General Behavior Inventory (GBI)

1. Abstract

The General Behavior Inventory (GBI), originally developed by Richard A. Depue and colleagues in 1981, represents one of the most rigorously evaluated psychometric instruments designed to identify the presence, frequency, and severity of affective symptomatology across the bipolar spectrum and unipolar depressive disorders. Developed within a behavioural high-risk paradigm, the GBI was engineered to identify individuals exhibiting subclinical or syndromal manifestations of cyclothymia, bipolar II disorder, bipolar I disorder, and major depressive disorder. In its classical adult self-report format, the instrument comprises 73 items scored on a 4-point Likert-type scale ranging from 0 (“never or hardly ever”) to 3 (“very often or almost constantly”), evaluating chronic and episodic behavioural manifestations over the preceding year. The inventory is divided into two primary overarching subscales: a 45-item Depression scale and a 28-item Hypomanic/Biphasic scale, the latter capturing hypomanic activation as well as rapid cyclic mood alternation. Items can be scored using continuous dimensional summation or a categorical, dichotomous “case-scoring” threshold model (where responses of 2 or 3 are scored as 1, indicating clinically salient symptom manifestation). Extensive psychometric validation has confirmed excellent internal consistency, with Cronbach’s alpha values consistently exceeding .90 to .95 across diverse clinical and nonclinical samples, robust 15-week test-retest reliability ($r = .73$), and superior discriminant validity in differentiating bipolar spectrum conditions from unipolar depression, attention-deficit/hyperactivity disorder (ADHD), and disruptive behaviour disorders. Subsequent developments have introduced validated parent-report versions (P-GBI) and empirically abbreviated screeners, such as the 14-item 7 Up 7 Down Inventory, demonstrating the tool’s enduring clinical and empirical utility.

2. Keywords

General Behavior Inventory, GBI, bipolar disorder, cyclothymia, hypomania, unipolar depression, mood disorders, behavioral activation system, psychometrics, psychiatric assessment, affective lability, high-risk paradigm

3. Authors

The General Behavior Inventory was formulated and psychometrically established by a distinguished team of clinical psychologists and behavioural neuroscientists led by Richard A. Depue, Ph.D., Professor Emeritus of Human Development and Psychology at Cornell University. Depue’s pioneering research integrated neurobiology, neurochemistry (specifically central dopaminergic functioning), and behavioural observation to map the biological vulnerability underpinnings of affective illness.

The original seminal 1981 validation was co-authored by:

• John F. Slater, Ph.D. — Department of Psychology, University of Minnesota.
• Hanna Wolfstetter-Kausch, Ph.D. — Department of Psychology, University of Minnesota.
• Daniel N. Klein, Ph.D. — Stony Brook University, widely recognised for his longitudinal contributions to chronic depressive conditions and affective psychopathology.
• Eric Goplerud, Ph.D. — George Mason University, focusing on clinical evaluation and substance abuse services.
• David A. Farr, Ph.D. — University of Minnesota.

Subsequent psychometric expansions, clinical adaptations, child and adolescent parent-report formats, and short-form derivations have been led extensively by Eric A. Youngstrom, Ph.D., Professor of Psychology and Neuroscience and Psychiatry at the University of North Carolina at Chapel Hill, in collaboration with prominent child and adolescent psychiatrists such as Robert L. Findling, M.D., M.B.A. (Stony Brook University / Johns Hopkins University) and Joseph R. Calabrese, M.D. (Case Western Reserve University).

4. Purpose

The primary purpose of the General Behavior Inventory is the operationalised, dimensional identification of individuals exhibiting behavioural manifestations characteristic of the bipolar spectrum, cyclothymia, and unipolar affective illness. Developed in an era when psychiatric taxonomy relied almost exclusively on cross-sectional categorical criteria that frequently obscured sub-syndromal and temperamental variations, the GBI was engineered within a “behavioural high-risk paradigm.” The conceptual rationale posited that genetic vulnerability to bipolar disorder is expressed continuously in the population through sub-affective, cyclothymic, and chronic dysregulatory traits. The GBI was designed to capture this lifelong phenotypic vulnerability prior to, during, and between full-blown acute syndromal episodes.

