Theoretical and clinical overview of affective temperaments in mood disorders

  • Xenia Gonda Department of Clinical and Theoretical Mental Health Semmelweis University; Department of Pharmacodynamics, Semmelweis University; Neuropsychopharmacology and Neurochemistry Research Group, National Academy of Sciences and Semmelweis University, Budapest; Laboratory for Suicide Research and Prevention, National Institute for Psychiatry and Addictions, Budapest, Hungary
  • Gustavo H. Vázquez Department of Neuroscience, University of Palermo, Buenos Aires, Argentina; International Consortium for Bipolar Disorders Research, Department of Psychiatry & Neuroscience Program, Harvard Medical School, Boston, McLean Division of Massachusetts General Hospital, Belmont, MA, USA
Palabras clave: Affective temperaments, Bipolar Disorders, Bipolar Spectrum, Mood Disorders, Personality


Temperaments are imperturbable variations of personality, traits and ways of reacting to the environment that characterize individuals and remain constant throughout several different situations. Temperaments usually play a central role in determining emotional reactions, therefore several temperamental models have attempted to establish the potential relationship between temperaments and affective disorders. According to Hagop Akiskal, affective temperaments are subclinical and subaffective trait-like manifestations of affective disorders. Unlike several models of temperament which were exclusively developed theoretically in order to describe healthy human functioning, later extrapolated to capture the pathological domains of mental and behavioral features, the current model of affective temperaments was developed on classical traditions and mainly based on the observation of subjects with mood disorders and their healthy first degree relatives. There is accumulating evidence concerning the development of affective temperaments based on their adaptive evolutionary characteristics and genetic background, and normative data from large national studies on general and healthy samples indicate their universal characteristics. Studies in affective patient populations indicate that the relationship between affective temperaments and affective illness is more complex than a simple extrapolation from psychopathology and mental health, and affective temperaments may represent a latent state of the staging model, playing a pathoplastic role in mood disorders determining their evolution, clinical features, main characteristics and outcome. A large body of data on affective temperaments has been published during the last decade, deserving a critical analysis presented in this overview.


La descarga de datos todavía no está disponible.


Akiskal, H. S. (1996). The temperamental foundations of affective disorders. London: Gaskell.

Akiskal, H. S. & Akiskal, K. K. (1992). Cyclothymic, hyperthymic and depressive temperaments as subaffective variants of mood disorders. En A. Tasman & M. B. Riba (Eds.) Annual Review, vol. II. Washington, D.C.: American Psychiatric Press.

Akiskal, H. S. & Akiskal, K. K. (2007). In search of Aristotle: temperament, human nature, melancholia, creativity and eminence. Journal Affective Disorders, 100, 1-6.

Akiskal, H. S., Bitar, A. H., Puzantian, V. R., Rosenthal, T. L., & Walker, P. W. (1978). The nosological status of neurotic depression: a prospective three- to four-year follow-up examination in light of the primary-secondary and unipolar-bipolar dichotomies. Archives of General Psychiatry, 35, 756-66.

Akiskal, H. S., Djenderedjian, A. M., Rosenthal, R. H., & Khani, M. K. (1977). Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. The American journal of psychiatry, 134, 1227-1233.

Akiskal, H. S. & Mallya, G. (1987). Criteria for the "soft" bipolar spectrum: treatment implications. Psychopharmacology Bulletin, 23, 68-73.

Akiskal, H. S., Maser, J. D., Zeller, P. J., Endicott, J., Coryell, W., Keller, M., … Goodwin, F. (1995). Switching from ‘unipolar’ to Bipolar II. An 11-Year Prospective-Study of Clinical and Temperamental Predictors in 559 Patients. Archives of General Psychiatry, 52, 114-123.

Akiskal, H. S. & Pinto, O. (1999). The evolving bipolar spectrum. Prototypes I, II, III, and IV. Psychiatric Clinics of North America, 22(3), 517-534.

Akiskal, K. K. & Akiskal, H. S. (2005). The theoretical underpinnings of affective temperaments: implications for evolutionary foundations of bipolar disorder and human nature. Journal of Affective Disorders, 85, 231-239.

