Journal of Affective Disorders 135 (2011) 2836

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Journal of Affective Disorders

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / j a d

Research report

Creativity and affective temperaments in non-clinical professional artists: An

empirical psychometric investigation
Marcello Vellante a, Giulia Zucca a, Antonio Preti a, b,, Davide Sisti c, Marco Bruno Luigi Rocchi c,
Kareen K. Akiskal d, Hagop S. Akiskal d, e
a
b
c
d
e

Department of Psychology, University of Cagliari, via Is Mirrionis 1, 09123 Cagliari, Italy

Genneruxi Medical Center, via Costantinopoli 42, 09129 Cagliari, Italy
Institute of Biomathematics. Polo Scientico, Loc. Crocicchia, University of Urbino, 61029 Urbino PU, Italy
International Mood Center, La Jolla, CA, USA
University of California at San Diego, La Jolla, CA, USA

a r t i c l e

i n f o

Article history:
Received 27 March 2011
Received in revised form 29 June 2011
Accepted 30 June 2011
Available online 5 August 2011
Keywords:
Mood disorders
Bipolar spectrum
Temperament
Creativity
Personality

a b s t r a c t
Objective: Manic-depression/bipolar disorder was linked to creativity, with affective
temperaments allegedly favoring creative expression and achievement, but a few studies
only empirically tested the link.
Methods: 152 undergraduate students attending preparatory courses for creative artistic
professions and 152 students in areas expected to lead to a profession mostly requiring the
application of the learned rules were invited to fill in the TEMPS-A (Temperament Evaluation
of the Memphis, Pisa, Paris and San Diego Autoquestionnaire), the General Health
Questionnaire (GHQ) and the Creative Achievement Questionnaire (CAQ). Latent class
analysis (LCA) was used to investigate the links between creativity scores and measures of
psychopathology.
Results: Creative participants and controls did not differ in terms of sex (males = 47%), age
(24.5 years, SD = 3.8), or socioeconomic status. Creative people scored higher than controls
on the CAQ and on the cyclothymic, hyperthymic and irritable subscales of the TEMPS-A, but
not on the GHQ. Greater involvement in creative activities rather than being a creative
achiever best differentiated those into the risk for bipolar spectrum class from the other
two classes extracted by the LCA from the TEMPS-A.
Limitations: The use of self-report measures to evaluate both creative involvement and the risk of
psychopathology, and the exclusive focus on artistic creativity limit the generalizability of the
findings.
Conclusions: This study confirms that the cyclothymic dimension of the bipolar spectrum is linked
to creativity, and this link is likely to result from increased involvement into pleasurable activities,
including creative ones.
2011 Elsevier B.V. All rights reserved.

1. Introduction
Akiskal's bipolar spectrum (1977; 1981; 1983) conceptualizes mood disorders alongside the Kraepelinian notion of a
Corresponding author at: Centro Medico Genneruxi, Via Costantinopoli
42, 09129 Cagliari, Italy. Tel.: + 39 070 480922.
E-mail address: apreti@tin.it (A. Preti).
0165-0327/$ see front matter 2011 Elsevier B.V. All rights reserved.
doi:10.1016/j.jad.2011.06.062

broad manic-depression syndrome extending from subclinical

manifestations to bipolar I disorder, and encompassing major
and minor depression, cyclothymic disorder and the variant of
bipolar disorder with hypomania (bipolar II). The TEMPS-A
(Temperament Evaluation of the Memphis, Pisa, Paris and San
Diego Autoquestionnaire) was developed to more precisely
dene the temperamental foundation of bipolar spectrum, with
ve subscales (dysthymic, cyclothymic, hyperthymic, irritable,

M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

and anxious) aimed at offering a multidimensional evaluation of

the affective temperaments that characterize people within the
bipolar spectrum (Akiskal and Akiskal, 2005a). The TEMPS-A is
rooted in an evolutionary biologic perspective (Akiskal and
Akiskal, 2005b), which has received some support from genetic
studies (Gonda et al., 2005; 2009).
Both past and recent studies purported a link between
manic-depression/bipolar disorder and creativity (Murray and
Johnson, 2010; Srivastava and Ketter, 2010), with emphasis on
the cyclothymic component of the manic-depression/bipolar
disorder spectrum (Akiskal and Akiskal, 1988; Andreasen,
1987; Juda, 1949; Kretschmer, 1931; Ludwig, 1992; Richards et
al., 1988; Srivastava et al., 2010; Strong et al., 2007).
Positive mood, and happiness in particular, was postulated
to fuel creativity (Baas et al., 2008; Davis, 2009). Enhanced
positive affect is a feature of both hypomania and mania, which
are core symptoms of bipolar disorder and may predispose
people within the manic-depression/bipolar disorder spectrum
to creativity (Murray and Johnson, 2010). By contrast, Akiskal
and Akiskal (1988) postulated that depression might provide
fresh insights which can be executed into the artistic oeuvre
during the energized phases of cyclothymia.
Whether or not creativity is linked to bipolar disorder has an
impact on clinical practice. Lithium was reported to negatively
inuence verbal learning and memory and negatively impact on
creativity (Wingo et al., 2009); however, Schou's (1979)
classical study on artists did not support this point of view. No
specic evidence is available on other drugs used to treat bipolar
disorder. Overall the area is understudied (Andreasen, 2008;
Murray and Johnson, 2010). Albeit these cognitive effects were
reported to be small, therapists treating patients with bipolar
disorder should be aware of the impact of pharmacotherapy on
patients involved in artistic, scientic or otherwise creative
professions, and be especially careful with young patients who
have not dened a profession yet. Indeed, better prophylaxis of
the disruptive episodes of manic-depression can have overall
benecial effects on the career of artists (Akiskal and Akiskal,
1988).
Most studies originating evidence on a link between
bipolar disorder and creativity were based on small, highly
selected samples, or considered retrospective accounts on
psychopathology (Akiskal and Akiskal, 1988; Andreasen and
Glick, 1988; Jamison, 1989; Jamison, 1993; Nowakowska et
al., 2005).
Only one study with reliable epidemiological data found an
overrepresentation of people diagnosed with bipolar disorder
among those who declared an artistic profession; the study
was based on the Epidemiological Catchment Area Study, and
included 20,861 adult participants (Tremblay et al., 2010).
However, people with bipolar disorder often have difculties in
nding and maintaining a job, so greater representation in
artistic professions might be the effect of social drift in less
structured and demanding occupations rather than the result of
a personal talent in creativity. Indeed, people with bipolar
disorder as those with a cyclothymic temperament may t
better with less structured activities and environments as those
typical of creative professions, in which they do not have to be
subordinates or follow strict rules.
Nevertheless, some features of bipolarity might contribute
to creative expression and success. Indeed, creativity is
something more than merely being able to connect remote

