Childhood maltreatment and bipolar disorder

Freitag, Kapoor, & Lamis, (2022) published “Childhood Maltreatment, Impulsive Aggression, and suicidality among patients diagnosed with bipolar disorder” in Psychological Trauma: Theory, Research, Practice, and Policy. I was drawn to this article because of the first two lines in the abstract: “Bipolar disorder is associated with a history of childhood maltreatment, impulsive aggression, and lethal suicide attempts. Often, aggression and violence prevent the diagnosed individual from receiving timely access to mental health care, leading to adverse outcomes such as repeated psychiatric hospitalization or even incarceration.”

They recruited a sample of 150 low-income patients with bipolar disorder who sought services from an outpatient behavioral health clinic. Here is the rest of the abstract:

We explored whether different types of childhood maltreatment (physical, sexual, emotional) are associated with impulsive aggression among individuals with bipolar disorder. Additionally, we examined whether impulsive aggression is related to suicidality. Finally, we sought to test the potential mediated effect of impulsive aggression on the relationship between childhood maltreatment and suicidality. Results: Findings suggest that all direct associations were significant and that impulsive aggression was a significant mediator in the relationship between childhood emotional and sexual abuse. However, when childhood physical abuse was included as an independent variable in the model, impulsive aggression did not mediate the association, even though impulsive aggression was related to suicidality. Conclusion: Results from this study suggest that impulsive aggression exerts a wide-ranging impact on suicidality in the context of childhood trauma in those with bipolar disorder. In the future, targeted interventions to address the underlying etiologies of aggression may translate into an improved quality of life, decreased rates of suicidality, and positive clinical outcomes among individuals with bipolar disorder.

As is often the case, I recognize the need for more research, but I see ample opportunity for diagnosticians and clinicians to ask better questions of clients with bipolar disorder. Impulsive aggressive behavior has been examined in numerous disorders (e.g., attention deficit and conduct disorders) and linked to both midbrain and prefrontal cortical regions. I also find it interesting that childhood physical abuse overrides the mediating power of impulsive aggression.