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Hyperthymic temperament

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"Hyperthymia" redirects here and is not to be confused with hyperthermia.
Hyperthymia
Other namesHyperthymic temperament, hyperthymic personality-type, chronic hypomania
Graph showing hyperthymia in comparison to bipolar spectrum disorders
SpecialtyPsychiatry, clinical psychology -although its classification as a disorder is still disputed
SymptomsHigh self-esteem, high energy, decreased need for sleep, optimism, impulsivity, talkativeness, high libido[1]
ComplicationsIncreased risk of bipolar disorder, substance abuse[2]
Usual onsetBefore 21 years old[3]
CausesGenetic, environmental, and psychological factors
Risk factorsUnknown, family history
Diagnostic methodBased on symptoms
TreatmentOften not needed, unless potential complications develop

Hyperthymic temperament, or hyperthymia, from Ancient Greek ὑπέρ ("over", meaning here excessive) + θυμός ("spirited"), is a proposed personality type characterized by an exceptionally, or in some cases, abnormally positive or irritated mood and disposition. It is generally defined by increased energy, vividness and enthusiasm for life activities, as opposed to dysthymia. Hyperthymia is similar to but more stable than hypomania.[4][5]

Characteristics of the hyperthymic temperament include:[6]

  • increased energy and productivity
  • short sleep patterns
  • self-assurance, self-confidence
  • talkativeness
  • risk-taking/sensation seeking
  • love of attention
  • cheerfulness and joviality
  • expansiveness
  • tirelessness

These features typically onset early in life (adolescence or early adulthood) and are relatively stable over time. In practice, hyperthymic temperament is often assessed with standardized temperament questionnaires such as the TEMPS-A, which measure it as one of the affective temperament dimensions.[7]

Clinical significance

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Adaptive functioning

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Many individuals with hyperthymic temperament function well and excel in occupational and social roles. Their elevated mood and energy levels can contribute to career success and relationship stability.[8] Hyperthymic traits such as confidence and high motivation are potentially advantageous. They are linked to a reduced risk of suicidal behavior and fewer hospitalizations among patients who develop mood disorders.[9] Hyperthymic temperament appears to exert a protective effect against several psychiatric conditions. Individuals scoring high on hyperthymic temperament are less likely to experience unipolar depression, dysthymia, or anxiety disorders.[10] It shows little to no comorbidity with major depression, indicating it may serve as a buffer or resilience factor against depressive illness. Among bipolar patients, hyperthymic temperament is associated with a later age of onset, milder illness course, and fewer suicide attempts,[10] indicating a generally better prognosis. This temperament may promote greater resilience and effective coping strategies, due to the combination of high energy and a positive appraisal style.[10]

Relationship with bipolar spectrum disorder

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Hyperthymic temperament shares similarities with bipolar spectrum disorder. Individuals with hyperthymic temperament maintain an elevated mood baseline but may transition into depression or mania.[11] If a person with hyperthymic temperament experiences a major depressive episode, their history of persistent elevated mood may indicate an underlying bipolar tendency.[11] American psychiatrist Akiskal termed this scenario "bipolar IV" – depression superimposed on a hyperthymic temperament.[11] In such cases, what may appear to be a consistently optimistic personality precedes the onset of mood episodes, potentially evolving into a bipolar pattern.[11] While hyperthymic traits are protective against unipolar depression, they do not protect against bipolar mania.[12] Hyperthymic temperament may predispose individuals to manic or hypomanic episodes. There is a genetic association between hyperthymic temperament and Bipolar I disorder, and clinically, hyperthymic features (such as reduced sleep need and impulsivity) may precede full manic episodes.[11] There is also an association with substance use and risk-taking behavior – hyperthymic individuals may be more prone to substance misuse during mood episodes, reflecting their stimulus-seeking tendencies.[10] When individuals with hyperthymic traits become depressed, standard antidepressant medications may be problematic: due to underlying bipolar spectrum neurobiology, antidepressants alone may be ineffective or may trigger mixed features or mania.[11] Mood stabilizers or treatments targeted toward bipolar disorder are considered more appropriate in such cases.[11]