29

associations between known ideas and concepts to produce

original or otherwise new constructs or tools. The capacity of
bringing new or original creations to social testing, by
comparison with scientic or aesthetic standards, and winning
against criticism is a crucial factor in creative achievement
(Preti and Miotto, 1997).
Anecdotal evidence indicates that creative people tend to
emerge as both sociable and popular with their peers; they also
appear to welcome social contact and show interest in social
activities (Post, 1994). When specically investigated, increased
extraversion was found in a sample of creative people compared
to less creative peers or people involved in noncreative
professions (Feist, 1998; Gelade, 1997), although negative
ndings have been reported as well (Feist, 1998). Elevated
extraversion has also been observed in patients with bipolar
disorder (Akiskal et al., 2006; Murray et al., 2007). Increased
sociability is a feature of hypomanic states (WHO, 1992), and
can be observed in patients diagnosed with bipolar disorder
when they are not overtly disturbed by the depressive or manic
phases of their psychopathology. Sociability is a core component
in creative achievement, and the ability to promote oneself by
networking might be a factor linking creativity and affective
disorders (Sass, 2001).
Openness to experience and intuitive thinking are two
central features of creativity, and both patients diagnosed with
bipolar disorder and people involved in creative professions
were reported to score higher in openness (as measured by the
Neuroticism, Extraversion, and Openness Personality Inventory:
Costa and McCrae, 1985) and intuitive thinking (as measured by
the MyersBriggs Type Indicator, which is based on Jungian
types: Myers and McCaulley, 1985) than comparison groups
(Srivastava and Ketter, 2010).
Finally, a strong ambition and drive to success characterize
people who excel because of their creative talent (Feist, 1998),
and ambition for success and recognition by others are features
observed in people diagnosed with bipolar disorder or at risk of
it (Johnson et al., 2009; Murray and Johnson, 2010).
A few studies tested the hypothesis that bipolar disorder
would promote creativity by recruiting patients with bipolar
disorders, and assessing their creative potential and talent
with instruments aimed at measuring propensity to be
creative. Akiskal and Akiskal (1988) reported that artistic
talent, creativity, and eminence in various professional
domains were over-represented among the kind of affective
disorders versus schizophrenia patients. In one of the two
other studies published on this topic to date, the close
relatives of patients with bipolar disorders were found more
creative than healthy people not at risk of affective disorders
on a scale designed to test everyday creativity (Richards et al.,
1988); in another study (Santosa et al., 2007), patients with
bipolar disorder in euthymic phase scored higher than
controls devoid of affective disorders on the BarronWelsh
Art Scale (Barron, 1963) but not on the Torrance Tests of
Creative Thinking (Torrance, 1990).
Another large study based on an affective disorder sample
found increased cyclothymia in artists and architects compared
with people involved in noncreative professions (Akiskal et al.,
2005a). One study done in a non-clinical sample and involving
128 students found an association between hypomanic
personality traits and the scores on three measures of creative
potential (Furnham et al., 2008). A link between a measure of

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M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

creative production and a past or current history of treatment

for mood disorder was found in yet another non-clinical sample
including 412 undergraduate students (Guastello et al., 2004).
One of the problems of research in this area is that comparison
groups need to be broad enough to provide perspective on the
hypomanic and energized aspects of temperament among the
artist types. In a study (Figueira et al., 2010) among medical
students, their temperaments were unremarkable, law students
and art students were cyclothymic and irritable; engineering
students were predominantly hyperthymic, while psychologists
and nurses were predominantly depressive or anxious in
temperament. This contrast provides some relative specicity
for cyclothymia and creativity.
The limited evidence from past studies suggests that creative
achievement would relate to milder forms of hypomania, while
more severe expressions of symptoms may negatively inuence
creative accomplishment (Akiskal and Akiskal, 2007; Richards
et al., 1988; Simeonova et al., 2005). Therefore, the investigation
of the affective temperament in non-clinical populations could
offer more specic clues on the links between creativity and
bipolar disorder and the mechanisms involved in it.
In this study we tested whether students in creative
disciplines were more likely than students in non-creative
disciplines to show indicators of affective temperament.
To this aim, we used the TEMPS-A. To date, the original
110-item version has been translated into 25 languages, and
validated in many countries with different cultural backgrounds (Akiskal and Akiskal, 2005a).
This study used the Italian brief, 39-item version of the
questionnaire, which proved as valid as the longer version, and
it is somehow more apt at investigating large samples from the
community (Preti et al., 2010).
Distribution of scores on the TEMPS-A subscales was
explored with Latent Class Analysis (LCA). LCA posits that a
heterogeneous group can be reduced to several homogeneous
subgroups by evaluating and then minimizing the associations
among responses across multiple variables, and tests for the
existence of discrete groups with a similar symptom or item
endorsement prole (Lazarsfeld and Henry, 1968; McCutcheon,
1987). On a theoretical basis, we expected that TEMPS-A scores
be distributed into three classes: a large basal class with the
lowest chance of endorsement of TEMPS-A items (people
devoid of affective traits); a depression-prone class, with higher
endorsement within the dysthymic and anxious temperaments; and a cyclothymic-prone class, including those people
who are likely to endorse most TEMPS-A items within all
temperaments. To the best of our knowledge, this is the rst
study applying LCA to the TEMPS-A.
2. Methods
2.1. Participants
The study was approved by the ethical board on clinical
investigation of the Department of Psychology of the
University of Cagliari. A total of 350 participants were invited
to ll in a booklet containing some self-report questionnaires
aimed at investigating creativity and their psychological
correlates, including indicators of psychopathology.
Three hundred and four participants completed the questionnaires: 152 were attending schools preparing for creative

