Can adaptive hyperactivation result in a positive score on the Mood Disorder Questionnaire? Evidence from a case-control study over a community survey

Background Bipolar Disorder (BD) remains challenging to identify, and the Mood Disorder Questionnaire (MDQ) may capture heterogeneous forms of hyperactivation, including adaptive patterns unrelated to psychopathology. Objectives To determine whether MDQ-positive individuals include a subgroup with adaptive hyperactivation—characterized by high quality of life (QoL) and minimal psychiatric morbidity—and to examine whether MDQ positivity also identifies diagnoses beyond BD. Methods Using data from a large Italian community survey with DSM-IV clinical interviews and MDQ screening, we conducted a case–control analysis. MDQ-positive individuals were stratified by SF-12 QoL scores (>40 vs. ≤40), and matched MDQ-negative controls were selected by age and sex. Psychiatric diagnoses were compared using ANOVA and chi-square tests. Results Among 91 MDQ-positive participants, 33% showed high QoL and exhibited markedly fewer psychiatric diagnoses than those with low QoL (χ²=15.529, p<0.0001). High-QoL MDQ-positive individuals displayed psychiatric morbidity comparable to MDQ-negative controls, whereas low-QoL MDQ-positive individuals showed excess anxiety, obsessive–compulsive, and eating disorders. Conclusions MDQ positivity identifies a heterogeneous population, including individuals with adaptive hyperactivation and preserved functioning. These findings highlight the need for more refined instruments capable of distinguishing adaptive from pathological hyperactivation and caution against over-pathologizing MDQ positivity in clinical and public health settings.