Larsson et al. BMC Psychiatry 2013, 13:97
http://www.biomedcentral.com/1471-244X/13/97
Patterns of childhood adverse events are associated with clinical characteristics of bipolar disorder
Abstract
Background: Previous studies in bipolar disorder investigating childhood trauma and clinical presentations of the
illness have mainly focused on physical and sexual abuse. Our aim was to explore further the relationship between
childhood trauma and disease characteristics in bipolar disorder to determine which clinical characteristics were
most strongly associated with childhood trauma total score, as well as subtypes of adverse childhood events,
including physical, sexual, emotional abuse and neglect.
Methods: 141 Patients with bipolar disorder were consecutively recruited, and disease history and clinical
characteristics were assessed. History of childhood abuse was obtained using the Childhood Trauma Questionnaire
(CTQ). Statistical methods used were factor analysis, Poisson and linear regression, and generalized additive
modeling (GAM).
Results: The factor analysis of CTQ identified three factors: emotional abuse/neglect, sexual abuse and physical
abuse. There were significant associations between CTQ total score and earlier onset of illness, reduced level of
psychosocial functioning (GAF; Global Assessment of Functioning) and decreased number of hospitalization, which
mainly were due to the factor emotional abuse/neglect. Physical abuse was significantly associated with lower GAF
scores, and increased number of mood episodes, as well as self-harm. Sexual abuse was significantly associated
with increased number of mood episodes. For mood episodes and self-harm the associations were characterized by
great variance and fluctuations.
Conclusions: Our results suggest that childhood trauma is associated with a more severe course of bipolar illness.
Further, childhood abuse (physical and sexual), as well as emotional abuse and neglect were significantly associated
with accelerating staging process of bipolar disorder. By using specific trauma factors (physical abuse, sexual abuse
and emotional abuse/neglect) the associations become both more precise, and diverse.
