Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder

Abstract

BackgroundChildhood abuse is a risk factor for poorer illness course in bipolar disorder, but the reasons why are unclear. Trait-like features such as affective instability and impulsivity could be part of the explanation. We aimed to examine whether childhood abuse was associated with clinical features of bipolar disorder, and whether associations were mediated by affective instability or impulsivity.MethodsWe analysed data from 923 people with bipolar I disorder recruited by the Bipolar Disorder Research Network. Adjusted associations between childhood abuse, affective instability and impulsivity and eight clinical variables were analysed. A path analysis examined the direct and indirect links between childhood abuse and clinical features with affective instability and impulsivity as mediators.ResultsAffective instability significantly mediated the association between childhood abuse and earlier age of onset [effect estimate (θ)/standard error (SE): 2.49], number of depressive (θ/SE: 2.08) and manic episodes/illness year (θ/SE: 1.32), anxiety disorders (θ/SE: 1.98) and rapid cycling (θ/SE: 2.25). Impulsivity significantly mediated the association between childhood abuse and manic episodes/illness year (θ/SE: 1.79), anxiety disorders (θ/SE: 1.59), rapid cycling (θ/SE: 1.809), suicidal behaviour (θ/SE: 2.12) and substance misuse (θ/SE: 3.09). Measures of path analysis fit indicated an excellent fit to the data.ConclusionsAffective instability and impulsivity are likely part of the mechanism of why childhood abuse increases risk of poorer clinical course in bipolar disorder, with each showing some selectivity in pathways. They are potential novel targets for intervention to improve outcome in bipolar disorder.

Impact of Childhood Trauma Histories Versus Recent Trauma Symptoms on Affective Lability in Adult Bipolar Disorder

“…Unexpectedly, self-reported histories of childhood trauma per se did not contribute significantly to ALS scores, despite prior literature linking childhood trauma with affective lability in adult bipolar disorder. [1][2][3]13 These provisional findings require corroboration with larger sample sizes and longitudinal assessment, direct evaluation of adult trauma, and closer evaluation of the timing of adult versus early life trauma vis-à-vis current affective symptoms. While the PCL-C is used to screen for PTSD, formal DSM-5 PTSD diagnoses were not ascertained.…”

Childhood trauma and suicidality in bipolar disorder: The mediatory role of impulsivity

“…18 Η συσχέτιση αυτή σε ασθενείς με ΔΔ έχει δειχθεί μόνο σε λίγες πρόσφατες μελέτες. [19][20][21] Εξάλλου, η παρορμητικότητα έχει σχετισθεί με την αυτοκτονικότητα σε ποικίλα δείγματα ψυχιατρικών ασθενών. 22 Ωστόσο, πρόσφατη συστηματική ανασκόπηση 23 δείχνει ότι η σχέση αυτή είναι περισσότερο πολύπλοκη στη ΔΔ.…”

“…Ορισμένες έρευνες εντοπίζουν συσχέτιση της αυτοκτονικότητας με το συνολικό σκορ της κλίμακας παρορμητικότητας Barratt (BIS-11). 20,[24][25][26][27] Άλλες έρευνες δεν εντοπίζουν σημαντική συσχέτιση με το συνολικό σκορ της BIS-11, [28][29][30][31][32][33][34][35] ενώ μία καταλήγει σε αρνητική συσχέτιση, 36 δηλαδή εντοπίζει χαμηλότερα επίπεδα παρορμητικότητας στους ασθενείς με ΔΔ και ιστορικό απόπειρας. Τέλος, κάποιες εντοπίζουν συσχέτιση με τουλάχιστον έναν υπότυπο της παρορμητικότητας, αλλά όχι με το συνολικό σκορ της.…”

19th Latest Advances in Psychiatry International Symposium

“…For example, modelling suggests that anger may mediate the link between emotional abuse and suicide attempts in people with BD, and that anxiety and depression may mediate the link between emotional abuse and anxiety and depression in BD 13–15 . So affect lability and impulsivity may lead to lower emotional regulation, greater sensitivity to stressors or less impulse control or substance misuse, in turn leading to early age at onset, relapse, staging and suicide attempts.…”

“…For example, modelling suggests that anger may mediate the link between emotional abuse and suicide attempts in people with BD, and that anxiety and depression may mediate the link between emotional abuse and anxiety and depression in BD. [13][14][15] So affect lability and impulsivity may lead to lower emotional regulation, greater sensitivity to stressors or less impulse control or substance misuse, in turn leading to early age at onset, relapse, staging and suicide attempts. That suggests affect lability and impulsivity might lend themselves to targeting by psychosocial or psychotherapeutic interventions such as trauma-focussed cognitive behavioural therapy, eye movement desensitisation and reprocessing (EMDR), acceptance and commitment therapy, dialectical behavioural therapy.…”