Traumatic experiences and the clinical course of bipolar disorder

Psychosocial stressors contribute to worsened syndromal and psychosocial outcome for bipolar patients but little research has examined the potential impact of child abuse and traumatic experiences in adulthood on the course of illness in bipolar disorder. Although Axis II disorders are frequently comorbid with bipolar disorder and adverse life events have been attributed to bipolar patient's own doing, there is little data on how Axis II disorders may impact the course of illness in bipolar disorder. This study compared clinical course for bipolar patients with and without childhood and adult trauma histories. The study also compared clinical course for bipolar patients with trauma histories with and without Cluster B Axis II disorders.; One hundred DSM-IV bipolar I and II inpatients and outpatients were interviewed for retrospective recall of course of illness and trauma histories. They also filled out a self-report measure of childhood abuse. Clinical outcome, including: rapid cycling pattern, substance abuse history, number of affective episodes, number of psychiatric hospitalizations, and number of suicide attempts, were compared for those with and without (a) severe childhood abuse; (b) adulthood trauma; (c) Cluster B Axis II disorders.; Participants with a history of severe child abuse were more likely to have a rapid cycling pattern (p < .01) and substance abuse/dependence (p < .05) than those without severe child abuse. Those with adulthood trauma had a greater number of affective episodes (p < .05), psychiatric hospitalizations (p < .05), and suicide attempts (p < .05) than those without adulthood trauma. When comparing groups based on timing of abuse (childhood versus adulthood), a rapid cycling pattern was most prevalent among those with severe childhood abuse (p < .01) and substance abuse/dependence was most prevalent among those with both severe child abuse and adult trauma (p < .05). After controlling for current affective state, participants with Cluster B Axis II disorders had more suicide attempts than participants without Cluster B disorders, regardless of whether the entire sample was examined (p < .05) or only those with severe child abuse (p < .05) or adult trauma (p < .05) were selected.; The study indicates that for bipolar patients, timing of traumatic experiences (childhood versus adulthood) results in different sequelae with regard to course of illness. After controlling for current affective state, a Cluster B Axis II diagnosis is related to a greater number of suicide attempts. The diagnosis of a Cluster B Axis II disorder was, however, complicated by current syndromal state which calls into question the validity of administering the SCID II to affectively ill individuals.