Author: Melissa Howard
There is not a definitive conclusion that childhood trauma (CT) may be responsible for the onset of bipolar disorder (BD), however, there have been multiple case studies that have shown that childhood adversity can trigger and impact the severity of mood episodes and psychosis.
BD has its roots in a combination of contributing factors; genetics, psychosocial, dynamics, environment, and CT are just to name a few. These precursors have shown to predict the frequency and complexities of mood episodes the disorder is synonymous for.
A case study¹ from 2019 states;
“The exposure to childhood trauma is associated with adverse outcomes in children and adolescents, including emotional (Bücker et al., 2012, Pears et al., 2008, Sesar et al., 2008), psychosocial (Pears et al., 2008, Sesar et al., 2008), cognitive (Bücker et al., 2012, De Bellis et al., 2013, Enlow et al., 2012, Mills et al., 2011, Pears et al., 2008), and functional impairments (Bücker et al., 2012).
There is evidence that young people who are genetically vulnerable are more susceptible to develop bipolar disorder when exposed to trauma (Garno et al., 2005, Goldberg and Garno, 2009, Leverich et al., 2002). In addition, a recent systematic review showed that childhood adversity is associated with bipolar disorder (Palmier-Claus et al., 2016), and a recent umbrella review of systematic reviews and meta-analyses showed that childhood adversity is a risk factor for bipolar disorder supported by highly suggestive evidence (Bortolato et al., 2017).”
To further understand the occurrence of CT and its link to BD, a study published in 2020² states;
“Childhood trauma (CT) has been repeatedly linked to earlier onset and greater severity of bipolar disorder (BD) in adulthood.
CT is a form of chronic stress usually in the form of emotional or physical abuse, neglect or sexual abuse (Child maltreatment is the abuse and neglect of people under 18 years of age. It includes all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust or power. Four types of child maltreatment are generally recognized: physical abuse, sexual abuse, psychological (or emotional or mental) abuse, and neglect. (https://apps.who.int/violence-info/child-maltreatment).
Abusive behaviors can also include bullying or familial dysfunctions. Prevalence of CT exposure is often under-reported but is likely to lie between 25% (as reported in the UK)6 and 40% (as reported in the USA)7 or even 50% in individuals with psychotic disorders.8,9 Other studies proposed that individuals with BD are 2.63 times more likely to report CT compared to healthy individuals (approximately 2.72 times for individuals with psychosis10,11). Additionally, individuals with BD exposed to CT are 1.85 times more likely to experience their first episode earlier,12–14 show increased rapid cycling15–18 and more severe forms of the disorder10,19–23 compared to those who did not experience CT.”
Now that I was able to provide a brief basis point and researched links between CT and BD, I must re affirm that ongoing studies are being facilitated to further confirm an accurate diagnostic criteria of CT and its effects on BD.
I possess a laundry list of CT experiences but before I delve deeper into them I must say that I did not know what an accurate definition of Post Traumatic Stress Disorder (PTSD) or Complex/Chronic Post Traumatic Stress Disorder (c-PTSD) was until I was in my early twenties following my BD 1 diagnosis.
I assumed trauma came from a car accident, losing a loved one, living in a country experiencing war, natural disasters, being assaulted, or escaping a fire, just to name a few. All of which are forms of trauma, however, trauma is much more complex than my past naive assumptions.
My psychotherapist informed me that I experienced PTSD (or c-ptsd which is not currently recognized as a psychiatric diagnosis). I shook my head and emphatically stated that I had not.
She went on to explain what PTSD for children was – but not limited to;
– Neglect
– A parent with a mental illness
– Physical, mental, emotional or verbal abuse.
– Sexual abuse
– Bullying
– Medical procedures
– Accidents
– Witnessing domestic strife or abuse
The C in front of PTSD stood for complex or chronic, meaning it was ongoing and there was never a known end to the trauma I had experienced as a child. After sharing her list of CT examples, I was able to check mark five as having experienced them.
My experiences with trauma began as a toddler. I was exposed to medical trauma at the age of two and it continued well into my youth. I lived with acute asthma and on a few occasions my airways became completely constricted that I stopped breathing. I endured physical, mental and emotional abuse from my father throughout my childhood and teen years. I was unable to self regulate my emotions causing me embarrassment, debilitating anxiety, insecurity, fear, and childhood depression. I was bullied throughout my childhood and teen years for being of mixed heritage.