artistic professions in the district of Cagliari (44 musicians in

training at the conservatoire, 36 painters and sculptors in
training in ne arts, 40 dancers, and 32 actors from drama
school), and 152 subjects were attending undergraduate courses
of the University of Cagliari in areas expected to lead to a
profession mostly requiring the application of the learned rules
(59 from the engineering courses, 60 from the law courses, and
33 from the foreign language courses).
Criteria for inclusion in the index group (hereinafter
creative people) were: to be undergoing studies leading to
an artistic profession requiring the production of brand new,
original works; to be expected to be exposed to public judgment
of the produced works, via an exhibition (for painters/visual
artists), public execution of musical compositions (for musicians), expression/playing in public (for dancers/dramatists),
during their course.
Criteria for inclusion in the contrast group (hereinafter
controls) were: to be undergoing studies leading to a
profession requiring the application of rules, without specically being requested to innovate their eld; to be expected not
to be exposed to public judgment of any creatively produced
work, in any eld, during their course.
We tried to match undergraduate courses to the artistic
schools, as far as the cognitive abilities required to be successful
in the eld were concerned (playing/persuasion for both law
students and dramatists/dancers; abstraction and symbolization for engineers and musicians; visual artists and students of
languages were unmatched).
The group of creative people was specically matched for
sex to the group of controls, since self-report measures of
psychopathology tend to be higher in females than in males and
differences by sex between the samples would have biased
results.
The study was carried out from spring 2008 to spring
2010. Each participant provided informed consent. Voluntary
participation (no fee paid) and having no impediment in
reading and understanding the Italian language correctly
were the only criterion of inclusion. The participation rate
was 83.5% in the creative group and 90% in the control group
(Fig. 1).
2.2. Measures
Each participant was guaranteed condentiality of the
investigation, and subsequently received a booklet containing
the questionnaires listed below, which they were asked to
complete.
The Creative Achievement Questionnaire (CAQ): this is a
self-report measure of creative involvement and achievement
that includes 10 domains of creativity, from the arts and
science to humor and culinary (Carson et al., 2005). Three
subscales apply here: one on self-evaluation assessing the
number of creative areas in which the participant is involved; a
second scale records major achievements by the participant in
any creative domain, and consists of a summary score on 10
areas rated 0 (no talent whatsoever) to 7 (public acknowledgement of the subject's talent on a national journal); a third
scale (3 items, yes/no format = 1/0) depicts how the participant is viewed by others as a creative stereotype (e.g. People
regularly accuse me of having an artistic temperament). The
original version showed good convergent and predictive

M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

Population
University students: n = 9437
Engineering :
5726
Law:
2836
Language:
875

31

Population
Arts schools students: n = 1900
Fine arts:
300
Dancing:
500
Drama:
300
Conservatoire: 800

Assessed for eligibility (n = 168)

Assessed for eligibility (n = 182)

Engineering: 63
Law:
67
Language:
38

Fine arts:
46
Dancing:
40
Drama:
40
Conservatoire: 56

Enrollment
Excluded (n = 30)

Excluded (n = 16)
Not meeting inclusion criteria
(n = 0)
Refused to participate
(n = 0)
Other reasons
(not returned booklet) (n = 16)
(incomplete data)
(n = 0)

Not meeting inclusion criteria

(n = 0)
Refused to participate
(n = 0)
Other reasons
(not returned booklet) (n = 28)
(incomplete data)
(n = 2)

Analysis
Analyzed (n = 152)

Analyzed (n = 152)

Excluded from analysis (n = 0)

Excluded from analysis (n = 0)

Fig. 1. Flowchart of the study STROBE diagram.

validity as far as other measures of creativity were concerned.

For the purpose of this study, the original English version of the
CAQ was translated into Italian by the principal investigator
(AP) then checked for correctness by an English-speaking
translator. A second English-speaking translator checked the
back translation into English.
The 12-item General Health Questionnaire (GHQ-12): this
scale is a 12-item self-report questionnaire on which respondents rate the degree of their psychological distress according
to the major symptoms area of mental disorders on a 4-point
scale (not at all, less than usual, more than usual, rather
more than usual), with reference to the past 4 weeks
(Goldberg, 1972; Politi et al., 1994). The respondents who
marked any statement in the scale applying to them rather
more than usual or more than usual scored 1, whereas those
reporting less than usual or not at all scored 0 (maximum

score= 12); this scoring method proved reliable enough to

discriminate people suffering from a mental disorder from
putatively healthy subjects (Politi et al., 1994). The aggregate
scores equal to 4 or higher (out of 12) typically classify cases of
common mental disorder, including adjustment disorders or
stress reactions.
The brief Temperament Evaluation of the Memphis, Pisa,
Paris and San Diego Autoquestionnaire (TEMPS-A): this is a
39-item yes-or-no self-report questionnaire designed to
quantify affective temperaments in psychiatric patients
and healthy subjects. It derives from a longer, 110-item
version, built-up on the concept of bipolar spectrum, and
includes ve subscales: dysthymic (D), cyclothymic (C),
hyperthymic (H), irritable (I) and anxious (A) (Akiskal and
Akiskal, 2005a). The validated Italian version, prepared via
translation and back-translation of the original brief scale,

32

M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

was used for this study (Preti et al., 2010). The TEMPS-A
proved able to readily distinguish patients with bipolar
disorder from healthy subjects, and it considered a good
description of the affective temperaments in both clinical
and non-clinical samples (Akiskal et al., 2005b).