Balanza-Martinez, V., Rubio, C., Selva-Vera, G., Martinez-Aran, A., Sanchez-Moreno, J., Salazar-Fraile, J., … Tabares-Seisdedos, R. (2008). Neurocognitive endophenotypes (Endophenocognitypes) from studies of relatives of bipolar disorder subjects: A systematic review. Neuroscience & Biobehavioral Reviews, 32, 1426-1438.

Baldassano, C. F., Marangell, L. B., Gyulai, L., Ghaemi, S. N., Joffe, H., Kim, D. R., … Cohen, L. S. (2005). Gender differences in bipolar disorder: retrospective data from the first 500 STEP-BD participants. Bipolar Disorders, 7, 465-70.

Berk, M., Conus, P., Lucas, N., Hallam, K., Malhi, G. S., Dodd, S., … Mcgorry, P. (2007). Setting the stage: from prodrome to treatment resistance in bipolar disorder. Bipolar Disorders, 9, 671-678.

Bouchard, T. J., Jr. (1994). Genes, environment, and personality. Science, 264, 1700-1701.

Caspi, A., Hariri, A. R., Holmes, A., Uher, R., & Moffitt, T. E. (2010). Genetic Sensitivity to the Environment: The Case of the Serotonin Transporter Gene and Its Implications for Studying Complex Diseases and Traits. American Journal of Psychiatry, 167, 509-527.

Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., … Poulton, R. (2003). Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science, 301, 386-389.

Cassano, G. B., Akiskal, H. S., Savino, M., Musetti, L., & Perugi, G. (1992). Proposed subtypes of bipolar II and related disorders: with hypomanic episodes (or cyclothymia) and with hyperthymic temperament. Journal of Affective Disorders, 26, 127-40.

Chiaroni, P., Hantouche, E. G., Gouvernet, J., Azorin, J. M., & Akiskal, H. S. (2005). The cyclothymic temperament in healthy controls and familially at risk individuals for mood disorder: endophenotype for genetic studies? J Affect Disorders, 85, 135-145.

Chotai, J., Jonasson, M., Hagglof, B., & Adolfsson, R. (2002). The Temperament Scale of Novelty Seeking in adolescents shows an association with season of birth opposite to that in adults. Psychiatry Research, 111, 45-54.

Chotai, J., Murphy, D. L., & Constantino, J. N. (2006). Cerebrospinal fluid monoamine metabolite levels in human newborn infants born in winter differ from those born in summer Psychiatry Research, 145, 189-97.

Clarke, H., Flint, J., Attwood, A. S., & Munafo, M. R. (2010). Association of the 5- HTTLPR genotype and unipolar depression: a meta-analysis. Psychological Medicine, 40, 1767-78.

Cloninger, C. R. (1994). Temperament and personality. Current Opinion in Neurobiology, 4, 266-73.

Craddock, N. & Sklar, P. (2013). Genetics of bipolar disorder. Lancet, 381, 1654-1662.

Evans, L., Akiskal, H. S., Keck, P. E., Mcelroy, S. L., Sadovnick, A. D., Remick, R. A., & Kelsoe, J. R. (2005). Familiality of temperament in bipolar disorder: support for a genetic spectrum. Journal of Affective Disorders, 85, 153-168.

Evans, L. M., Akiskal, H. S., Greenwood, T. A., Nievergelt, C. M., Keck, P. E., Mcelroy, S. L., … Kelsoe, J. R. (2008). Suggestive linkage of a chromosomal locus on 18p11 to cyclothymic temperament in bipolar disorder families. American Journal of Medical Genetics Part B, 147B, 326-332.

Gassab, L., Mechri, A., Bacha, M., Gaddour, N., & Gaha, L. (2008). Affective temperaments in the bipolar and unipolar disorders: distinctive profiles and relationship with clinical features. Encephale, 34, 477-82.

Gonda, X., Fountoulakis, K. N., Juhasz, G., Rihmer, Z., Lazary, J., Laszik, A., … Bagdy, G. (2009). Association of the s allele of the 5-HTTLPR with neuroticism-related traits and temperaments in a psychiatrically healthy population. European Archives of Psychiatry and Clinical Neuroscience, 259, 106-13.

