Childhood trauma in bipolar disorder

Stuart Watson,I Nicol Ferrier,Joanna Moncrieff,Dominic Dougall,Allan H Young,Richard Porter,Peter Gallagher

doi:10.1177/0004867413516681

Abstract

Objective:There has been little investigation of early trauma in bipolar disorder despite evidence that stress impacts on the course of this illness. We aimed to compare the rates of childhood trauma in adults with bipolar disorder to a healthy control group, and to investigate the impact of childhood trauma on the clinical course of bipolar disorder.Methods:Retrospective assessment of childhood trauma was conducted using the Childhood Trauma Questionnaire (CTQ) in 60 outpatients with bipolar disorder being treated for a depressive episode and 55 control participants across two centres in north-east England and New Zealand.Results:Significantly higher rates of childhood trauma were observed in patients with bipolar I and bipolar II disorder compared to controls. Logistic regression, controlling for age and sex, identified emotional neglect to be the only significant CTQ subscale associated with a diagnosis of bipolar disorder. Childhood history of sexual abuse was not a significant predictor. Associations with clinical severity or course were less clear.Conclusions:Childhood emotional neglect appears to be significantly associated with bipolar disorder. Limitations include the relatively small sample size, which potentially increases the risk of type II errors. Replication of this study is required, with further investigation into the neurobiological consequences of childhood trauma, particularly emotional neglect.

Highlights

The high prevalence and incidence (Merikangas et al, 2011), chronicity of symptoms (Judd et al, 2002, 2003), and psychosocial impairment (Judd et al, 2005) of bipolar disorder underlines the need to establish its aetiological and risk factors
One study has shown that early parental loss is more common (Agid et al, 1999), whilst others have shown that childhood stressful life events are less common (Horesh et al, 2011) or as common (Horesh and Iancu, 2010) in bipolar disorder compared with healthy controls
Children and adolescents with bipolar disorder have been shown to be exposed to more negative life events and less positive events compared to controls (Romero et al, 2009), interestingly, a recent paper suggested that the link between stressful events and bipolar disorder may be a consequence of the illness

Summary

Introduction

The high prevalence and incidence (Merikangas et al, 2011), chronicity of symptoms (Judd et al, 2002, 2003), and psychosocial impairment (Judd et al, 2005) of bipolar disorder underlines the need to establish its aetiological and risk factors. Reported childhood abuse has been associated with an adverse illness course (Garno et al, 2005; Leverich et al, 2002), more depressive episodes (Garno et al, 2005), greater severity of mania (Garno et al, 2005; Leverich et al, 2002), with earlier onset (Carballo et al, 2008; Garno et al, 2005; Leverich et al, 2002), suicidal ideation (Carballo et al, 2008; Leverich et al, 2002), substance abuse (Brown et al, 2005; Carballo et al, 2008), and with impaired performance on tests of neuropsychological function (Savitz et al, 2008) Interpretation of these findings is limited by the clinical and methodological heterogeneity of these studies (Daruy-Filho et al, 2011)

Methods

Results

Discussion

Conclusion