A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies.

In an attempt to study predisposition to bipolar manic-depressive disorder, we developed a behavioral paradigm to identify persons at risk for various forms of the disorder. We provide a theoretical discussion for denning bipolar disorder within the broader framework of common human diseases and then employ this framework to derive dimensions of bipolar disorder that define its distinctness from the normal phenotype. These dimensions (behavioral and nonbehavioral features of disorder) are operationalized in the form of a self-report inventory which estimates the probability that an individual is at risk. Five external validation studies using nontest criteria are presented, including interview, roommate, family history, clinical characteristics, and longitudinal mood rating investigations. Results indicate that the inventory serves as a promising first-stage case identification procedure for bipolar disorder when employed in a research context. To date, most research on human disorders has focused on the pathophysiology underlying signs and symptoms (Depue Evans, 1981). If comprehensive models of etiology are to be derived, however, other This study was supported by National Institutes of Health grants awarded to the first author by the Graduate