Gonda, X., Rihmer, Z., Zsombok, T., Bagdy, G., Akiskal, K. K., & Akiskal, H. S. (2006). The 5HTTLPR polymorphism of the serotonin transporter gene is associated with affective temperaments as measured by TEMPS-A. Journal of Affective Disorders, 91, 125-31.

Grande, I., Frey, B. N., Vieta, E., & Kapczinski, F. (2013). Soft Bipolar Spectrum and Staging in Bipolar Disorder. Current Psychiatry Reviews, 9, 33-40.

Hantouche, E. G., Akiskal, H. S., Lancrenon, S., Allilaire, J. F., Sechter, D., Azorin, J.M., & Chatenet-Duchene, L. (1998). Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP). Journal of Affective Disorders, 50, 163-173.

Hantouche, E. G., Allilaire, J. P., Bourgeois, M. L., Azorin, J. M., Sechter, D., Chatenet-Duchene, L., & Lancrenon, S. (2001). The feasibility of self-assessment of dysphoric mania in the French national EPIMAN study. Journal of Affective Disorders, 67, 97-103.

Henry, C., Lacoste, J., Bellivier, F., Verdoux, H., Bourgeois, M. L., & Leboyer, M. (1999). Temperament in bipolar illness: impact on prognosis. Journal of Affective Disorders, 56, 103-108.

Henry, C., Sorbara, F., Lacoste, J., Gindre, C., & Leboyer, M. (2001). Antidepressant-induced mania in bipolar patients: Identification of risk factors. The Journal of Clinical Psychiatry, 62, 249-255.

Homberg, J. R. & Lesch, K. P. (2011). Looking on the bright side of serotonin transporter gene variation. Biol Psychiatry, 69, 513-9.

Judd, L. L. & Akiskal, H. S. (2000). Delineating the longitudinal structure of depressive illness: beyond clinical subtypes and duration thresholds. Pharmacopsychiatry, 33, 3-7.

Kang, J. I., Namkoong, K. & Kim, S. J. (2008). The association of 5-HTTLPR and DRD4 VNTR polymorphisms with affective temperamental traits in healthy volunteers. Journal of Affective Disorders, 109, 157-63.

Kapczinski, F., Dias, V. V., Kauer-Sant'anna, M., Brietzke, E., Vazquez, G. H., Vieta, E., & Berk, M. (2009). The potential use of biomarkers as an adjunctive tool for staging bipolar disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 33, 1366-1371.

Kapczinski, F., Vieta, E., Andreazza, A.C., Frey, B.N., Gomes, F.A., Traniontina, J., Kauer-Sant'anna, M., Grassi-Oliveira, R., Post, R.M. 2008. Allostatic load in bipolar disorder: Implications for pathophysiology and treatment. Neuroscience & Biobehavioral Reviews, 32, 675-692.

Karg, K., Burmeister, M., Shedden, K., & Sen, S. (2011). The Serotonin Transporter Promoter Variant (5-HTTLPR), Stress, and Depression Meta-analysis Revisited Evidence of Genetic Moderation. Archives of General Psychiatry, 68, 444-454.

Kawamura, Y., Liu, X. X., Akiyama, T., Shimada, T., Otowa, T., Sakai, Y., … Akiskal, H. S. (2010). The association between oxytocin receptor gene (OXTR) polymorphisms and affective temperaments, as measured by TEMPS-A. Journal of Affective Disorders, 127, 31-37.

Kelsoe, J. R. (2003). Arguments for the genetic basis of the bipolar spectrum. Journal of Affective Disorders, 73, 183-197.

Kesebir, S., Vahip, S., Akdeniz, F., & Yuncu, Z. (2005a). The relationship of affective temperament and clinical features in bipolar disorder. Türk Psikiyatri Dergisi, 16, 164-169.

Kesebir, S., Vahip, S., Akdeniz, F., Yuncu, Z., Alkan, M., & Akiskal, H. (2005b). Affective temperaments as measured by TEMPS-A in patients with bipolar I disorder and their first-degree relatives: a controlled study. Journal of Affective Disorders, 85, 127-133.