2.3. Statistical analysis

All data were coded and analyzed using the Statistical
Package for Social Sciences (SPSS) for Windows (Chicago,
Illinois 60606, USA), version 13.
Scale reliability was measured by Guttman's lambda2
(Guttman, 1945), which is now considered a better lower
bound estimate of reliability than Cronbach's alpha (Sijtsma,
2009). To compare groups, reliability values of .70 are
considered satisfactory (Bland and Altman, 1997). However,
when dealing with subscales derived from a single questionnaire, values around .60 are considered acceptable (Nunnally,
1978).
All tests were two-tailed, with a conservative p = .05. All
data were analyzed with non-parametric statistics due to
non-normality (KolmogorovSmirnov, with Lilliefors significance correction, p b .01 or lower in all explorations).
Categorical data were analyzed in between-group comparisons with 2, with Yates correction when appropriate. The
MannWhitney test was used to compare the ordinal variables. Spearman's rho correlation coefcients were used to
examine associations between two continuous variables.
LCA was conducted with Mplus 3 (Muthn and Muthn,
2004). The LoMendellRubin's adjusted likelihood ratio test
(LRT: Lo et al., 2001) was used to compare models with
different numbers of latent classes. Model selection was
conducted according to tting indices (lower values = better
t) such as likelihood ratio (2*Ln(L)), the Akaike information criterion (AIC: Akaike, 1987), the Bayesian information
criterion (BIC: Schwarz, 1978), and the sample-size adjusted
BIC (SSABIC: Sclove, 1987). Standardized entropy measure
was used to assess accuracy in participants' classication
(values range 0 to 1), with higher values indicating better
classication.
Multinomial logistic regression was used to assess the
association between class membership and creativity (scores
on the CAQ) variables, taking into account demographic (i.e.
gender and age) and clinical (scores on the GHQ-12) variables.
Differences between classes were expressed with odds ratio
with 95% condence interval (CI), except for scores on the
TEMPS-A subscales. The extraction of the LCA classes was not
independent from the scores on the TEMPS-A subscales, so no
inferential statistics could be calculated. However, for descriptive purposes, mean and standard deviations of TEMPS-A
subscales by classes were reported, and the effect sizes of
differences between classes were calculated according to Cliff's
delta (with C.I.), which is appropriate in case of violations of
normality. The Cliff's delta represents the degree of overlap
between the two distributions of scores: the greater the
overlap, the less the difference between the groups (Cliff,
1993). It ranges from 1 to +1 (according to the order of
overlap between two groups), and takes the expected value of
zero if the two sample distributions are extracted from the
same population.

2.4. Sample size

We carried out a preliminary power calculation to determine the minimum sample size to test our hypothesis. Based on
t-test, we determined that a sample of 52 participants per group
would be needed to achieve 80% power to detect a difference
with d = 0.50 (medium effect size) in the measures of creativity
and in those of psychopathology, at a 2-sided signicance level
of .05 and allocation ratio of 1 to 1. For its corresponding nonparametric test (MannWhitney test), a sample of 64 participants per group would be needed at the same levels of power
and signicance (the efciency of the MannWhitney test is
about 0.95 of its corresponding t-test) (Lehmann, 1975).
Calculation was done with G*Power 3 (Faul et al., 2007).

3. Results
Creative people and controls did not differ in terms of sex,
age, socioeconomic status (as measured by the educational
level of their parents) and marital status (Table 1).
The reliability of most questionnaires in the sample was
acceptable (Guttman's lambda2 higher than .70 or near it in
subscales), with the possible exception of the hyperthymic
subscale of the TEMPS-A (Guttman's lambda2 = .58).
On the CAQ, creative participants described themselves as
more involved in creative activities than controls; they also
reported greater achievements in the explored elds, and to
be more likely to correspond to the creative stereotype in
the eyes of friends and acquaintances (Table 2).
Creative participants did not score higher than the
controls on the GHQ-12, but they differed from the controls
on the cyclothymic, hyperthymic and irritable subscales of
the TEMPS-A.
The CAQ involvement, achievements and stereotype subscales were positively related to the cyclothymic and the
hyperthymic subscales of the TEMPS-A (Table 3).

Table 1
General characteristics of the sample (n = 304).
Sociodemographic
group

Creative people Controls

Statistics
(N = 152) N (%) (N = 152) N (%)
2[1] = 0.00,
p = 1.00

Gender
Male
Female
Age
Mean (SD)

Highest level of
parental education
Lower than high
school diploma
High school
diploma
College graduate
or higher
Marital status
Unmarried

71 (46.7%)
81 (53.3%)
24.2 (4.4)

71 (46.7%)
81 (53.3%)
24.9 (3.3)

44 (28.9%)

52 (34.2%)

66 (43.4%)

68 (44.7%)

42 (27.6%)

32 (21.1%)

149 (98.0%)

146 (96.1%)

t(302)
= 1.53,
p = .12

2[2] = 2.05,
p = .36

2[1] = 0.45,
p = .49

M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

Table 2
Differences by measures of creativity and psychopathology between creative
people and controls.
Creative people Controls
(n = 152)
(n = 152)

CAQ
involvement
CAQ
achievements
CAQ stereotype
GHQ-12
TEMPS-A
Dysthymic
Cyclothymic
Hyperthymic
Irritable
Anxious

MannWhitney
U test

Mean (SD)
median

Mean (SD)
median

3.4 (1.8) 3.0

2.4 (1.8) 2.0 U = 7959.0, p b .0001

7.5 (4.7) 7.0

2.8 (2.7) 2.0 U = 3800.5, p b .0001

1.0 (0.7) 1.0

3.6 (3.3) 3.0

0.4 (0.5) 0.0 U = 5966.0, p b .0001

3.4 (3.1) 3.0 U = 11229.0, p = .671

1.6 (1.6)
5.0 (3.1)
3.1 (1.9)
1.5 (1.6)
1.2 (1.1)

1.9 (2.0)
3.8 (2.9)
2.6 (1.7)
1.1 (1.4)
1.2 (1.0)

1.0
5.0
3.0
1.0
1.0

1.0
4.0
2.0
1.0
1.0

U = 11074.5, p = .523
U = 9121.0, p = .001
U = 9740.0, p = .017
U = 9875.5, p = .028
U = 11533.0, p = .979

CAQ = The Creative Achievement Questionnaire.

GHQ-12 = The 12-item General Health Questionnaire.
TEMPS-A = The Temperament Evaluation of the Memphis, Pisa, Paris and
San Diego Autoquestionnaire.

As expected, the GHQ-12 was positively related to all

subscales of the TEMPS-A, with the exception of the hyperthymic
subscale. No signicant links emerged between GHQ and CAQ
scores.