Neurobiological factors

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Dopaminergic influence

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Hyperthymic temperament is associated with dysregulation in brain dopamine pathways. In particular, the mesolimbic dopamine pathway (ventral tegmental area projecting to the nucleus accumbens in the ventral striatum) and the mesocortical pathway (projections to frontal regions like the orbitofrontal cortex) are implicated.[11] These pathways govern reward processing, motivation, and mood regulation. Neuroimaging evidence shows that reward-related circuits including frontostriatal regions such as the ventral striatum and orbitofrontal cortex tend to be more active in individuals with hyperthymic temperament.[13] Such findings support the view that hyperthymic temperament involves dopaminergic hyper-responsivity in reward networks, although not to a pathological degree.

Neural connectivity patterns

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Functional Magnetic Imaging (fMRI) study identified that Individuals with hyperthymic temperament showed distinct functional connectivity in regions such as the prefrontal cortex, anterior cingulate cortex (ACC), amygdala, thalamus, and hippocampus.[14] These neural patterns were dissimilar from those of individuals with cyclothymic, irritable, or anxious temperaments, which tended to cluster together.[14]

Reward circuit activation

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fMRI research has found that individuals with higher hyperthymic trait levels exhibit altered activation in reward-related brain circuits. During anticipation of non-monetary rewards, people with higher hyperthymic temperament show reduced activation in the premotor cortex, whereas performance feedback elicits heightened responses in sensory-related areas proportional to their hyperthymic scores.[15] The brains of hyperthymic individuals appear to respond more robustly to actual positive outcomes while requiring less activation during anticipatory phases.[15] This profile may reflect differences in how positive emotions are regulated and processed in the brain.

Genetic factors

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Family and twin studies indicate that affective temperaments, including hyperthymia, are moderately heritable.[16] Hyperthymic temperament in particular has an estimated heritability of 21%.[16] Unaffected relatives of bipolar probands tend to score higher on the hyperthymic temperament scale.[17] There are significant associations between hyperthymic temperament and loci on chromosomes 12q15 and 22q13.[18] These loci correspond to the MDM1 gene, which is involved in nuclear protein functions and FBLN1 genes, which plays a role in extracellular matrix organization. In addition, there are associations for hyperthymic temperament with loci on chromosomes 4, 8, 20, and 6, particularly near the CDSN and PSORS1C1 genes, which are associated with neuroticism, risk-taking behavior, and schizophrenia[19]

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Hyperthymic temperament is characterized by a consistently elevated mood and high energy levels, distinguishing it from other mood disorders within the bipolar spectrum. Unlike Bipolar I and Bipolar II disorders, which involve episodic mood swings between manic or hypomanic and depressive states, hyperthymia presents a stable mood without significant depressive episodes.[11] In contrast to cyclothymic disorder, marked by frequent shifts between mild depressive and hypomanic symptoms, hyperthymic individuals maintain a persistent, elevated mood with minimal fluctuation.[11] While hypomania shares features with hyperthymia, such as elevated mood and increased activity, hypomania is episodic and represents a noticeable change from an individual's typical behavior, whereas hyperthymic temperament is a lifelong, stable trait.[11] Additionally, hyperthymic temperament differs from euthymia, the state of a normal, stable mood, by consistently exhibiting higher-than-average positivity and energy levels.[11]