Kochman, F. J., Hantouche, E. G., Ferrari, P., Lancrenon, S., Bayart, D., & Akiskal, H. S. (2005). Cyclothyrnic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. Journal of Affective Disorders, 85, 181-189.

Kraepelin, E. (1921). Manic-Depressive Illness and Paranoia. Edinburgh: Livingstone.

Kuehner, C. (2003). Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatrica Scandinavica, 108, 163-74.

Landaas, E. T., Johansson, S., Halmoy, A., Oedegaard, K. J., Fasmer, O. B., & Haavik, J. (2011). No association between the serotonin transporter gene polymorphism 5-HTTLPR and cyclothymic temperament as measured by TEMPS-A. Journal of Affective Disorders, 129, 308-312.

Lazary, J., Lazary, A., Gonda, X., Benko, A., Molnar, E., Hunyady, L., … Bagdy, G. (2009). Promoter Variants of the Cannabinoid Receptor 1 Gene (CNR1) in Interaction With 5-HTTLPR Affect the Anxious Phenotype. American Journal of Medical Genetics Part B, 150B, 1118-1127.

Levinson, D. F. (2006). The genetics of depression: A review. Biological psychiatry, 60, 84-92.

Lewinsohn, P. M., Klein, D. N., Durbin, E. C., Seeley, J. R., & Rohde, P. (2003). Family study of subthreshold depressive symptoms: risk factor for MDD? Journal of Affective Disorders, 77, 149-157.

Lohoff, F. W. (2010). Overview of the genetics of major depressive disorder. Current Psychiatry Reports, 12, 539-46.

Matsumoto, S., Akiyama, T., Tsuda, H., Miyake, Y., Kawamura, Y., Noda, T., … Akiskal, H. S. (2005). Reliability and validity of TEMPS-A in a Japanese non-clinical population: application to unipolar and bipolar depressives. Journal of Affective Disorders, 85, 85-92.

Mazzarini, L., Pacchiarotti, I., Colom, F., Sani, G., Kotzalidis, G.D., Rosa, A.R., … Vieta, E. (2009). Predominant polarity and temperament in bipolar and unipolar affective disorders. Journal of Affective Disorders, 119, 28-33.

Mechri, A., La Kerkeni, N., Touati, I., Bacha, M., & Gassab, L. (2011). Association between cyclothymic temperament and clinical predictors of bipolarity in recurrent depressive patients. Journal of Affective Disorders, 132, 285-288.

Mendlowicz, M. V., Jean-Louis, G., Kelsoe, J. R., & Akiskal, H. S. (2005). A comparison of recovered bipolar patients, healthy relatives of bipolar probands, and normal controls using the short TEMPS-A. Journal of Affective Disorders, 85, 147-151.

Neves-Pereira, M., Mundo, E., Muglia, P., King, N., Macciardi, F., & Kennedy, J. L. (2002). The brain-derived neurotrophic factor gene confers susceptibility to bipolar disorder: evidence from a family-based association study. The American Journal of Human Genetics, 71, 651-5.

Oedegaard, K. J., Syrstad, V. E. G., Morken, G., Akiskal, H. S., & Fasmer, O. B. (2009). A study of age at onset and affective temperaments in a Norwegian sample of patients with mood disorders. Journal of Affective Disorders, 118, 229-233.

Perugi, G., Toni, C., Maremmani, I., Tusini, G., Ramacciotti, S., Madia, A., … Akiskal, H. S. (2012). The influence of affective temperaments and psychopathological traits on the definition of bipolar disorder subtypes: A study on Bipolar I Italian National sample. Journal of Affective Disorders, 136, E41-E49.

Perugi, G., Toni, C., Travierso, M. C., & Akiskal, H. S. (2003). The role of cyclothymia in atypical depression: toward a data-based reconceptualization of the borderline-bipolar II connection. Journal of Affective Disorders, 73, 87-98.

Rihmer, Z. (1980). Season of birth and season of hospital admission in bipolar depressed female patients. Psychiatry Research, 3, 247-51.

