Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Is bipolar disorder more common in highly intelligent people? A cohort study of a million men


Anecdotal and biographical reports have long suggested that bipolar disorder is more common in people with exceptional cognitive or creative ability. Epidemiological evidence for such a link is sparse. We investigated the relationship between intelligence and subsequent risk of hospitalisation for bipolar disorder in a prospective cohort study of 1 049 607 Swedish men. Intelligence was measured on conscription for military service at a mean age of 18.3 years and data on psychiatric hospital admissions over a mean follow-up period of 22.6 years was obtained from national records. Risk of hospitalisation with any form of bipolar disorder fell in a stepwise manner as intelligence increased (P for linear trend <0.0001). However, when we restricted analyses to men with no psychiatric comorbidity, there was a ‘reversed-J’ shaped association: men with the lowest intelligence had the greatest risk of being admitted with pure bipolar disorder, but risk was also elevated among men with the highest intelligence (P for quadratic trend=0.03), primarily in those with the highest verbal (P for quadratic trend=0.009) or technical ability (P for quadratic trend <0.0001). At least in men, high intelligence may indeed be a risk factor for bipolar disorder, but only in the minority of cases who have the disorder in a pure form with no psychiatric comorbidity.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2
Figure 3


  1. Jamison KR . Manic-depressive illness and creativity. Sci Am 1995; 272: 62–67.

    Article  CAS  PubMed  Google Scholar 

  2. Nettle D . Strong Imagination: Madness, Creativity and Human Nature. Oxford University Press : Oxford, 2001.

    Google Scholar 

  3. Koenen KC, Moffitt TE, Roberts AL, Martin LT, Kubzansky L, Harrington H et al. Childhood IQ and adult mental disorders: a test of the cognitive reserve hypothesis. Am J Psychiatry 2009; 166: 50–57.

    Article  PubMed  Google Scholar 

  4. MacCabe JH, Lambe MP, Cnattingius S, Sham PC, David AS, Reichenberg A et al. Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study. Br J Psychiatry 2010; 196: 109–115.

    Article  PubMed  Google Scholar 

  5. Zammit S, Allebeck P, David AS, Dalman C, Hemmingsson T, Lundberg I et al. A longitudinal study of premorbid IQ Score and risk of developing schizophrenia, bipolar disorder, severe depression, and other nonaffective psychoses. Arch Gen Psychiatry 2004; 61: 354–360.

    Article  PubMed  Google Scholar 

  6. Gale CR, Deary IJ, Boyle SH, Barefoot J, Mortensen LH, Batty GD . Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age: the vietnam experience study. Arch Gen Psychiatry 2008; 65: 1410–1418.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gale CR, Batty GD, Tynelius P, Deary IJ, Rasmussen F . Intelligence in early adulthood and subsequent hospitalization for mental disorders. Epidemiology 2010; 21: 70–77.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gunnell D, Magnusson PK, Rasmussen F . Low intelligence test scores in 18 year old men and risk of suicide: cohort study. BMJ 2005; 330: 167.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Carlstedt B, Mardberg B . Construct-validity of the swedish enlistment battery. Scand J Psychol 1993; 34: 353–362.

    Article  Google Scholar 

  10. Carlstedt B . Cognitive abilities - aspects of structure, process and measurement University of Gothenburg: Gothenburg, 2000.

  11. Epidemiologiskt Centrum S. Patientregistret. Utskrivningar från sluten vård 1964–2005. Kvalitet och innehåll. Socialstyrelsen: Stockholm, 2006.

  12. Sellgren C, Landen M, Lichtenstein P, Hultman CM, Langstrom N . Validity of bipolar disorder hospital discharge diagnoses: file review and multiple register linkage in Sweden. Acta Psychiatr Scand 2011; 124: 447–453.

    Article  CAS  PubMed  Google Scholar 

  13. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C et al. External review and validation of the Swedish national inpatient register. BMC Public Health 2011; 11: 450.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ekholm B, Ekholm A, Adolfsson R, Vares M, Osby U, Sedvall GC et al. Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses. Nord J Psychiatry 2005; 59: 457–464.

    Article  PubMed  Google Scholar 

  15. Dalman C, Broms J, Cullberg J, Allebeck P . Young cases of schizophrenia identified in a national inpatient register--are the diagnoses valid? Soc Psychiatry Psychiatr Epidemiol 2002; 37: 527–531.

    Article  PubMed  Google Scholar 

  16. Glahn DC, Almasy L, Barguil M, Hare E, Peralta JM, Kent JW et al. Neurocognitive endophenotypes for bipolar disorder identified in multiplex multigenerational families. Arch Gen Psychiatry 2010; 67: 168–177.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pepe MS, Janes H, Longton G, Leisenring W, Newcomb P. Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. Am J Epidemiol 2004; 159: 882–890.

    Article  PubMed  Google Scholar 

Download references


This work was conducted in The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology which is supported by the Biotechnology and Biological Sciences Research Council, the Economic and Social Research Council, the Engineering and Physical Sciences Research Council and the Medical Research Council, as part of the Lifelong Health and Wellbeing Initiative (G0700704/84698). David Batty is a UK Wellcome Trust Fellow. Finn Rasmussen is supported by the Swedish Council for Working Life and Social Research. The study sponsors had no role in the study design, the collection of data, or in the preparation of this manuscript.

Author information

Authors and Affiliations


Corresponding authors

Correspondence to C R Gale or F Rasmussen.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Molecular Psychiatry website

Supplementary information

PowerPoint slides

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Gale, C., Batty, G., McIntosh, A. et al. Is bipolar disorder more common in highly intelligent people? A cohort study of a million men. Mol Psychiatry 18, 190–194 (2013).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • bipolar disorder
  • cognitive ability
  • comorbidity
  • intelligence

This article is cited by


Quick links