References

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  1. ^ "Hyperthymic Temperament". Psychiatric Times Vol 36, Issue 9. 13 September 2019.
  2. ^ Karam, Elie G.; Salamoun, Mariana M.; Yeretzian, Joumana S.; Mneimneh, Zeina N.; Karam, Aimee N.; Fayyad, John; Hantouche, Elie; Akiskal, Kareen; Akiskal, Hagop S. (June 2010). "The role of anxious and hyperthymic temperaments in mental disorders: a national epidemiologic study". World Psychiatry. 9 (2): 103–110. doi:10.1002/j.2051-5545.2010.tb00287.x. PMC 2911090. PMID 20671899.
  3. ^ "Hyperthymic Temperament". Psychiatric Times Vol 36, Issue 9. 13 September 2019.
  4. ^ "hyperthymia - Wiktionary". en.wiktionary.org. Retrieved 2015-05-13.
  5. ^ Dubovsky, S.L.; Dubovsky, A.N. (2008). Concise Guide to Mood Disorders. American Psychiatric Publishing. p. 39. ISBN 9781585627653. Retrieved 2015-05-13.
  6. ^ "Clinical Validation of The Bipolar Spectrum: Focus on Hypomania, Cyclothymia, and Hyperthymia". 154th Annual Meeting of the American Psychiatric Association. 2001. Archived from the original on 2011-06-19.
  7. ^ Akiskal, Hagop S.; Mendlowicz, Mauro V.; Jean-Louis, Girardin; Rapaport, Mark H.; Kelsoe, John R.; Gillin, J. Christian; Smith, Tom L. (2005). "TEMPS-A: validation of a short version of a self-rated instrument designed to measure variations in temperament". Journal of Affective Disorders. 85 (1–2): 45–52. doi:10.1016/j.jad.2003.10.012. ISSN 0165-0327. PMID 15780675.
  8. ^ Luciano, Mario; Steardo, Luca; Sampogna, Gaia; Caivano, Vito; Ciampi, Carmen; Del Vecchio, Valeria; Di Cerbo, Arcangelo; Giallonardo, Vincenzo; Zinno, Francesca; De Fazio, Pasquale; Fiorillo, Andrea (2021-01-09). "Affective Temperaments and Illness Severity in Patients with Bipolar Disorder". Medicina. 57 (1): 54. doi:10.3390/medicina57010054. ISSN 1648-9144. PMC 7826695. PMID 33435391.
  9. ^ Şenormancı, Güliz; Turan, Çetin; Çelik, Sevim Karakaş; Çelik, Aycan; Edgünlü, Tuba Gökdoğan; Akbaş, Dilek; Akca, Ayşe Semra Demir; Şenormancı, Ömer (2022). "Prodynorphin (PDYN) gene polymorphisms in Turkish patients with methamphetamine use disorder, changes in PDYN serum levels in withdrawal and the relationship between PDYN, temperament and depression". Journal of Ethnicity in Substance Abuse. 21 (2): 522–537. doi:10.1080/15332640.2020.1785361. ISSN 1533-2659. PMID 32597371.
  10. ^ a b c d Luciano, Mario; Steardo, Luca; Sampogna, Gaia; Caivano, Vito; Ciampi, Carmen; Del Vecchio, Valeria; Di Cerbo, Arcangelo; Giallonardo, Vincenzo; Zinno, Francesca; De Fazio, Pasquale; Fiorillo, Andrea (2021-01-09). "Affective Temperaments and Illness Severity in Patients with Bipolar Disorder". Medicina. 57 (1): 54. doi:10.3390/medicina57010054. ISSN 1648-9144. PMC 7826695. PMID 33435391.
  11. ^ a b c d e f g h i j k l Rihmer, Zoltán; Akiskal, Kareen K.; Rihmer, Annamária; Akiskal, Hagop S. (2010). "Current research on affective temperaments". Current Opinion in Psychiatry. 23 (1): 12–18. doi:10.1097/YCO.0b013e32833299d4. ISSN 1473-6578. PMID 19809321.
