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Early physical and sexual abuse associated with an adverse course of bipolar illness

  • Gabriele S Leverich
    Correspondence
    Address reprint requests to Gabriele S. Leverich, M.S.W., Biological Psychiatry Branch, National Institute of Mental Health, Building 10, Room 3S 239, 10 Center Drive, MSC 1272, Bethesda MD 20892-1272, USA
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Biological Psychiatry Branch (GSL, KDD, KAA, RMP), National Institute of Mental Health, Bethesda, Maryland, USA
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  • Susan L McElroy
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Biological Psychiatry Program (SLM, PEK) Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Trisha Suppes
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Bipolar Disorder Clinic and Research Program (TS, AJR), Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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  • Paul E Keck Jr
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Biological Psychiatry Program (SLM, PEK) Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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  • Kirk D Denicoff
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Biological Psychiatry Branch (GSL, KDD, KAA, RMP), National Institute of Mental Health, Bethesda, Maryland, USA
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  • Willem A Nolen
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    University Medical Centre (WAN, RK), Utrecht and Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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  • Lori L Altshuler
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    VA Medical Center (LLA, MAF), Los Angeles, California, USA
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  • A.John Rush
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Bipolar Disorder Clinic and Research Program (TS, AJR), Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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  • Ralph Kupka
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    University Medical Centre (WAN, RK), Utrecht and Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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  • Mark A Frye
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    VA Medical Center (LLA, MAF), Los Angeles, California, USA
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  • Karen A Autio
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Biological Psychiatry Branch (GSL, KDD, KAA, RMP), National Institute of Mental Health, Bethesda, Maryland, USA
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  • Robert M Post
    Affiliations
    Stanley Foundation Bipolar Treatment Outcome Network (GSL, SLM, TS, PEK, KDD, WAN, LLA, AJR, RK, MAF, KAA, RMP), USA

    Biological Psychiatry Branch (GSL, KDD, KAA, RMP), National Institute of Mental Health, Bethesda, Maryland, USA
    Search for articles by this author

      Abstract

      Background: There is growing awareness of the association between physical and sexual abuse and subsequent development of psychopathology, but little is known, however, about their relationship to the longitudinal course of bipolar disorder.
      Methods: We evaluated 631 outpatients with bipolar I or II disorder for general demographics, a history of physical or sexual abuse as a child or adolescent, course of illness variables, and prior suicide attempts, as well as SCID-derived Axis I and patient endorsed Axis II comorbidity.
      Results: Those who endorsed a history of child or adolescent physical or sexual abuse, compared with those who did not, had a history of an earlier onset of bipolar illness, an increased number of Axis I, II, and III comorbid disorders, including drug and alcohol abuse, faster cycling frequencies, a higher rate of suicide attempts, and more psychosocial stressors occurring before the first and most recent affective episode. The retrospectively reported associations of early abuse with a more severe course of illness were validated prospectively.
      Conclusions: Greater appreciation of the association of early traumatic experiences and an adverse course of bipolar illness should lead to preventive and early intervention approaches that may lessen the associated risk of a poor outcome.

      Keywords

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