Research confirms a link between childhood trauma and severe symptoms of bipolar disorder in adults. Patients who had experienced childhood trauma had a younger age at onset, were more likely to experience rapid cycling, and had more suicide attempts and depressive episodes than patients who had not, report Monica Aas (University of Oslo, Norway) and co-workers. Moreover, the team found a clear dose–response effect of abuse on bipolar symptoms.
The findings may help to identify patients at risk for a severe clinical course, and therefore “further highlight the importance of assessing childhood trauma in bipolar disorder research, which should be systematically included in the clinical assessment of the patients,” Aas et al write in The Clinical Journal of Psychiatry.
Their study included 418 French and 169 Norwegian bipolar disorder patients, of whom 178 reported emotional neglect in childhood, 71 physical neglect, 153 emotional abuse, 55 physical abuse, and 104 reported sexual abuse on the Childhood Trauma Questionnaire.
A dose–response effect was evident for younger age at onset, rapid cycling, and a larger number of suicide attempts, with these outcomes increasing with the more types of trauma patients had experienced. For example, the average age at onset was about 26 years in patients with no childhood trauma, falling to 20 years in those with three subtypes of trauma.
However, on multivariate analysis, only emotional and sexual abuse were independently associated with age at onset and suicide attempts, and only sexual abuse was independently associated with rapid cycling. Neglect was not associated with bipolar symptom severity. “This suggests that the trauma probably must reach a certain level of intensity […] to have an effect on the phenotype,” comment the researchers.
Physical abuse was not significantly associated with bipolar symptoms, but there is evidence linking this to psychosis, Aas et al note, whereas emotional trauma is more often associated with bipolar disorder.
They say: “We could hypothesize that emotional abuse and sexual abuse are associated with development of emotional dysregulation, which may be an underlying core link between childhood trauma and increased symptomatology in bipolar disorder patients.”
Population of focus: Children in Europe
Link to resource:
Journal: Journal of Clinical Psychiatry