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Psychopathologic structure of bipolar disorders: exploring dimensional phenotypes, their relationships, and their associations with bipolar I and II disorders

Published online by Cambridge University Press:  17 October 2018

Ji Hyun Baek
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Kyooseob Ha
Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea Institute of Human Behavioral Medicine, Seoul National University College of Medicine, Seoul, Korea
Yongkang Kim
Department of Statistics, Seoul National University, Seoul, Korea
Young-ah Cho
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
So Yung Yang
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Yujin Choi
Samsung Biomedical Research Institute, Seoul, Korea
Sung-Lee Jang
Samsung Biomedical Research Institute, Seoul, Korea
Taesung Park
Department of Statistics, Seoul National University, Seoul, Korea
Tae Hyon Ha
Department of Psychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
Kyung Sue Hong*
Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea Samsung Biomedical Research Institute, Seoul, Korea
Author for correspondence: Kyung Sue Hong, E-mail:



Given its diverse disease courses and symptom presentations, multiple phenotype dimensions with different biological underpinnings are expected with bipolar disorders (BPs). In this study, we aimed to identify lifetime BP psychopathology dimensions. We also explored the differing associations with bipolar I (BP-I) and bipolar II (BP-II) disorders.


We included a total of 307 subjects with BPs in the analysis. For the factor analysis, we chose six variables related to clinical courses, 29 indicators covering lifetime symptoms of mood episodes, and 6 specific comorbid conditions. To determine the relationships among the identified phenotypic dimensions and their effects on differentiating BP subtypes, we applied structural equation modeling.


We selected a six-factor solution through scree plot, Velicer's minimum average partial test, and face validity evaluations; the six factors were cyclicity, depression, atypical vegetative symptoms, elation, psychotic/irritable mania, and comorbidity. In the path analysis, five factors excluding atypical vegetative symptoms were associated with one another. Cyclicity, depression, and comorbidity had positive associations, and they correlated negatively with psychotic/irritable mania; elation showed positive correlations with cyclicity and psychotic/irritable mania. Depression, cyclicity, and comorbidity were stronger in BP-II than in BP-I, and they contributed significantly to the distinction between the two disorders.


We identified six phenotype dimensions; in addition to symptom features of manic and depressive episodes, various comorbidities and high cyclicity constructed separate dimensions. Except for atypical vegetative symptoms, all factors showed a complex interdependency and played roles in discriminating BP-II from BP-I.

Original Articles
Copyright © Cambridge University Press 2018 

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