament, personality, and cognitive characteristics shared by creative individuals and those with genetic liability to bipolar disorder and/or psychosis. The clinical overlap between bipolar disorder and schizophrenia is also represented, as are the characteristics unique to each disorder.