Rihmer, Z., Erdos, P., Ormos, M., Fountoulakis, K.N., Vazquez, G., Pompili, M., & Gonda, X. (2011). Association between affective temperaments and season of birth in a general student population. Journal of Affective Disorders, 132, 64-70.

Rottig, D., Rottig, S., Brieger, P., & Marneros, A. (2007). Temperament and personality in bipolar I patients with and without mixed episodes. Journal of Affective Disorders, 104, 97-102.

Sen, S., Burmeister, M., & Ghosh, D. (2004). Meta-analysis of the association between a serotonin transporter promoter polymorphism (5-HTTLPR) and anxiety-related personality traits. American Journal of Medical Genetics Part B, 127B, 85-89.

Serafini, G., Pompili, M., Innamorati, M., Fusar-Poli, P., Akiskal, H. S., Rihmer, Z., … Tatarelli, R. (2011). Affective temperamental profiles are associated with white matter hyperintensity and suicidal risk in patients with mood disorders. Journal of Affective Disorders, 129, 47-55.

Sklar, P., Gabriel, S. B., Mcinnis, M. G., Bennett, P., Lim, Y.M., Tsan, G., … Lander, E. S. (2002). Family-based association study of 76 candidate genes in bipolar disorder: BDNF is a potential risk locus. Brain-derived neutrophic factor. Molecular Psychiatry, 7, 579-93.

Sole, B., Bonnin, C. M., Torrent, C., Martinez-Aran, A., Popovic, D., Tabares-Seisdedos, R., & Vieta, E. (2012). Neurocognitive Impairment Across the Bipolar Spectrum. CNS Neurosc Therap, 18, 194-200.

Somers, J. M., Goldner, E. M., Waraich, P., & Hsu, L. (2006). Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Canadian Journal of Psychiatry, 51, 100-13.

Thompson, J. M., Gallagher, P., Hughes, J. H., Watson, S., Gray, J. M., Ferrier, I. N., & Young, A. H. (2005). Neurocognitive impairment in euthymic patients with bipolar affective disorder. The British Journal of Psychiatry, 186, 32-40.

Tondo, L., Baldessarini, R. J., Vazquez, G., Lepri, B., Visioli, C. (2013). Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders. Acta Psychiatrica Scandinavica, 127, 355-364.

Tsutsumi, T., Terao, T., Hatanaka, K., Goto, S., Hoaki, N., & Wang, Y. M. (2011). Association between affective temperaments and brain-derived neurotrophic factor, Glycogen synthase kinase 3 beta and Wnt signaling pathway gene polymorphisms in healthy subjects. Journal of Affective Disorders, 131, 353-357.

Vazquez, G. H. & Gonda, X. (2013). Affective Temperaments and Mood Disorders: A Review of Current Knowledge. Current Psychiatry Reviews, 9, 21-32.

Vazquez, G. H., Kahn, C., Schiavo, C. E., Goldchluk, A., Herbst, L., Piccione, M., … Akiskal, H. S. (2008). Bipolar disorders and affective temperaments: A national family study testing the "endophenotype" and "subaffective" theses using the TEMPS-A Buenos Aires. Journal of Affective Disorders, 108, 25-32.

Vazquez, G. H., Tondo, L., Mazzarini, L., & Gonda, X. (2012). Affective temperaments in general population: A review and combined analysis from national studies. J Affect Disord, 139, 18-22.

Zandi, P. P., Belmonte, P. L., Willour, V. L., Goes, F. S., Badner, J. A., Simpson, S. G., … Potash, J. B. (2008). Association study of Wnt signaling pathway genes in bipolar disorder. Archives of General Psychiatry, 65, 785-93.

Zhang, K. R., Yang, C. X., Xu, Y., Sun, N., Yang, H., Liu, J. L., … Shen, Y. (2010). Genetic association of the interaction between the BDNF and GSK3B genes and major depressive disorder in a Chinese population. Journal of Neural Transmission, 117, 393-401.

Cómo citar
Gonda, X., & Vázquez, G. H. (2014). Theoretical and clinical overview of affective temperaments in mood disorders. Psicodebate, 14(2), 39-58.