Heritability of bipolar spectrum disorders. Unity or heterogeneity?

BACKGROUND: The purpose of this study was to investigate whether the three disorders in the bipolar spectrum, Bipolar I disorder, Bipolar II disorder and Cyclothymia, are various expressions of an underlying genetic commonality.

METHOD: A sample consisting of same-sexed mono (MZ)- and dizygotic (DZ) twins were identified using hospital and outpatient registers (N=303). DSM-III-R criteria were assessed by personal interviews. Cross tabulations were used to compare concordance rates for different definitions of the bipolar spectrum. Correlations in liability and estimation of the heritability (h) with biometrical model fitting were performed.

RESULTS: Concordance rates were higher among MZ- than DZ pairs for all the single diagnoses and main combinations of diagnoses. Cross-concordance between different diagnoses was observed. The heritability of Bipolar I was .73, of Bipolar I+II .77 and of Bipolar I+II+Cyclothymia .71.

LIMITATION: Probands were not sampled from the general population. Most often the same person interviewed both twins in a pair. The statistical power was restricted in some sub-analyses.

CONCLUSION: The 'Bipolar Spectrum' category consisting of Bipolar I disorder, Bipolar II disorder and Cyclothymia constitute one entity with high heritability without detectable shared family environmental effects. Future genetic and clinical work might consider that all variants of the bipolar spectrum are an expression of one underlying genetic liability.