Journal Review: 'Preferential Association Between Childhood Emotional Abuse and Bipolar Disorder' - Article Example

? Journal Article Review: 'Preferential Association Between Childhood Emotional Abuse and Bipolar Disorder' Table of Contents Part A: Review 3 I. Introduction 3 II. Methods 3 III. Results 4 IV. Discussion 5 Part B: Reflection 6 References 8 Part A: Review I. Introduction Where genetic determinants have not been conclusively identified, psychological stress factors as determinants of bipolar disorder have been inferred to be a rich research vein, in light of findings that implicate such stress factors to the disorder's onset and recurrence. The article notes that while there has been emphasis on such psychological stress factors as key life events, not as much focus has been given to stress factors from earlier in life, in the form of childhood trauma. On the other hand, the article notes that there are higher incidences of reported trauma in childhood among patients with bipolar disorder compared to patients with unipolar disorder. Moreover, there is a modulation effect that has been found between the traumatic events in childhood and bipolar disorder, in terms of time of onset and a host of conditions that include simultaneous drug use, psychosis, and suicidal tendencies. On the other hand, while the literature strongly suggests that the occurrence of trauma in childhood may be linked to the disorder's onset, expression and eventual treatment outcome, past studies have been methodically hampered by such crucial factors as lacking control groups, small sample sizes, and variances in the tests of assessment, some resorting to interviews and others to questionnaires. To address these and other shortcomings, therefore, the article details the result of a study that had three aims: 1) a retrospective assessment of how prevalent and severe different childhood trauma subtypes are, in bipolar patients and in control groups; 2) to find out what, for different trauma subtypes, the “preferential implications” are relative to bipolar disorder; and 3) to find out what their “dose-effect” are (Etain, 2010). II. Methods 80 percent of screened, approached subjects (100 controls and 250 bipolar subjects) agreed to participate and constituted the sample population, so that the final sample population consisted of 206 bipolar subjects and 94 controls. Further screening tests were conducted on the included subjects to determine their psychiatric fit to their respective groups, in the form of the the Diagnostic Interview for Genetic Studies, prior to the administration of the Childhood Trauma Questionnaire or CTQ. Five trauma subtypes were explored in the CTQ: emotional and physical neglect, and emotional, physical and sexual abuse, where every low severity rating for each subtype by a subject was considered indicative of trauma presence. The data was statistically analyzed, normalized where possible, and the differences in results between the bipolar group and controls were analyzed (Etain, 2010). III. Results The analytical aim was to determine differences between test and control populations. CTQ scores were higher in significant fashion for the bipolar subjects compared to those in the control group. Multiple trauma was defined as the presence of two or more trauma subtypes in a subject, where the severity level is low or higher across the severity gradient (none, low, moderate and severe). Multiple trauma presence was statistically of higher frequency among bipolar subjects compared to controls. Moreover, there was a positive correlation between the total number of trauma on the one hand and the bipolar subjects' proportion for every category (Etain, 2010). Of the five subtypes of trauma investigated, statistical analyses yielded emotional abuse as having significant statistical association with bipolar disorder. Moreover, analysis revealed that strength of emotional abuse correlates with higher proportions of bipolar subjects for each gradient of severity of emotional abuse (Etain, 2010). IV. Discussion The study took off from findings in previous studies of high levels of childhood trauma among bipolar disorder patients ,and went further by 1) investigating the trauma subtypes for their correlation with bipolar disorder, and how severe and frequent those subtypes are for controls and for bipolar patients; 2) the dose effect of each of those trauma subtypes on the disorder. The study validated the initial hypothesis of correlation, while going further by identifying one particular trauma subtype, emotional abuse, as strongly correlated; and identifying that severity and frequency of trauma correlated with more frequent occurrences of the disorder across all levels of severity of abuse. The suggestion is that victims of childhood trauma are at risk of developing bipolar disorder, validating an arguably implicit hypothesis of the study (Etain, 2010). The study notes several limitations. One is that the CTQ was open to bias of recall, which could have affected results, though the proponents were quick to point out that such was unlikely, given the high accuracy and confidence given to CTQ responses. Two, while the bipolar subjects were tested while they were euthymic, or relatively stable, the study notes that the patients could have been suffering from “residual symptoms”, something that could not be fully set aside as a factor affecting responses. Three, there was no gender matching between controls and the bipolar group, even as the study notes that gender was not affective of total CTQ scores there recorded in the study (Etain, 2010). The authors suggest that one potential implication of the findings is that those who suffer from childhood trauma are at an increased risk of developing bipolar disorder, and that that suggestion in turn has implications for treatment of adults with the disorder. The benefit is towards providing clinicians with an insight into treating the disorder, by focusing, for instance, on treatment protocols that focus on the childhood traumas. Moreover, the study was able to lay down the foundation for further validation tests and studies, and new studies related to childhood traumas, emotional abuse and bipolar disorder (Etain, 2010). Part B: Reflection I am suffering from the disorder that was discussed in the article. As a person with bipolar disorder, the article was immensely interesting. The study was quick to note that it did not establish a definite causality between childhood trauma and the development of bipolar disorder. Nonetheless, I think that it is extremely useful information that there is a definite and pronounced association between emotional abuse and bipolar disorder. For one, where clinicians to put the findings to use in treating people with the disorder, they would then have some tacit knowledge of where they have to look for within the patient's life history for possible therapeutic intervention. Aside from looking at more recent life turmoil, which is the conventional practice as the study notes, clinicians and practitioners can go back to a patient's childhood, and look for the presence of trauma there. As a person suffering from the disorder, the insight serves me very well indeed. On my own, I can begin to understand something of my disorder, by maybe looking into my own past and my own childhood, and going through my past to see if I had suffered any kind of emotional trauma. If I did suffer at all, how severe and how frequent that trauma was? How did that trauma affect me then and now? There in the questioning I I can hope to begin looking to help me deal with my own disorder (Etain, 2010). I find it interesting that the study went as far as grading different trauma subtypes, and coming to the conclusion that it is emotional rather than physical abuse, and abuse rather than neglect, that are generally strongly associated with bipolar disorder. This is useful, because it lays the groundwork for studies validating the findings, and for further studies on childhood abuse and bipolar disorder (Etain, 2010). Lastly, commenting on the ethics of the study, the study pointed out that it followed strict ethical protocols. One, they elicited explicit permission from the subjects for participation in the study. Two, the proponents did not gather data from those who refused to be part of the study, citing legal prohibitions. I find this commendable and worth emulating (Etain, 2010). References Etain, B. et al. (2010). Preferential Association Between Childhood Emotional Abuse and Bipolar Disorder. Journal of Traumatic Stress 23 (3). Read More