Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jun 19, 2021; 11(6): 242-252
Published online Jun 19, 2021. doi: 10.5498/wjp.v11.i6.242
Psychological predictors of bipolarity in panic disorder
Da Hye Oh, Doo-Heum Park, Seung-Ho Ryu, Jee Hyun Ha, Hong Jun Jeon
Da Hye Oh, Doo-Heum Park, Seung-Ho Ryu, Jee Hyun Ha, Hong Jun Jeon, Department of Psychiatry, Konkuk University Medical Center, Seoul 05030, South Korea
Doo-Heum Park, Seung-Ho Ryu, Jee Hyun Ha, Hong Jun Jeon, Department of Psychiatry, Konkuk University School of Medicine, Seoul 05029, South Korea
Author contributions: Jeon HJ conceptualized this study; Jeon HJ, Park DH, Ryu SH and Ha JH collected and interpreted the data; Oh DH conducted statistical analysis and wrote the original draft; Jeon HJ revised the manuscript; all authors reviewed and approved the final article.
Institutional review board statement: This study was approved by the Institutional Review Board of Konkuk University Hospital (IRB number: KUMC 2021-01-028).
Informed consent statement: Written informed consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: The authors have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hong Jun Jeon, MD, Assistant Professor, Department of Psychiatry, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, South Korea.
Received: February 24, 2021
Peer-review started: February 24, 2021
First decision: April 21, 2021
Revised: May 6, 2021
Accepted: May 24, 2021
Article in press: May 24, 2021
Published online: June 19, 2021

Panic disorders frequently occur with affective disorders, particularly bipolar disorder. Patients with panic disorder and bipolar disorder are more likely to present with severe symptoms, such as high rates of suicidal behavior, poor symptomatic and functional recovery, and poor drug responses.


To investigate the psychological characteristics of panic disorder patients related to bipolarity.


A total of 254 patients (136 men and 118 women, mean age = 33.48 ± 3.2 years) who were diagnosed with panic disorder were included in the study. Panic disorder with bipolarity (BP+) was defined as a score of ≥ 7 on the Korean version of the Mood Disorder Questionnaire (K-MDQ), and a score lower than 7 was considered as a panic disorder without bipolarity (BP-). Self-report questionnaires were analyzed to examine their association with bipolarity. Psychological tests used in the study were the Mood Disorder Questionnaire (MDQ), Panic Disorder Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory (STAI), Temperament and Character Inventory (TCI), and Minnesota Multiphasic Personality Inventory (MMPI). Statistical analyses were performed to evaluate the correlation between bipolarity of panic disorder patients and various psychological test results indicative of psychological characteristics.


Patients with a K-MDQ score of 7 or more were considered to have a history of manic or hypomanic episodes (BP+ group, n = 128), while patients with K-MDQ scores below 7 were defined as those without bipolarity (BP- group, n = 126). The BP+ group were more likely to be unmarried (single 56.2% vs 44.4%, P = 0.008) and younger (30.78 ± 0.59 vs 37.11 ± 3.21, P < 0.001). Additionally, the BP+ group had significantly higher scores on psychological assessment scales, such as the hypochondriasis, psychopathic deviate, masculinity-femininity, psychasthenia, schizophrenia, and hypomania (Ma) in MMPI, and novelty seeking, harm avoidance and self-transcendence in TCI, and STAI (state and trait) compared to the BP- group. In logistic regression analysis, depression in MMPI, self-directedness in TCI, and age were negatively associated with MDQ score, meanwhile, Ma in MMPI and STAI (trait) were positively associated with MDQ score.


The result of this study suggests that almost 50% of patients with panic disorder are likely to have hypomanic or manic symptoms, and certain psychological factors are associated bipolarity in panic disorder.

Keywords: Panic disorder, Bipolar disorder, Bipolarity, Anxiety, Minnesota Multiphasic Personality Inventory, Temperament and Character Inventory

Core Tip: The close relationship between panic disorder and bipolar disorder has been suggested in the literature. In this study, we showed that panic disorder patients with high anxiety trait were more likely to have bipolar symptoms. Moreover, low self-directedness scores on the Temperament and Character Inventory and high scores on the hypomanic clinical scale in Minnesota Multiphasic Personality Inventory were also associated with bipolarity in patients with panic disorder. We suggest that certain psychological characteristics may help clinician to make a tailored treatment strategy for panic disorder.