The clinical significance of creativity in bipolar disorder

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Abstract

Clinical implications of the high rates of creativity within bipolar disorder (BD) have not been explored. The aim of this review is to outline these implications by (i) reviewing evidence for the link between creativity and BD, (ii) developing a provisional model of mechanisms underpinning the creativity–BD link, (iii) describing unique challenges faced by creative-BD populations, and (iv) systematically considering evidence-based psychosocial treatments in the light of this review. While more research into the creativity–BD nexus is urgently required, treatment outcomes will benefit from consideration of this commonly occurring phenotype.

Section snippets

Introduction and overview

American Psychological Association guidelines assert that best research evidence is only one driver of evidence-based practice (American Psychological Association, 2005). Clinicians should also consider patient characteristics, values and context and use clinical expertise to integrate this information into their case formulations and treatment plans.

In this review, we take one disorder — bipolar disorder — and consider the clinical implications of one associated characteristic — creativity.

Definitions

Bipolar disorder is defined on the basis of manic symptoms of varying severity. Bipolar I disorder, defined by a full-blown episode of mania (either without a concomitant episode of depression or with a concomitant depression, labeled a ‘mixed’ episode), receives more research and clinical attention than milder forms. Nonetheless, increasing attention has been given to bipolar II disorder, defined by hypomanic episodes and depressive episodes, and cyclothymia, defined by frequent swings between

Evidence for an association between creativity and bipolar disorder

The “mad genius” notion remains so prominent that the author of a recent review found it necessary to write, “Creativity is not a kind of psychopathology!” (Runco, 2004, p.679). The perennial stereotype aside, there is broad evidence that creativity and psychopathology are correlated. For example, a recent meta-analysis of 36 studies estimated the effect size linking psychopathological traits to divergent thinking to be .50 (Ma, 2009). The strongest evidence is for a link between creativity and

An organizing scheme

It can be concluded that BD is related to a number of characteristics that might drive creative accomplishment. An emphasis on high goal setting, and particularly ambitions for public recognition and creative accomplishment, may provide the fuel for pursuing creative accomplishments. Positive affectivity might promote more divergent, creative thinking, and impulsivity may foster production of novel products without self-censorship. Finally, personality traits of N, E and O may promote success

Performance lifestyle as a precipitating or perpetuating factor for mood dysregulation

Some features of the creative professions, particularly artistic performance, may be counterproductive for people with BD. Although not universal components of these careers, five features warrant attention — reinforcement of emotionality, occupational stress, substance misuse, irregular sleep and activity schedules, and challenges to goal regulation (see also Table 1).

Creativity and engagement with treatment

Ambivalence towards treatment is common for people with BD (Leahy, 2007). Here, we focus on how creativity and its associated temperaments and values may interfere with acceptance of the diagnosis and an aversion to the goals of stabilizing mood and “restoring normalcy”.

Acceptance of the BD diagnosis is often an iterative process, with clients returning to the question many times throughout therapy (Newman, Leahy, Beck, Reilly-Harrington, & Gyulai, 2002). Those with less severe forms of the

Creativity and evidence-based treatments

Medication remains the first line treatment for BD I, but there is growing support for augmenting pharmacotherapy with psychosocial treatments (Goodwin, 2009, Yatham et al., 2006). Four adjunctive psychological treatments for BD have been investigated in some depth: psychoeducation, cognitive behaviour therapy (CBT), family focussed therapy (FFT), and interpersonal and social rhythm therapy (IPSRT). These treatments share core characteristics in format and content (Miklowitz et al., 2008, Scott

Conclusions

Treatment outcomes in bipolar disorder remain unsatisfactory (Nierenberg, 2009). Although adjunctive psychosocial approaches have proven broadly effective in randomized controlled trials, refinement of these interventions is urgently required (Miklowitz, 2008). Here, we outline basic and clinical implications of the link between creativity and BD, and demonstrate how creativity may both moderate and mediate treatment outcomes. For clinical research, the primary outputs of this review are

Acknowledgement

The authors thank the Sean Costello Foundation for their encouragement to pursue this work.

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