3.1. Latent class analysis

The 3-class solution was the best compromise between all
the considered indexes. The AIC and the SSABIC progressively
declined across the different model, until a plateau at the 4class
solution (12010.8 and 12097.6, respectively, versus 12109.2
and 12174.1 in the 3-class solution); the BIC decline was more
clear-cut, and values in the 4-class (12601.8) and the 5-class
solution (12741.6) were higher than in the 3-class solution
(12551.5). In the 3-class solution the entropy was .88, which
indicated a good classication of participants in the model.
This solution yields to a baseline class (LC1) with low
endorsement of most TEMPS-A items, including 103 participants (33.8%), and two classes with scores into the symptomatic
interval on both the cyclothymic and the dysthymic subscales of

33

the TEMPS-A: the LC2 includes 136 (44.7%) participants, while

the LC3 includes 65 (21.3%) participants.
Compared to the baseline class (LC1), the LC2 class had
higher scores on the dysthymic, cyclothymic, irritable, and
anxious TEMPS-A subscales, but not on the hyperthymic
subscale. The LC3 class had higher scores than the baseline
class on all TEMPS-A subscales. LC3 class also had higher scores
than the LC2 class on the dysthymic (Cliff's delta = 0.58; 95% CI:
0.39 to 0.72) and cyclothymic (0.93; 0.84 to 0.97) subscales, and
also, but at lower effect size, on the hyperthymic (0.34; 0.12 to
0.53), irritable (0.22; 0.03 to 0.39), and anxious (0.22; 0.01 to
0.41) subscales.
Overall, the LC3 class had the highest probability of
endorsement on all items, while the LC2 endorsement was
intermediate between the baseline class and the high endorsement class (Fig. 2).
There were no differences by gender. Younger people and
people scoring above the threshold for clinical case on the
GHQ-12 were more likely in both symptomatic classes (LC2 and
LC3) compared to the baseline class (LC1). CAQ involvement
but not CAQ achievement or the CAQ creative stereotype
scores associated with LC3 (Table 4).
4. Discussion
This study found students involved in courses leading to a
creative profession scoring higher than an age- and gendermatched control group on the TEMPS-A (a measure of affective
temperaments). TEMPS-A more than GHQ-12 (a measure of
current psychological distress used to screen clinically active
mental disorders) differentiated creative participants from
controls. As suggested by past literature, the cyclothymic
subscale of the TEMPS-A was specically related to a biographical
measure of creative achievement, the CAQ. As in past studies,
there was a relatively high endorsement rate on the hyperthymic
and anxious TEMPS-A items, since these items cover socially
desirable traits in the Italian population (Placidi et al., 1998;
Akiskal et al., 1998; Preti et al., 2010).
This study also provided the rst evidence that scores on
the TEMPS-A can be decomposed into clusters with a
different level of endorsement on the dimensions that dene
the bipolar spectrum, with a class endorsing on the
dysthymic, cyclothymic, and hyperthymic subscales dening
a putatively risk for bipolar disorder spectrum class. Indeed,

Table 3
Matrix of correlations between measures total sample (n = 304).
CAQ

TEMPS-A
Dysthymic
Cyclothymic
Hyperthymic
Irritable
Anxious
GHQ-12

TEMPS-A

Involvement

Achievement

Stereotype

Dysthymic

Cyclothymic

Hyperthymic

Irritable

Anxious

.029
.251
.313
.161

.029
.207
.272

.051
.179
.253
.128
.071
.076

.515
.076
.307
.276
.323

.229
.455
.331
.406

.256
.080
.016

.207
.211

.152

.044
.141

.116
.058
.090

CAQ = The Creative Achievement Questionnaire.

GHQ-12 = The 12-item General Health Questionnaire.
TEMPS-A = The Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire.
Spearman's rho p b .01.
Spearman's rho p b .0001.

34

M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

Fig. 2. Prole plot for the latent class analysis of the TEMPS-A (39 items). The Y-axis represents the class-specic mean scores as proportions of the maximum score
for the indicator concerned. The X-axis contains the 39-item prole of the TEMPS-A.

indicative of a predisposition to mood and anxiety disorders

outside the bipolar spectrum.
Scores on the GHQ-12 were statistically higher in the LC2
and the LC3 than the baseline LC1 class, providing validity to
the retrieved solution.
Sample size precluded the further differentiation of a risk
for bipolar disorder spectrum class into a predominantly
major depression class and a truly bipolar disorder class. A
four-class solution was discarded because it did not t well on

the LC3 includes people with positive endorsement on most

TEMPS-A items, and scores on this class were close to those
observed in past studies with TEMPS-A applied in clinical
samples (Akiskal et al., 2005a,b, 2006). However, since the
study did not include a clinical group, we cannot better
establish the exact correspondence of this class to the bipolar
spectrum, nor can we ascertain the clinical nature of the
intermediate LC2 class, whether it is still within the bipolar
spectrum, albeit in an attenuated form, or denes a prole

Table 4
Distribution of TEMPS-A and measures of creativity and psychopathology in the 3-class solution.
All data: n (%)
or mean (SD)
Sex
Males, n (%)
Females, n (%)
Age
GHQ-12
CAQ
Involvements
Achievements
Stereotype
TEMPS-A
Dysthymic

LC1

LC2

LC3

n = 103

n = 136

n = 65

59 (57%)
44 (43%)
1
25.5 (3.8)
1
1.9 (2.5)
1

56 (41%)
80 (59%)
OR = 0.57 (0.321.00)
24.4 (3.9)
OR = 0.91 (0.850.98)
4.1 (3.2)
OR = 1.33 (1.191.48)

27 (41%)
38 (59%)
OR = 0.60 (0.291.23)
23.3 (3.6)
OR = 0.83 (0.760.92)
5.0 (3.1)
OR = 1.45 (1.271.64)

2.5 (2.0)
1
5.0 (5.2)
1
0.6 (0.7)
1

2.8 (1.7)
OR = 1.06 (0.921.33)
4.7 (3.8)
OR = 0.94 (0.871.02)
0.7 (0.7)
OR = 1.33 (0.842.09)