In clinical practice, the GBI serves several pivotal functions:

• Differential Diagnosis between Unipolar and Bipolar Depression: A prominent challenge in clinical psychiatry involves distinguishing patients presenting with acute major depressive episodes who harbour an underlying bipolar diathesis from those with unipolar major depressive disorder. Misdiagnosing bipolar depression as unipolar depression frequently leads to inappropriate antidepressant monotherapy, precipitating phase acceleration, manic switches, or rapid cycling. The GBI provides a structured assessment of lifetime hypomanic, irritable, and biphasic lability, illuminating latent bipolarity in ostensibly depressed individuals.
• Differentiation from Disruptive and Neurodevelopmental Disorders: In child, adolescent, and young adult populations, mood lability, impulsivity, psychomotor agitation, and behavioural dysregulation often overlap phenomenologically with ADHD, oppositional defiant disorder (ODD), and conduct disorder. The GBI’s specific focus on biphasic shifts, episodic changes in energy, and biological vegetative shifts enables clinicians to parse mood-driven cyclical instability from chronic executive dysfunction or behavioural defiance.
• Longitudinal Assessment and High-Risk Research: In epidemiological and developmental psychopathology research, the GBI is employed to identify asymptomatic or sub-syndromal youth and emerging adults who stand at high genetic or temperamental risk for developing full bipolar I or II disorder. This enables the study of neurobiological markers, environmental stressors, and endophenotypes that predict conversion to formal psychiatric illness.
• Measurement of Treatment Response: While originally constructed as a trait-like screener spanning a 12-month window, modified versions of the GBI have been successfully deployed in psychopharmacological and psychotherapeutic clinical trials to track longitudinal reductions in chronic affective instability and symptom burden.

5. Psychological Construct

The GBI operationalises affective disorder pathology through a multi-dimensional framework that distinguishes between purely unipolar depressive manifestations and the dynamic, oscillating manifestations characteristic of bipolar spectrum liability. Affective illness is conceptualised not as static states of mood disturbance, but as regulatory impairments across behavioural activation, motoric energy, cognitive cadence, and vegetative biological rhythms.

1. Unipolar / Bipolar Depressive Dimension (45 Items)

The Depression subscale evaluates both core psychological and somatic-vegetative features of sustained low mood. Crucially, the GBI items assess not merely transitory sadness, but prolonged periods where energy, self-esteem, and psychomotor speed are chronically or episodically dampened without obvious environmental triggers. The construct comprises:

• Affective and Anhedonic Features: Persistent dysphoria, crying spells, anhedonia (loss of capacity to experience pleasure), feelings of profound emptiness, and pervasive guilt.
• Cognitive Damping: Slowed processing speed, indecisiveness, difficulty concentrating, feelings of intellectual inadequacy, and cognitive hopelessness.
• Psychomotor and Vegetative Symptoms: Pervasive lack of physical energy, chronic lethargy, heavy limb sensations, hypersomnia or insomnia, psychomotor retardation, and social withdrawal.

Representative Conceptual Item: “Have you become sad, depressed, or irritable for several days or more without really understanding why?”

2. Hypomanic / Biphasic Dimension (28 Items)

The hypomanic construct in the GBI is bifurcated into pure behavioural activation/euphoria and rapid mood oscillation (biphasic/lability). Depue and colleagues recognised that hypomanic states in non-clinical or community settings rarely present solely as classical, uninterrupted euphoria; rather, they are characterized by irritability, hyper-reactivity, racing ideation, and sudden shifts into exhaustion or dysphoria.

• Pure Hypomanic Activation: Episodes of uncharacteristic, sustained physical and mental energy, marked decreases in the subjective need for sleep without fatigue, heightened optimism bordering on grandiosity, increased goal-directed productivity, motoric restlessness, rapid speech, and impulsive behavioural engagement (e.g., reckless spending, uninhibited social behaviour).
• Biphasic and Cyclothymic Alternation: The rapid alternation between states of energetic enthusiasm and subsequent depressive dejection. This dimension captures the hallmark “switches” of cyclothymia—the experience of waking up full of vigor and ambition only to collapse hours or days later into irritable exhaustion, apathy, or despair.

Representative Conceptual Item: “Has your mood or energy shifted rapidly back and forth from happy to sad or high to low?”

6. Theoretical Framework

The General Behavior Inventory is rooted in the neurobehavioral theory of affective disorders formulated by Richard A. Depue, which integrates Reinforcement Sensitivity Theory, central neurochemistry, and Kraepelinian continuous psychopathology models.