I lived through a traumatic accident and underwent three surgeries that compromised the use of my right arm after suffering medical negligence at the hands of my orthopaedic surgeon. It was at this point I developed suicidal ideation which would eventually evolve into a suicidal attempt in my later teen years.
At twelve, my mood fluctuations became erratic. The polarity of my outbursts would cycle between heightened irritation and anger to inconsolable sadness, often within the same day.
I was diagnosed with illnesses that required surgical intervention, one of which triggering a major depressive episode and a lengthy period of dissociation.
Towards the end of my teen years I was displaying obvious symptoms of hypomania that were going unrecognized by an incompetent psychiatrist. His under diagnosis of my symptoms and lack of appropriate treatment contributed to my first depressive psychosis which subsequently evolved into mania and then a manic psychosis. Shortly after, I was admitted to a hospital under the care of a new psychiatrist who formally diagnosed me with Bipolar Disorder 1.
Looking back at my CT and the acuteness of the BD symptoms I’ve lived through, I know my childhood adversities contributed to the severity of my BD episodes.
Consequently, piecing together my childhood experiences of CT, my family discovered my father had been living with undiagnosed BD. Somewhere along my paternal lineage was the genetic link for BD. This discovery allowed me to realize that my father’s untoward behaviour throughout my younger life had nothing to do with me and everything to do with his undiagnosed BD and his own unresolved CT.
I have been able to discern that genetics may be the main precursor for my BD 1 diagnosis, however, my experience with chronic or complex CT has contributed to the severity of my mood episodes as well as the development of psychosis.
Today, I live a fulfilling life that I am proud of.
A life I never thought imaginable living with the polarity of BD. With this being said from a place of stability, my life did not fall into place easily.
I have done just over two decades of Cognitive Behavioural Therapy (CBT) to alter the negative tape that had repeated itself over and over again during my years of trauma. It became a part of me. I felt that I was useless and insignificant, unworthy of being loved, and unintelligent because of the way mental and physical illness impacted my education. My negative beliefs played on a loop well into my adulthood. Only to be intensified when I relapsed into a BD episode, acted upon my triggers or when I felt like a failure as a mother, wife, daughter and friend.
CBT allowed me to break down the negative thought patterns to make them manageable to navigate through. Today I am able to utilize my skills effectively, interrupt and decipher the negative notions before they are able to impact my behaviour. Most of the time I am able to seize the unexpected worries and doubts but there have also been many times in my past that my behaviour has been altered because of them. It has been a learning curve that I continue to work on daily.
I have participated in transactional writing to my younger self following my most acute manic and psychotic episode just over a decade ago. I was guided by my psychotherapist because the concept of communicating to my inner child and acknowledging her trauma was foreign to me.
My experiences had never been appropriately validated. I was gaslit or blamed for BD symptoms I lacked control over. It was uncomfortable to address my younger self with love and compassion.
I gained an understanding of how to protect my inner child when I was being triggered by event’s similar to my past. For example, being yelled at, not listened to or being told that I experienced a “little bit of trauma.”
It was a challenge for me to be vulnerable, acknowledging my triggers, sitting with the discomfort of my emotions and communicating to my younger self that she/I was now safe and I could let go of my trauma responses that kept me protected during my childhood.
It has been an arduous and exhaustive journey which will be life long. In knowing this, I have created firm boundaries for myself. I understand my limitations and often work through the frustrations with CBT when “why can’t I be like everyone else?” infiltrates my thoughts. The answer to my own question, “I will never be like anyone else because I am me and It has taken me many years to be comfortable with this notion.”
The information provided is not a conduit for self diagnosis. Its sole purpose is to share information. The therapies that I use to navigate through my BD and CT symptoms provide me with the relief I need to engage in my everyday life. These therapies may not work for everyone as BD and CT is based on individual experiences.
Please reach out to your health care provider if you or a loved one are experiencing a crisis.
Alternatively you may contact 911 for immediate emergency attention or the toll free suicide prevention hotline in the US and Canada at 988. A list of international crisis hotlines can be found here.
References:
The content of the International Bipolar Foundation blogs is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician and never disregard professional medical advice because of something you have read in any IBPF content.