3.7 (2.0)
OR = 1.37 (1.101.71)
6.4 (4.8)
OR = 0.99 (0.901.08)
0.8 (0.6)
OR = 1.17 (0.672.05)

0.6 (1.0)

1.8 (1.5)
Cliff'd = 0.51 (0.370.62)
4.7 (1.6)
Cliff'd = 0.87 (0.760.93)
2.7 (1.8)
Cliff' d = 0.01 ( 0.140.16)
1.6 (1.4)
Cliff'd = 0.64 (0.520.74)
1.4 (1.1)
Cliff'd = 0.40 (0.260.53)

3.7 (1.8)
Cliff'd = 0.87 (0.800.93)
8.7 (1.6)
Cliff'd = 0.99 (0.961.00)
3.7 (1.7)
Cliff'd = 0.34 (0.140.52)
2.3 (1.8)
Cliff'd = 0.73 (0.620.81)
1.8 (1.0)
Cliff'd = 0.61 (0.470.73)

Cyclothymic

1.4 (1.2)

Hyperthymic

2.6 (1.8)

Irritable

0.2 (0.5)

Anxious

0.7 (0.7)

Latent Class I, corresponding to the baseline class with low endorsing of TEMPS-A items was used as a referent term.
Condence intervals not including unity indicate statistical signicance (p b 0.05). Signicant results in bold.

M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

the BIC, but in this solution a class with high endorsement on

the dysthymic and the anxious items and a moderate to low
endorsement on the cyclothymic and hyperthymic items was
found, distinct from a class with high endorsement on all
TEMPS-A items (the putatively bipolar disorder class), and
another class with moderate endorsement on most but not all
TEMPS-A items (a putatively risk for minor mood and anxiety
disorders class) (data available on request).
In our study, the results of a multinomial logistic regression
model indicated that greater involvement in creative activities
rather than being a creative achiever best differentiated those
into the risk for bipolar spectrum class from the other classes.
Enhanced involvement in pleasurable activities as creative
activities might be is a feature of both hypomania and mania.
Greater involvement in creative activities might lead to
increased productivity, but the dispersion of energies that this
implies might decrease overall chances of success. Indeed, past
studies found that creative achievement results from a
combination of originality, talent, and passion mixed with
sustained effort and persistence (Feist, 1998; Schuldberg, 2001).
A bipolar temperament might negatively affect creativity,
despite increasing involvement into creative activities. This
might explain why creative involvement rather than achievement differentiates the risk for bipolar spectrum class from
the other classes in this sample, a nding that is coherent with
past evidence indicating that hypomania rather than full mania
is associated to creativity, while more severe expressions of
symptoms may negatively inuence creative accomplishment
(Akiskal and Akiskal, 1988; Richards et al., 1988; Simeonova et
al., 2005). It should also be noted that the sample included
students, who had scarce opportunity to achieve full evidence
of creative success.
Creative students in this study were involved in the arts.
There is some evidence that the links between creativity and
psychopathology are conned to the arts and are less evident or
absent in the domain of sciences and technology (reviewed in
Akiskal and Akiskal, 2010; Simonton, 2009). Therefore our
ndings cannot be extended to people involved in science
before specic testing in the domain of scientic and technological creativity.
The main limitation of our study is the use of self-report
measures to evaluate both creative involvement and achievement and the risk of psychopathology. Both the GHQ-12 (Politi
et al., 1994) and the TEMPS-A (Akiskal and Akiskal, 2005a)
were proved to be valid and reliable as far as the construct they
measure is concerned. This study also provided evidence that
the CAQ can differentiate students professionally involved in
creative activities from students who are pursuing a course
leading to a profession principally requiring the application of
rules, extending past ndings on its validity (Carson et al.,
2005). Therefore we are condent that the links we observed
are reproducible with adequate sample size. However, study
constraints (the need of recruiting a large sample) precluded
the use of a standardized interview to specically test the
presence of clinical diagnoses in this supposedly non-clinical
sample, nor did we expose participants to validated tests aimed
at measuring their creative potential, as in past studies
(Richards et al., 1988; Santosa et al., 2007). Moreover, GHQ
assesses only current (past 4 weeks) psychological distress and
therefore did not capture mood disorder patients who were
euthymic at the time of the study.

35

In conclusion, this study conrms that the cyclothymic

dimension of the bipolar spectrum is linked to creativity, and
this link is likely to result from increased involvement into
pleasurable activities, including creative ones. Whether greater
involvement in creative activities is a requisite to achieve
success in people with temperament within the bipolar
spectrum remains an open question. One possible mediating
variable worth pursuing that might underlie success among
cyclothymic artists is obsessivecompulsive traits (Akiskal et
al., 2005a,b).
Role of funding source
Research was supported by internal funds only.
Conict of interest
Authors declare that to the best of their knowledge they have no conicts
of interest to declare concerning the results of this study.

