Personality Traits Influence Bipolar Screening Tool

Certain patient personality traits may influence hypomania checklist-32 (HCL-32) scores when screening patients for bipolar disorder (BD), with elevated scores for typical extraversion and neuroticism.

In a retrospective cross-sectional study involving 168 patients with BD and major depressive disorder (MDD), the researchers sought to evaluate the impact of personality traits on the performance of HCL-32 screening by utilizing the Eysenck Personality Questionnaire (EPQ) and HCL-32. The relationships between demographic data, diagnosis, and clinical rating scales were also examined. The significance of the study was to improve the early clinical recognition of BD and to diminish the rates of misdiagnosis of MDD.

The results revealed that diagnosis was not associated with extraversion but was related to neuroticism. Greater HCL-32 scores were noted in typical extraverted patients compared with atypical extraverted patients. The best cutoff value for BD recognition was 15 for typical extraversion groups and 12.5 for atypical extraversion groups.

HCL-32 scores of typical neuroticism were higher than the atypical type in patients with MDD, but there was no variation in patients with BD. There was no difference in HCL-32 scores between patients with MDD and BD in patients with typical neuroticism. However, among atypical neurotic patients, the HCL-32 scores of patients with BD were higher compared with patients with MDD. The cutoff value was 14.5.

The authors wrote, “To the best of our knowledge, this is the first research to explore the interaction of personality traits via EPQ scale and HCL-32 scores and quantify the results to provide clinicians with specific reference values to distinguish between BD and MDD.”

They also noted that the results demonstrated that HCL-32 needs to be combined with the evaluation of patients’ personality traits and could provide clinicians with practical reference indicators of the HCL-32 scale.

“Clinicians should also consider the patients’ personality traits when referring to HCL-32 scores, so as to increase the recognition rate of BD and eliminate false positives as much as possible,” concluded the authors.


—Yvette C. Terrie, BSPharm, RPh



Wang Q, Sui A, Gong L, et al. Personality traits influence the effectiveness of hypomania checklist-32 in screening for bipolar disorder. Front Psychiatry. 2022;13:919305. doi:10.3389/fpsyt.2022.919305