Verbal abuse worsens bipolar disease outcome

By Lucy Piper, Senior medwireNews Reporter

Experiencing verbal abuse in childhood has a lasting negative effect on the course of bipolar disorder, researchers have found.

Similar to a history of sexual and physical abuse, verbal abuse in isolation was associated with an earlier onset of bipolar disorder and worse prognosis compared with no abuse.

“[T]hese findings are of considerable interest from a clinical, theoretical, and treatment intervention perspective”, say the researchers, led by Robert Post (Bipolar Collaborative Network, Bethesda, Maryland, USA).

They say that reducing the “impact of verbal abuse on the unfolding course of bipolar disorder appears to be an important target of therapeutics and worthy of attempts at primary and secondary prophylaxis.”

Of 634 adults with bipolar disorder, aged 40 years on average, 151 (24%) experienced verbal abuse in isolation as a child. These individuals were aged, on average, 16.5 years at the onset of bipolar disorder, compared with 20.6 years for the 223 patients with no history of abuse.

This earlier age at onset was similar to that for the 30 (5%) patients who had a history of sexual abuse, at 17.5 years, and the presence of additional types of abuse lowered the age of onset further, with the lowest age, at 13.1 years, seen in the 87 (14%) patients who had a history of verbal, physical and sexual abuse.

The effect of verbal abuse on age of bipolar onset was related to its frequency, with patients reporting having experienced verbal abuse “occasionally” or “frequently” developing bipolar disorder earlier than those experiencing it “never” or “rarely”.

The researchers report in Bipolar Disorders that “[v]erbal abuse even in the absence of physical or sexual abuse is not benign and does seem to convey important and long-lasting effects on bipolar illness onset and course.”

They found that patients with a history of verbal abuse were more likely to have comorbid anxiety disorder and drug abuse, at 52% and 38%, respectively, than those without such a history, at 34% and 27%. Rapid cycling also occurred at a higher rate, at 74% versus 63%.

There was also evidence suggesting that experiencing childhood verbal abuse was related to progression or deterioration of bipolar disorder, in that affected patients were significantly more likely to rate a “definite” increase in the severity of depression, mania and mood episode frequency.

Given the potential neurobiological effects of verbal abuse, the team recommends interventions such as family-focused treatment to prevent the occurrence of verbal abuse and other psychotherapies to lessen its effects.

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