Introduction: Childhood trauma comes as a result of the child’s exposure to extremely negative and stressful events, which the child cannot elaborate (Bouras and Lazaratou, 2012). Childhood trauma dimensions are emotional neglect, emotional abuse, physical neglect, physical abuse and sexual abuse (Bernstein et al., 1994, Bernstein et al., 2003).
It is known that childhood traumatic events are risk factors for developing all major psychiatric disorders and especially bipolar disorder, and predispose to a higher clinical severity of the disorder (earlier age at onset, increased risk of suicide attempt and increased risk of comorbidity) and worse prognosis (Agnew-Blais and Danese, 2016). Childhood trauma leads to alterations of affective regulation, impulse control and cognitive functioning that might decrease the ability to cope with environmental stressors in adult life (Bucker et al., 2013, Jimenez et al., 2017). More specifically, for psychotic features in Bipolar Disorder, that are classified into mood congruent and mood incongruent, the existing literature is inconsistent regarding their association with childhood trauma (Agnew-Blais and Danese, 2016, Cakir et al., 2016, Etain et al., 2017a, Hammersley et al., 2003, Romero et al., 2009, Upthegrove et al., 2015). Psychiatric family history, for which there are contradictory findings, that is, positive associations (Romero et al., 2009) and negative associations (Thesing et al., 2015) with history of childhood trauma, has not yet been investigated whether it moderates the association between history of childhood trauma and life time psychosis in Bipolar Disorder. Therefore, this is the main aim of the present study.
Aim: Τhe aims of this study are three. First, the comparison of the history of childhood trauma between patients with Bipolar Disorder type I and type II and healthy controls. Second, it will be studied whether family history of major psychiatric disorders (schizophrenia, depression and bipolar disorder) is associated with history of childhood trauma in patients with bipolar disorder. And third, patients with or without psychotic features will be compared on dimensions of childhood trauma taking into account demographics, clinical characteristics and psychiatric family history.
Methods: The sample of the study consists of 149 patients, men and women, aged 18-80 years, with Bipolar Disorder type I (N=99) and II (N=50), who were hospitalized at the inpatient unit or were followed-up at the specialized outpatient clinic of affective disorders of ATTIKON General University Hospital from 2014 until today and 98 control participants. The exclusion criteria in the control group are as follows: 1) no personal history of mental disease, 2) no family history of schizophrenia, depression, bipolar disorder, suicide attempt or other major psychiatric disorder in first degree relatives (siblings, parents and children).
A semi-structured interview based on MINI-5 (Sheehan et al., 1998) was used to record the clinical phenotype of Bipolar Disorder. The self-report Child Abuse and Trauma Scale (CATS) (Sanders and Becker-Lausen, 1995) was used to record the history of childhood trauma. The dimensions of the questionnaire are the following: neglect/negative home atmosphere, sexual abuse, punishment and emotional abuse (Kent and Waller, 1998, Sanders and Becker-Lausen, 1995). The Family Interview for Genetic Studies (FIGS) (NIMH 1992). was used to collect family history. Finally, the control group were given a questionnaire in which socio-demographic data were recorded.
Results: First, patients with Bipolar Disorder I and II had a significantly higher overall childhood trauma score compared to control group. Also, significantly higher were the scores of participants with Bipolar Disorder in all dimensions of the CATS (Child Abuse and Trauma Scale) taking into account all their demographic data (age, gender, years of education, working and family status). Specifically, in the whole sample, women showed significantly higher scores in the dimensions “Neglect/Negative Home Atmosphere” and “Punishment” and in the total CATS score, indicating more trauma compared to men. Also, as the age of the participants increased, their score on the dimension “Neglect/Negative Home Atmosphere” was diminishing, meaning that the older the participants were, the fewer traumatic events they reported, both all patients as well as patients with Bipolar Disorder I. Regarding years of education, the more educated participants were, the lower the score on the “Punishment” dimension was, both in all patients as well as in patients with Bipolar Disorder I. Finally, workers had a significantly lower total CATS score compared to unemployed/students, both in all patients as well as in patients with Bipolar Disorder I.
Second, childhood trauma was not associated with family history of major psychiatric disorders (schizophrenia, depression and bipolar disorder).
Third, psychotic features were not associated with childhood trauma. However a significant interaction effect of lifetime psychosis with family history of bipolar disorder was found for two dimensions of the CATS (Neglect/Negative Home Atmosphere, Emotional abuse ) and for the total CATS score only in patients with Bipolar Disorder type I, but not in the total number of patients. That is, the presence of lifetime psychosis was associated with greater scores on the aforementioned dimensions in patients with Bipolar Disorder type I without a family history of bipolar disorder, while associated with lower scores in patients with Bipolar Disorder type I with a family history of bipolar disorder, indicating that patients with a family history of bipolar disorder had psychotic features with less childhood trauma while patients without a family history of bipolar disorder had psychotic features with more childhood trauma.
Conclusion: Childhood trauma and psychiatric family history have competing effects on psychosis (negative interaction) in Bipolar Disorder. The moderating role of psychiatric family history might explain the literature inconsistencies in associations between history of childhood trauma and psychotic features in Bipolar Disorder.