Childhood Maltreatment and Bipolar Disorder: A Critical Review of the Evidence

Review Article

Childhood Maltreatment and Bipolar Disorder: A Critical Review of the Evidence

Helen L Fisher and Georgina M Hosang

Affiliation: MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK


ABSTRACT

Background
Research exploring the potential role of childhood maltreatment in the onset and course of bipolar disorder (BD) has burgeoned over the past decade. However, the quality of these studies has been called into question, and a systematic approach is required to review this expanding literature.
Method
Electronic and manual searches were conducted to locate all published papers that had investigated the association between childhood maltreatment and BD. Studies that reported prevalence rates of physical, sexual, or emotional abuse or neglect among individuals with BD were selected. Papers were also included if they had explored the association between maltreatment exposure and the major clinical features of the disorder (age at onset, duration of untreated illness, rapid cycling, psychotic features, and suicidal behavior).
Results
Twenty‐nine papers were included in this review, but a wide range of methodological limitations were identified, indicating that the results of existing studies should be interpreted cautiously. Only six studies utilized psychometrically tested measures of maltreatment, diagnostic interviews for BD, and included at least 100 affected individuals. Childhood maltreatment was tentatively shown to be more common in BD than in control subjects, but prevalence rates varied. There was also inconsistency for associations with the clinical expression of BD. Increased suicide attempts among those exposed to sexual or emotional abuse was the only replicated finding.
Conclusion
Associations between childhood maltreatment and the development and clinical presentation of BD remain unclear. Systematic investigation utilizing scientifically rigorous approaches is required to establish the potentially important etiological and clinical implications of early adversity for BD.

Keywords: bipolar disorder, child abuse, trauma, maltreatment, review, etiology, clinical course
Correspondence: Helen L Fisher, PO80 SGDP Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Tel: (44)‐207‐848‐5430; Fax: (44)‐207‐848‐0866; e‐mail: helen.fisher@iop.kcl.ac.uk