References
Akaike, H., 1987. Factor analysis and AIC. Psychometrika 52, 317332.
Akiskal, H.S., 1981. Subaffective disorders: dysthymic, cyclothymic, and
bipolar II disorders in the borderline realm. Psychiatr. Clin. North Am.
4, 2546.
Akiskal, H.S., 1983. The bipolar spectrum: new concepts in classication and
diagnosis. In: Grinspoon, L. (Ed.), Psychiatry Update: The American
Psychiatric Association Annual Review, 2. American Psychiatric Press,
Washington, DC, pp. 271292.
Akiskal, H.S., Akiskal, K., 1988. Reassessing the prevalence of bipolar
disorders: clinical signicance and artistic creativity. Psychiatr. Psychobiol. 3, 2936.
Akiskal, H.S., Akiskal, K.K., 2005a. Special issue: TEMPS: Temperament
Evaluation of Memphis, Pisa, Paris and San Diego. J. Affect. Disord. 85,
1242.
Akiskal, K.K., Akiskal, H.S., 2005b. The theoretical underpinnings of affective
temperaments: implications for evolutionary foundations of bipolar
disorder and human nature. J. Affect. Disord. 85, 231239.
Akiskal, H.S., Akiskal, K.K., 2007. In search of Aristotle: temperament, human
nature, melancholia, creativity, and eminence. J. Affect. Disord. 100, 16.
Akiskal, H.S., Akiskal, K.K., 2010. Bipolar Disorder: The GeniusInsanity
Debate: Focus on Bipolarity, Temperament, Creativity, and Leadership.
Wiley-Blackwell, Singapore, pp. 8389.
Akiskal, H.S., Djenderedjian, A.M., Rosenthal, R.H., Khani, M.K., 1977.
Cyclothymic disorder, validating criteria for inclusion in the bipolar
affective group. Am. J. Psychiatry 134, 12271233.
Akiskal, H.S., Placidi, G.F., Maremmani, I., Signoretta, S., Liguori, A., Gervasi, R.,
Mallya, G., 1998. TEMPS-I: delineating the most discriminant traits of the
cyclothymic, depressive, hyperthymic and irritable temperaments in a
nonpatient population. J. Affect. Disord. 51, 719.
Akiskal, H.S., Mendlowicz, M.V., Jean-Louis, G., Rapaport, M.H., Kelsoe, J.R.,
Gillin, J.C., Smith, T.L., 2005a. TEMPS-A: validation of a short version of a
self-rated instrument designed to measure variations in temperament.
J. Affect. Disord. 85, 4552.
Akiskal, K.K., Savino, M., Akiskal, H.S., 2005b. Temperament proles in
physicians, lawyers, managers, industrialists, architects, journalists, and
artists: a study in psychiatric outpatients. J. Affect. Disord. 85, 201206.
Akiskal, H.S., Kilzieh, N., Maser, J.D., Clayton, P.J., Schettler, P.J., Traci Shea, M.,
Endicott, J., Scheftner, W., Hirschfeld, R.M., Keller, M.B., 2006. The distinct
temperament proles of bipolar I, bipolar II and unipolar patients.
J. Affect. Disord. 92, 1933.
Andreasen, N.C., 1987. Creativity and mental illness: prevalence rates in
writers and their rst-degree relatives. Am. J. Psychiatry 144,
12881292.
Andreasen, N.C., 2008. The relationship between creativity and mood
disorders. Dialogues Clin. Neurosci. 10, 251255.
Andreasen, N.C., Glick, I.D., 1988. Bipolar affective disorder and creativity:
implications and clinical management. Compr. Psychiatry 29, 207217.
Barron, F., 1963. BarronWelsh Art Scale, A Portion of the Welsh Figure
Preference Test. Consulting Psychologists Press, Palo Alto, CA.
Baas, M., De Dreu, C.K.W., Nijstad, B.A., 2008. A meta-analysis of 25 years of
mood-creativity research: hedonic tone, activation, or regulatory focus?
Psychol. Bull. 134, 779806.
Bland, J.M., Altman, D.G., 1997. Statistics notes: Cronbach's alpha. Br. Med. J.
314, 572.

36

M. Vellante et al. / Journal of Affective Disorders 135 (2011) 2836

Carson, S.H., Peterson, J.B., Higgins, D.M., 2005. Reliability, validity, and factor
structure of the creative achievement questionnaire. Creativity Res. J. 17,
3750.
Cliff, N., 1993. Dominance statistics: ordinal analyses to answer ordinal
questions. Psychol. Bull. 114, 494509.
Costa Jr., P.T., McCrae, R.R., 1985. The NEO Personality Inventory Manual.
Psychological Assessment Resources, Odessa, FL.
Davis, M.A., 2009. Understanding the relationship between mood and
creativity: a meta-analysis. Organ. Behav. Hum. Decis. Process. 108,
2538.
Faul, F., Erdfelder, E., Lang, A.G., Buchner, A., 2007. G*Power 3: a exible
statistical power analysis program for the social, behavioral, and biomedical
sciences. Behav. Res. Methods 39, 175191.
Feist, G.J., 1998. A meta-analysis of personality in scientic and artistic
creativity. Pers. Soc. Psychol. Rev. 2, 290309.
Figueira, M.L., Caeiro, L., Ferro, A., Cordeiro, R., Duarte, P.M., Akiskal, H.S., Akiskal,
K.K., 2010. Temperament in Portuguese university students as measured by
TEMPS-A: implications for professional choice. J. Affect. Disord. 123, 3035.
Furnham, A., Batey, M., Anand, K., Maneld, J., 2008. Personality, hypomania,
intelligence and creativity. Pers. Individ. Dif. 44, 10601069.
Gelade, G.A., 1997. Creativity in conict: the personality of the commercial
creative. J. Genet. Psychol. 158, 6778.
Goldberg, D.P., 1972. The Detection of Psychiatric Illness by Questionnaire.
Oxford University Press, London.
Gonda, X., Juhasz, G., Laszik, A., Rihmer, Z., Bagdy, Gy., 2005. Subthreshold
depression is linked to functional polymorphism of the 5HT transporter
gene. J. Affect. Disord. 87, 291297.
Gonda, X., Fountoulakis, K.N., Rihmer, Z., Lazary, J., Laszik, A., Akiskal, K.K.,
Akiskal, H.S., Bagdy, G., 2009. Towards a genetically validated new affective
temperament scale: a delineation of the temperament phenotype of
5-HTTLPR using the TEMPS-A. J. Affect. Disord. 112, 1929.
Guastello, S.J., Guastello, D.D., Hanson, C.A., 2004. Creativity, mood disorders,
and emotional intelligence. J. Creative Behav. 38, 260281.
Guttman, L., 1945. A basis for analyzing testretest reliability. Psychometrika
10, 255282.
Jamison, K.R., 1989. Mood disorders and patterns of creativity in British
writers and artists. Psychiatry 52, 125134.
Jamison, K.R., 1993. Touched With Fire: ManicDepressive Illness and the
Creative Temperament. The Free Press, New York.
Johnson, S.L., Eisner, L.R., Carver, C.S., 2009. Elevated expectancies among
persons diagnosed with bipolar disorder. Br. J. Clin. Psychol. 48, 217222.
Juda, A., 1949. The relationship between highest mental capacity and psychic
abnormalities. Am. J. Psychiatry 106, 296307.
Kretschmer, E., 1931. Psychiatry of Men of Genius. Translated by Cattell, R.B.
London, Kegan, Paul, Trench, Trubner.
Lazarsfeld, P., Henry, N., 1968. Latent Structure Analysis. Houghton Mifin,
New York.
Lehmann, E.L., 1975. Nonparametrics. Statistical Methods Based on Ranks.
Holden-Day, San Francisco.
Lo, N., Mendell, N.R., Rubin, D.B., 2001. Testing the number of components in
a normal mixture. Biometrika 88, 767778.
Ludwig, A.M., 1992. Creative achievement and psychopathology: comparison
among professions. Am. J. Psychother. 46, 330356.
McCutcheon, A.L., 1987. Latent Class Analysis. Sage Publications, Beverly Hills (CA).
Murray, G., Johnson, S.L., 2010. The clinical signicance of creativity in bipolar
disorder. Clin. Psychol. Rev. 30, 721732.
Murray, G., Goldstone, E., Cunningham, E., 2007. Personality and the
predisposition(s) to bipolar disorder: heuristic benets of a twodimensional model. Bipolar Disord. 9, 453461.
Muthn, L., Muthn, B.O., 2004. Mplus: The Comprehensive Modelling
Program for Applied Researchers - User's Guide. Muthn & Muthn, Los
Angeles, CA.
Myers, I.B., McCaulley, M.H., 1985. Manual: A Guide to the Development and
Use of the MyersBriggs Type Indicator. Consulting Psychologists Press,
Palo Alto, CA.