  12. ^ Karam, Elie G.; Salamoun, Mariana M.; Yeretzian, Joumana S.; Mneimneh, Zeina N.; Karam, Aimee N.; Fayyad, John; Hantouche, Elie; Akiskal, Kareen; Akiskal, Hagop S. (2010). "The role of anxious and hyperthymic temperaments in mental disorders: a national epidemiologic study". World Psychiatry. 9 (2): 103–110. doi:10.1002/j.2051-5545.2010.tb00287.x. PMC 2911090. PMID 20671899.
  13. ^ Nusslock, Robin; Young, Christina B.; Damme, Katherine S.F. (2014). "Elevated reward-related neural activation as a unique biological marker of bipolar disorder: Assessment and treatment implications". Behaviour Research and Therapy. 62: 74–87. doi:10.1016/j.brat.2014.08.011. PMC 6727647. PMID 25241675.
  14. ^ a b Qiu, Yidan; Wu, Xiaoyan; Liu, Bingyi; Huang, Ruiwang; Wu, Huawang (2024). "Neural substrates of affective temperaments: An intersubject representational similarity analysis to resting-state functional magnetic resonance imaging in nonclinical subjects". Human Brain Mapping. 45 (7): e26696. doi:10.1002/hbm.26696. ISSN 1065-9471. PMC 11058400. PMID 38685815.
  15. ^ a b Ogura, Yukiko; Wakatsuki, Yumi; Hashimoto, Naoki; Miyamoto, Tamaki; Nakai, Yukiei; Toyomaki, Atsuhito; Tsuchida, Yukio; Nakagawa, Shin; Inoue, Takeshi; Kusumi, Ichiro (2023). "Hyperthymic temperament predicts neural responsiveness for nonmonetary reward". Psychiatry and Clinical Neurosciences Reports. 2 (3): e140. doi:10.1002/pcn5.140. ISSN 2769-2558. PMC 11114308. PMID 38867834.
  16. ^ a b Greenwood, Tiffany A.; Badner, Judith A.; Byerley, William; Keck, Paul E.; McElroy, Susan L.; Remick, Ronald A.; Sadovnick, A.Dessa; Akiskal, Hagop S.; Kelsoe, John R. (2013). "Heritability and genome-wide SNP linkage analysis of temperament in bipolar disorder". Journal of Affective Disorders. 150 (3): 1031–1040. doi:10.1016/j.jad.2013.05.035. PMC 3759543. PMID 23759419.
  17. ^ Greenwood, Tiffany A.; Badner, Judith A.; Byerley, William; Keck, Paul E.; McElroy, Susan L.; Remick, Ronald A.; Sadovnick, A.Dessa; Akiskal, Hagop S.; Kelsoe, John R. (2013). "Heritability and genome-wide SNP linkage analysis of temperament in bipolar disorder". Journal of Affective Disorders. 150 (3): 1031–1040. doi:10.1016/j.jad.2013.05.035. PMC 3759543. PMID 23759419.
  18. ^ Greenwood, Tiffany A.; Akiskal, Hagop S.; Akiskal, Kareen K.; Kelsoe, John R. (2012). "Genome-Wide Association Study of Temperament in Bipolar Disorder Reveals Significant Associations with Three Novel Loci". Biological Psychiatry. 72 (4): 303–310. doi:10.1016/j.biopsych.2012.01.018. PMC 3925336. PMID 22365631.
  19. ^ Gonda, Xenia; Eszlari, Nora; Torok, Dora; Gal, Zsofia; Bokor, Janos; Millinghoffer, Andras; Baksa, Daniel; Petschner, Peter; Antal, Peter; Breen, Gerome; Juhasz, Gabriella; Bagdy, Gyorgy (2021-06-01). "Genetic underpinnings of affective temperaments: a pilot GWAS investigation identifies a new genome-wide significant SNP for anxious temperament in ADGRB3 gene". Translational Psychiatry. 11 (1): 337. doi:10.1038/s41398-021-01436-1. ISSN 2158-3188. PMC 8169753. PMID 34075027.

Further reading

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