The Behavioral Facilitation System (BFS)

At the core of Depue’s theoretical model is the Behavioral Facilitation System (BFS), conceptually equivalent to Jeffrey Gray’s Behavioral Approach System (BAS). The BFS is a neurobehavioral motivational system mediated primarily by ascending mesolimbic and mesocortical dopaminergic pathways originating in the ventral tegmental area and projecting to the nucleus accumbens, amygdala, and prefrontal cortex. The BFS is responsible for:

• Regulating active engagement with the environment in response to reward cues, incentives, and novel stimuli.
• Modulating locomotor activity, energetic arousal, exploratory behaviour, assertiveness, and anticipatory positive affect (e.g., excitement, hope, self-confidence).

Neurobehavioral Model of Bipolar Vulnerability

Depue and colleagues postulated that the core biological vulnerability to bipolar spectrum disorders consists of a genetically determined hypersensitivity, hyper-reactivity, and homeostatic instability of the BFS. In individuals predisposed to bipolar disorder, the BFS lacks regulatory equilibrium:

• BFS Hyperactivation: Exposure to reward incentives, success, social challenges, or circadian disruptions precipitates uncontrolled runaway BFS positive feedback, clinically manifesting as hypomania or mania (hyper-arousal, grandiosity, motoric hyperactivity, decreased sleep need, flight of ideas).
• BFS Collapse / Deactivation: Following hyperactivation, or in response to frustrative non-reward, loss, or chronic stress, the fragile system collapses into severe hypo-activation, producing the clinical picture of depression (anhedonia, psychomotor retardation, amotivation, energy depletion).
• Cyclothymic Lability: Cyclothymia represents the fundamental sub-affective phenotypic expression of an inherently unstable BFS that constantly oscillates around its homeostatic setpoint.

The Continuous Spectrum Paradigm

The GBI rejects strict Kraepelinian dichotomies that separate clinical disease from normal personality. Instead, drawing from Hagop Akiskal’s conceptualisation of the bipolar spectrum, the GBI assumes that affective temperament, sub-clinical cyclothymia, bipolar II disorder, and bipolar I disorder exist on a unified neurobiological continuum. The GBI was designed explicitly to measure the behavioural expressions of this underlying dimension, demonstrating that high GBI scorers exhibit the same neuroendocrine, electrophysiological, and familial aggregation markers as diagnosed bipolar probands.

7. Validity

The GBI has been subjected to exhaustive empirical evaluation across community, clinical, collegiate, and paediatric samples over more than four decades, yielding robust evidence for its construct, criterion, convergent, and discriminant validity.

Construct and Convergent Validity

In initial validation studies conducted across nonclinical collegiate cohorts and clinical psychiatric outpatients (Depue et al., 1981), individuals scoring above empirical thresholds on the GBI demonstrated substantial concordance with independent structured diagnostic interviews, including the Research Diagnostic Criteria (RDC) and subsequent DSM criteria. Convergent validity analyses demonstrate strong, statistically significant correlations between GBI Depression subscale scores and validated depressive inventories such as the Beck Depression Inventory (BDI; $r = .65$ to $.82$) and the Center for Epidemiologic Studies Depression Scale (CES-D). The Hypomanic/Biphasic subscale correlates strongly with measures of BAS sensitivity, affective intensity, and hypomanic personality traits (e.g., the Hypomanic Personality Scale, $r = .60$ to $.75$).

Discriminant Validity and Clinical Specificity

A primary psychometric strength of the GBI is its ability to differentiate clinically overlapping conditions:

• Bipolar vs. Unipolar Depression: In clinical studies by Depue and Klein (1988) and subsequent trials by Pendergast et al. (2014), the Hypomanic/Biphasic subscale reliably discriminated patients with bipolar I and bipolar II disorder from individuals with unipolar major depressive disorder. Unipolar depressed patients score highly on the Depression scale but obtain very low scores on the Hypomanic/Biphasic scale, whereas bipolar individuals show elevations across both dimensions.
• Paediatric Bipolar vs. ADHD and Disruptive Disorders: In youth psychiatric cohorts, Danielson et al. (2003) and Youngstrom et al. (2001, 2005) demonstrated that the GBI (specifically the parent-report format, P-GBI) successfully distinguishes paediatric bipolar disorder from ADHD, conduct disorder, and anxiety disorders. Receiver Operating Characteristic (ROC) analyses demonstrated Area Under the Curve (AUC) metrics frequently ranging between .82 and .92, indicating exceptional discriminative diagnostic performance.

