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J Psychiatr Res. 2017 Dec;95:37-45. doi: 10.1016/j.jpsychires.2017.07.013. Epub 2017 Jul 29.

Childhood trauma, dimensions of psychopathology and the clinical expression of bipolar disorders: A pathway analysis.

Author information

1
AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Fondation Fondamental, Créteil, France. Electronic address: bruno.etain@inserm.fr.
2
Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France.
3
Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France; Institut Pasteur, Unité Perception et Mémoire, Paris, France.
4
Fondation Fondamental, Créteil, France; Service de Psychiatrie, Centre Hospitalier Princesse-Grace, Avenue Pasteur, Monaco.
5
Fondation Fondamental, Créteil, France; Pôle de Psychiatrie, Hôpital Sainte Marguerite, Assistance Publique Hôpitaux de Marseille, France; Aix-Marseille Université, CNRS, CRN2M UMR 7286, Marseille, France.
6
AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France; Université Paris Diderot, UMR-S 1144, Paris, France; Fondation Fondamental, Créteil, France.
7
Fondation Fondamental, Créteil, France; Clinique Universitaire de Psychiatrie, CHU de Grenoble, Grenoble, France.
8
Fondation Fondamental, Créteil, France; Département d'Urgence et Post Urgence Psychiatrique, CHRU Montpellier, INSERM U1061, Université Montpellier 1, Montpellier, France.
9
Fondation Fondamental, Créteil, France; Centre Expert Trouble Bipolaire, Pôle de Psychiatrie Générale Universitaire, Centre Hospitalier Charles Perrens, Bordeaux, France.
10
Fondation Fondamental, Créteil, France; Université de Lorraine, CHU de Nancy et Pôle 6 de Psychiatrie et Psychologie Clinique, Centre Psychothérapique de Nancy, 1 rue du Docteur Archambault, Laxou Cedex, France.
11
Fondation Fondamental, Créteil, France; Université de Versailles Saint-Quentin, Centre Hospitalier de Versailles, Service de Psychiatrie Adulte, Le Chesnay, France.
12
Fondation Fondamental, Créteil, France; Inserm, U955, Equipe Psychiatrie Translationnelle, Créteil, France; Université Paris Est, Faculté de Médecine, Créteil, France; AP-HP, Hôpitaux Universitaires Henri Mondor, DHU Pepsy, Pôle de Psychiatrie et d'Addictologie, Créteil, France.
13
Center in Creteil, France.
14
Center in Paris, France.
15
Center in Bordeaux, France.
16
Center in Montpellier, France.
17
Center in Marseille, France.
18
Center in Nancy, France.
19
Center in Grenoble, France.
20
Center in Versailles, France.
21
Center in Monaco, France.

Abstract

BACKGROUND:

This study aims at testing for paths from childhood abuse to clinical indicators of complexity in bipolar disorder (BD), through dimensions of affective dysregulation, impulsivity and hostility.

METHOD:

485 euthymic patients with BD from the FACE-BD cohort were included from 2009 to 2014. We collect clinical indicators of complexity/severity: age and polarity at onset, suicide attempt, rapid cycling and substance misuse. Patients completed questionnaires to assess childhood emotional, sexual and physical abuses, affective lability, affect intensity, impulsivity, motor and attitudinal hostility.

RESULTS:

The path-analysis demonstrated significant associations between emotional abuse and all the affective/impulsive dimensions (p < 0.001). Sexual abuse was moderately associated with emotion-related dimensions but not with impulsivity nor motor hostility. In turn, affect intensity and attitudinal hostility were associated with high risk for lifetime presence of suicide attempts (p < 0.001), whereas impulsivity was associated with a higher risk of lifetime presence of substance misuse (p < 0.001). No major additional paths were identified when including Emotional and Physical Neglect in the model.

CONCLUSIONS:

This study provides refinement of the links between early adversity, dimensions of psychopathology and the complexity/severity of BD. Mainly, dimensions of affective dysregulation, impulsivity/hostility partially mediate the links between childhood emotional to suicide attempts and substance misuse in BD.

KEYWORDS:

Affect instability; Age at onset; Bipolar disorder; Childhood trauma; Emotional abuse; Hostility; Lability impulsivity; Polarity at onset; Rapid cycling; Sexual abuse; Substance misuse; Suicide

[Indexed for MEDLINE]

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