Revisiting the association between childhood trauma and psychosis in bipolar disorder: A quasi-dimensional path-analysis

AbstractBackgroundChildhood 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.

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Immature defense mechanisms mediate the relationship between childhood trauma and onset of bipolar disorder

Journal of Affective Disorders ◽

10.1016/j.jad.2020.10.029 ◽

2021 ◽

Vol 278 ◽

pp. 672-677

Author(s):

Leilei Wang ◽

Yi Yin ◽

Qingtao Bian ◽

Yanfang Zhou ◽

Junchao Huang ◽

...

Keyword(s):

Bipolar Disorder ◽

Childhood Trauma ◽

Defense Mechanisms ◽

The Relationship

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Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2014.74 ◽

2014 ◽

Vol 32 (1) ◽

pp. 21-30 ◽

Cited By ~ 26

Author(s):

J. Cotter ◽

M. Kaess ◽

A. R. Yung

Keyword(s):

Bipolar Disorder ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Childhood Trauma ◽

Psychotic Disorders ◽

Functional Disability ◽

Clinical Work ◽

Borderline Personality ◽

Response To Treatment ◽

Neurocognitive Deficits

ObjectivesWe aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.MethodsNarrative review of the peer-reviewed English language literature in the area.ResultsHigh rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment.ConclusionsRoutine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

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Reliability of reports of childhood trauma in bipolar disorder: A test–retest study over 18 months

Journal of Trauma & Dissociation ◽

10.1080/15299732.2016.1141147 ◽

2016 ◽

Vol 17 (4) ◽

pp. 511-519 ◽

Cited By ~ 10

Author(s):

Ciaran Shannon ◽

Donncha Hanna ◽

Leo Tumelty ◽

Daniel Waldron ◽

Chrissie Maguire ◽

...

Keyword(s):

Bipolar Disorder ◽

Childhood Trauma

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The Different Effect of Childhood Trauma on Amygdala and Hippocampus in Patients with Bipolar Disorder and Healthy Controls

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.288 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S92-S92 ◽

Cited By ~ 1

Author(s):

D. Janiri ◽

P. De Rossi ◽

A. Simonetti ◽

G. Spalletta ◽

G. Sani

Keyword(s):

Bipolar Disorder ◽

Childhood Trauma ◽

Negative Reinforcement ◽

Biological Response ◽

Childhood Trauma Questionnaire ◽

Hippocampal Subfields ◽

Cornu Ammonis ◽

Response To Stress ◽

Competing Interest ◽

The Impact

IntroductionChildhood trauma (CT) is a relevant environmental stressor for bipolar disorder (BP). Amygdala and hippocampus are key areas involved both in the pathophysiology of BP and in mediating the biological response to stress.ObjectivesStructural neuroimaging studies help clarifying neural correlates of the relationship between BP diagnosis and CT.AimsTo verify the impact of CT on amygdala and hippocampus and hippocampal subfields volumes in BP patients and healthy control (HC).MethodsWe assessed 105 outpatients, diagnosed with BPI or BPII according to DSM-IV-TR criteria, and 113 HC subjects. History of CT was obtained using the childhood trauma questionnaire (CTQ). High-resolution magnetic resonance imaging was performed on all subjects and volumes of amygdala, hippocampus, nucleus accumbens, caudate, pallidum, putamen, thalamus and hippocampal subfields were measured through FreeSurfer.ResultsAll deep gray matter structures were smaller in BP than HC. CT modulated the impact of the diagnosis on bilateral amygdala and hippocampus, in particular on subiculum, presubiculum and cornu ammonis CA1. It was associated with bilateral decreased volumes in HC and increased volumes in patients with BP.ConclusionsChildhood trauma impacts on the amygdala and hippocampus, brain areas involved in response to stress and emotion processing, and specifically on the hippocampal subfields most implicated in learning trough positive/negative reinforcement.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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