Predictive and Longitudinal Validity

Longitudinal prospective investigations within the Longitudinal Investigation of Bipolar Spectrum (LIBS) project (Alloy, Abramson, Depue, et al.) confirmed that high scores on the GBI Hypomanic/Biphasic scale in non-clinical young adults prospectively predicted an elevated rate of first-onset major affective episodes, conversion to bipolar II disorder, and increased frequency of hospitalisations over multi-year follow-ups, establishing the instrument’s prognostic predictive validity.

Cross-Cultural and Demographic Invariance

While early exploratory work by Chmielewski et al. (1995) noted raw mean score differences across racial and ethnic groups (e.g., Caucasian participants reporting slightly lower symptom endorsement than minority cohorts), subsequent rigorous multi-group confirmatory factor analyses by Pendergast et al. (2015) in large Black and White young adult samples established structural and metric measurement invariance. This confirms that the underlying latent constructs of depression and hypomanic lability are measured equivalently across racial groups, allowing unbiased comparative and clinical assessment.

8. Reliability

The GBI displays consistently high indices of classical internal consistency and temporal test-retest stability across diverse study populations.

Internal Consistency

Across nonclinical young adults, psychiatric adult outpatients, and caregiver cohorts, the internal consistency of the GBI scales is consistently within the excellent range:

• Depression Subscale (45 items): Cronbach’s alpha ($lpha$) ranges from .93 to .97 across multiple independent investigations (Depue et al., 1981; Pendergast et al., 2014). The mean inter-item correlations typically fall between .25 and .38, indicating high item homogeneity without excessive, redundant collinearity.
• Hypomanic / Biphasic Subscale (28 items): Cronbach’s alpha ($lpha$) consistently yields values ranging from .90 to .95 (Depue et al., 1981; Youngstrom et al., 2001). McDonald’s omega ($\omega_t$ and $\omega_h$) coefficients evaluated in modern psychometric re-evaluations similarly confirm robust composite reliability exceeding .92.

Test-Retest Stability

Because the GBI was engineered to capture chronic vulnerability traits and longitudinal behavioural patterns rather than brief, transient state fluctuations, its temporal stability is substantial:

• In the original 5-study validation by Depue et al. (1981), retesting nonclinical participants over an extended 15-week interval yielded a test-retest reliability coefficient of $r = .73$ ($p < .001$).
• Shorter retest intervals (2 to 4 weeks) in nonclinical populations demonstrate test-retest coefficients exceeding $r = .80$ to $.86$.
• Informant/Parent versions (P-GBI) have demonstrated stability coefficients ranging from $r = .75$ to $.82$ over 1-to-3-month periods in stable paediatric cohorts.

Standard Error of Measurement (SEM)

Given the high reliability coefficients ($lpha > .93$), the Standard Error of Measurement (SEM) for both the Depression and Hypomanic scales is relatively small in relation to their scale lengths. For dimensional Likert sum scoring, the SEM for the Depression scale is approximately 4.5 to 5.2 points, while for the Hypomanic scale it is approximately 3.1 to 3.8 points. When applying the dichotomous case-scoring algorithm, the SEM is further constrained, providing narrow confidence intervals around individual patient diagnostic cutoffs.

9. Factor Analysis

The internal dimensionality of the GBI has been examined through both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), spanning adult self-report, parent-report, and brief clinical screener formats.

Original Exploratory Factor Structure

In the foundational work of Depue et al. (1981, 1987), factor analyses of the 73 items demonstrated a robust two-factor overarching structure:

1. Depression Factor: Accounting for the largest proportion of total variance, this factor is characterised by primary loadings (predominantly $> .45$) from items assessing despair, lethargy, psychomotor retardation, social isolation, and chronic self-reproach.
2. Hypomanic / Biphasic Factor: Characterised by loadings from items measuring hyper-activation, reduced sleep need, grandiosity, and intense mood alternation/lability. In some three-factor exploratory solutions, this dimension occasionally splits into a “Pure Hypomanic Activation” factor and a separate “Biphasic Lability / Mood Swings” factor; however, these two sub-dimensions correlate so strongly ($r > .70$) that clinical practice and psychometric conventions combine them into a single 28-item composite scale.