Nowakowska, C., Strong, C.M., Santosa, C.M., Wang, P.W., Ketter, T.A., 2005.
Temperamental commonalities and differences in euthymic mood
disorder patients, creative controls, and healthy controls. J. Affect.
Disord. 85, 207215.
Nunnally, J.C., 1978. Psychometric Theory, 2nd ed. New York, McGraw-Hill.
Placidi, G.F., Maremmani, I., Signoretta, S., Liguori, A., Akiskal, H.S., 1998. A
prospective study of stability and change over 2 years of affective
temperaments in 1418 year old Italian high school students. J. Affect.
Disord. 51, 199208.
Politi, P.L., Piccinelli, M., Wilkinson, G., 1994. Reliability, validity and factor
structure of the 12-item General Health Questionnaire among young
males in Italy. Acta Psychiatr. Scand. 90, 432437.
Post, F., 1994. Creativity and psychopathology. A study of 291 world-famous
men. Br. J. Psychiatry 165, 2234.
Preti, A., Miotto, P., 1997. Creativity, evolution and mental illnesses. J. Memet.
Evol. Model. Inf. Transm. 1 Available at: http://cfpm.org/jom-emit/1997/
vol1/preti_a&miotto_p.html.
Preti, A., Vellante, M., Zucca, G., Tondo, L., Akiskal, K., Akiskal, H., 2010. The
Italian version of the validated short TEMPS-A: the temperament
evaluation of Memphis, Pisa, Paris and San Diego. J. Affect. Disord. 120,
207212.
Richards, R., Kinney, D.K., Lunde, I., Benet, M., Merzel, A.P.C., 1988. Creativity
in manicdepressives, cyclothymes, their normal relatives and control
subjects. J. Abnorm. Psychol. 97, 281288.
Santosa, C.M., Strong, C.M., Nowakowska, C., Wang, P.W., Rennicke, C.M.,
Ketter, T.A., 2007. Enhanced creativity in bipolar disorder patients: a
controlled study. J. Affect. Disord. 100, 3139.
Sass, L.A., 2001. Schizophrenia, modernism, and the creative imagination:
On creativity and psychopathology. Creativity Res. J. 13, 5574.
Schou, M., 1979. Artistic productivity and lithium prophylaxis in manic
depressive illness. Br. J. Psychiatry 135, 97103.
Schuldberg, D., 2001. Creativity and psychopathology: categories, dimensions, and dynamics. Creativity Res. J. 13, 105110.
Schwarz, G., 1978. Estimating the dimension of a model. Ann. Stat. 6,
461464.
Sclove, S.L., 1987. Application of model-selection criteria to some problems in
multivariate analysis. Psychometrika 52, 333343.
Sijtsma, K., 2009. On the use, the misuse, and the very limited usefulness of
Cronbach's alpha. Psychometrika 74, 107120.
Simeonova, D.I., Chang, K.D., Strong, C., Ketter, T.A., 2005. Creativity in
familial bipolar disorder. J. Psychiatr. Res. 39 (6), 623631.
Simonton, D.K., 2009. Varieties of (scientic) creativity: a hierarchical model
of domain-specic disposition, development, and achievement. Persp.
Psychol. Sci. 4, 441452.
Srivastava, S., Ketter, T.A., 2010. The link between bipolar disorders and
creativity: evidence from personality and temperament studies. Curr.
Psychiatry Rep. 12, 522530.
Srivastava, S., Childers, M.E., Baek, J.H., Strong, C.M., Hill, S.J., Warsett, K.S.,
Wang, P.W., Akiskal, H.S., Akiskal, K.K., Ketter, T.A., 2010. Toward
interaction of affective and cognitive contributors to creativity in bipolar
disorders: a controlled study. J. Affect. Disord. 125, 2734.
Strong, C.M., Nowakowska, C., Santosa, C.M., Wang, P.W., Kraemer, H.C.,
Ketter, T.A., 2007. Temperamentcreativity relationships in mood
disorder patients, healthy controls and highly creative individuals.
J. Affect. Disord. 100, 4148.
Torrance, E.P., 1990. Torrance Tests of Creative Thinking. Scholastic Testing
Service, Bensenville, IL.
Tremblay, C.H., Grosskopf, S., Yang, K., 2010. Brainstorm: occupational
choice, bipolar illness and creativity. Econ. Hum. Biol. 8, 233241.
WHO (World Health Organization), 1992. Tenth Revision of the International
Classication of Diseases and Related Health Problems (ICD10). WHO
Press, Geneve.
Wingo, A.P., Wingo, T.S., Harvey, P.D., Baldessarini, R.J., 2009. Effects of
lithium on cognitive performance: a meta-analysis. J. Clin. Psychiatry 70,
15881597.