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August 25, 2005

Half of Those w/ Bipolar Disorder Had Childhood Abuse?

Severe childhood trauma or childhood abuse appears to have occurred in about half of people with bipolar disorder, according to one new study of 100 patients from the USA published in the February 2005 British Journal of Psychiatry. This is of course according to this one small survey (so don't put too much value on it yet). This study seems to have a number of weaknesses that make it difficult to generalize from - including the small sample size, and the "self-reported" nature of the study.

Childhood trauma or abuse has been associated with many different types of adult psychiatric disorder, including suicidality, substance misuse and dependence, and psychosis. This study set out to examine the prevalence and types of childhood abuse reported by adult patients with bipolar disorder, and to relate them to the complexity of the current illness.

100 patients were studied at an academic specialty centre for the treatment of bipolar disorder in New York. Histories of severe childhood abuse were identified in about half of the sample and were associated with onset of illness at an early age, as well as with more severe manic symptoms, compared with patients without a history of abuse.

Severe emotional abuse or neglect was significantly associated with substance misuse or dependence. Rapid cycling between manic and depressive mood in the last year was significantly linked to severe emotional abuse or neglect, or physical abuse.

There was also a significant association between a lifetime suicide attempt and severe childhood sexual abuse (though not emotional or physical abuse).

Multiple forms of abuse in childhood - which occurred in about a third of the people studied - showed a graded increase in risk for both suicide attempts and rapid recycling between manic and depressive mood in adulthood.

The prevalence of severe childhood abuse found in around half of the sample is consistent with the findings of previous studies, and is only slightly higher than that found among patients with major depression.

Also consistent with the findings of this study are reports suggesting that multiple forms of child maltreatment often occur together, and may contribute additively or synergistically to psychiatric disorders and suicidality seen in adulthood.

The authors of the study comment that in the light of the high prevalence of childhood abuse in their sample, coupled with its influence on suicide risk, it would seem prudent for clinicians routinely to evaluate histories of childhood trauma in patients with bipolar disorder.

Consideration of the nature and extent of abuse in childhood may also bear directly on suicide risk assessment among these patients.

Further prospective studies are needed to confirm and extend the findings of this study.

For further information, or a press copy of the full paper, please contact Deborah Hart or Thomas Kennedy in the External Affairs Department.
Telephone: 020 7235 2351 Extensions. 127 or 154
E-mail: dhart@rcpsych.ac.uk or tkennedy@rcpsych.ac.uk

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