Confirmatory Factor Analysis (CFA) and Bifactor Models

Modern structural modeling studies (Pendergast et al., 2014, 2015) using robust weighted least squares estimators (WLSMV) on categorical item responses have tested competing structural models:

• Two-Factor Oblique Model: Specifies correlated latent Depression and Hypomanic/Biphasic factors. This model achieves strong fit indices in both clinical and community populations: Comparative Fit Index ($ ext{CFI}) > .94$, Tucker-Lewis Index ($ ext{TLI}) > .94$, and Root Mean Square Error of Approximation ($ ext{RMSEA}) < .055$.
• Bifactor Model: Evaluates a general “Affective Instability” or “General Distress” factor alongside orthogonal specific factors for Depression and Hypomania. Research indicates that while a general distress component exists, the specific hypomanic factor maintains strong unique variance and predictive utility, essential for differentiating bipolar from unipolar affective phenotypes.

Item Loadings and Abbreviated Derivatives

Item-level factor loadings on designated scales are exceptionally robust, with the majority of items demonstrating standardised factor loadings ($lambda$) between .50 and .85. Cross-loadings between the unipolar depression items and pure hypomanic activation items are negligible ($< .20$), confirming structural divergence. This clean factor structure enabled Youngstrom, Murray, Johnson, and Findling (2016) to utilise factor analytic and Item Response Theory (IRT) parameters to extract the 14 highest-performing items, creating the 7 Up 7 Down Inventory (7 items measuring mania/activation, 7 items measuring depression), which maintains the core factorial structure of the parent 73-item instrument with minimal information loss.

10. Instrument / Measurement Tool

The structural, administrative, and operational parameters of the General Behavior Inventory are outlined below:

• Instrument Name: General Behavior Inventory (GBI)
• Primary Author: Richard A. Depue, Ph.D. (with subsequent versions by Eric A. Youngstrom, Ph.D., et al.)
• Test Type: Clinical psychological assessment, self-report behavioural questionnaire (also available as parent/informant proxy: P-GBI)
• Target Population: Adults (aged 18 and older); parent-report format (P-GBI) validated for children and adolescents aged 5 to 17 years.
• Time Required for Administration: Approximately 20 to 30 minutes for the full 73-item self-report inventory; 3 to 5 minutes for the 14-item 7 Up 7 Down short version.
• Item Composition: 73 total items
  • Depression Subscale: 45 items evaluating chronic/episodic unipolar and bipolar depressive symptoms.
  • Hypomanic / Biphasic Subscale: 28 items evaluating hypomanic energy, behavioural activation, and rapid biphasic mood swings.
• Reference Time Window: Behaviors, feelings, and energy changes experienced over the past year (12 months), capturing longitudinal baseline functioning and trait stability.
• Response Format: 4-point Likert-type scale:
  • 0 = Never or hardly ever
  • 1 = Sometimes
  • 2 = Often
  • 3 = Very often or almost constantly
• Scoring Methodologies:
  • 1. Dimensional / Continuous Likert Scoring: Item scores are directly summed across subscales. Depression scale range: 0 to 135; Hypomanic/Biphasic scale range: 0 to 84. Higher cumulative scores indicate greater symptom frequency and severity.
  • 2. Dichotomous / Case-Scoring Algorithm: Devised by Depue et al. (1987) to identify clinical cases within epidemiological and high-risk research. Responses of 0 or 1 are scored as 0 (absent/subclinical), while responses of 2 or 3 are scored as 1 (clinically significant endorsement). Subscale items are then summed:
    • Dichotomous Depression Score: Range 0 to 45.
    • Dichotomous Hypomanic/Biphasic Score: Range 0 to 28.
• Standard Diagnostic Cutoff Benchmarks (Dichotomous Scoring):
  • Unipolar Depressive Pattern: Depression scale $ge 11$, Hypomanic/Biphasic scale $< 13$.
  • Bipolar Spectrum / Cyclothymic Pattern: Hypomanic/Biphasic scale $ge 13$ (often accompanied by an elevated Depression score $ge 11$).
  • Non-Case / Control Pattern: Both scales fall below respective clinical thresholds.

11. Permissions & Fee and Test Year

The General Behavior Inventory was first published in 1981 by Richard A. Depue and colleagues in the Journal of Abnormal Psychology (American Psychological Association). Unlike many commercial proprietary psychometric inventories (e.g., MMPI-3, PAI), the original General Behavior Inventory, its parent-report adaptation (P-GBI), and the short-form 7 Up 7 Down variant have been made broadly accessible by their authors for non-profit academic research, scientific inquiry, and educational clinical training.

The inventory is available for open academic use without commercial royalty fees. Validated English copies, scoring templates, and translations into multiple languages (including Spanish, Dutch, and French) are maintained and distributed through academic repositories, notably through the Center for Excellence in Community Mental Health at the University of North Carolina at Chapel Hill under the curation of Dr. Eric A. Youngstrom. While researchers and practitioners are free to download and implement the scale for scientific and clinical screening purposes, formal commercial publication, commercial electronic redistribution, or inclusion in monetised proprietary testing platforms requires written authorisation and licensing agreements from the copyright holders and original authors.

12. References

Chmielewski, P. M., Fernandes, L. O., Yee, C. M., & Miller, G. A. (1995). Ethnicity and gender in scales of psychosis proneness and mood disorders. Journal of Abnormal Psychology, 104(3), 464–470. https://doi.org/10.1037/0021-843x.104.3.464

Danielson, C. K., Youngstrom, E. A., Findling, R. L., & Calabrese, J. R. (2003). Discriminative validity of the General Behavior Inventory using youth report. Journal of Abnormal Child Psychology, 31(1), 29–39. https://doi.org/10.1023/A:1021717231272

Depue, R. A., & Klein, D. N. (1988). Identification of unipolar and bipolar affective conditions in nonclinical and clinical populations by the General Behavior Inventory. In D. L. Dunner, E. S. Gershon, & J. E. Barrett (Eds.), Relatives at risk for mental disorders (pp. 179–202). Raven Press.

Depue, R. A., Krauss, S., & Spoont, M. R. (1987). A two-dimensional threshold model of seasonal bipolar affective disorder. In D. Magnusson & A. Ohman (Eds.), Psychopathology: An interactional perspective (pp. 95–123). Academic Press.

Depue, R. A., Slater, J. F., Wolfstetter-Kausch, H., Klein, D. N., Goplerud, E., & Farr, D. A. (1981). A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies. Journal of Abnormal Psychology, 90(5), 381–437. https://doi.org/10.1037/0021-843X.90.5.381

Pendergast, L. L., Youngstrom, E. A., Brown, C., Jensen, D., Abramson, L. Y., & Alloy, L. B. (2015). Structural invariance of General Behavior Inventory (GBI) scores in Black and White young adults. Psychological Assessment, 27(1), 21–30. https://doi.org/10.1037/pas0000020

Pendergast, L. L., Youngstrom, E. A., Merkitch, K. G., Moore, K. A., Black, C. L., Abramson, L. Y., & Alloy, L. B. (2014). Differentiating bipolar disorder from unipolar depression and ADHD: The utility of the General Behavior Inventory. Psychological Assessment, 26(1), 195–206. https://doi.org/10.1037/a0035138

Youngstrom, E. A., Findling, R. L., Danielson, C. K., & Calabrese, J. R. (2001). Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory. Psychological Assessment, 13(2), 267–276. https://doi.org/10.1037/1040-3590.13.2.267

Youngstrom, E. A., Genzlinger, J. E., Egerton, G. A., & Van Meter, A. R. (2015). Multivariate meta-analysis of the discriminative validity of caregiver, youth, and teacher rating scales for pediatric bipolar disorder: Mother knows best about mania. Archives of Scientific Psychology, 3(1), 112–137. https://doi.org/10.1037/arc0000024

Youngstrom, E. A., Murray, G., Johnson, S. L., & Findling, R. L. (2016). The 7 Up 7 Down Inventory: A 14-item measure of manic and depressive tendencies carved from the General Behavior Inventory. Psychological Assessment, 25(4), 1377–1383. https://doi.org/10.1037/a0033975

Youngstrom, E. A., Zhao, J., Mankoski, R., Forbes, R. A., Marcus, R. M., Carson, W., & Findling, R. L. (2013). Clinical significance of treatment effects with aripiprazole versus placebo in a study of manic or mixed episodes associated with pediatric bipolar I disorder. Journal of Child and Adolescent Psychopharmacology, 23(2), 72–79. https://doi.org/10.1089/cap.2012.0024

13. Items of the Scale