Childhood Trauma Related Manicdepressive Bipolar Disorder
Manic-Depressive Bipolar Disorder in children, as well as adults could be related to early childhood trauma, in that the physical aspects of the illness could be an emotional and behavioral response to early stressors, much like stressful events have been shown to trigger other kinds of physical illness. The probable cause for bipolar disorder in early childhood has yet to be ascertained, though a plausible explanation could include a response to early traumatic events as well as biological components. Though adjustment disorders and some mood disorders develop in response to recent stressors, many major depressions are clearly related to an earlier occurring stressful event (Carson, Butcher, Mineka, 213). Stressful life events have been shown to potentially precipitate the various manic-depressive episodes of bipolar disorder (Cogan). Few depressions occur in the absence of some significant anxiety producing factor (Carson, 216). “Research findings, clinical experience, and family accounts provide substantial evidence that bipolar disorder, also called manic-depressive illness, can occur in children and adolescents”(NIMH). While proper diagnosis is necessary, it is important to recognize that bipolar disorder may be superimposed on children who are demoralized and have a lowered self-esteem, making diagnosis difficult at best (Cogan).
Bipolar disorder is typically a recurrent disorder (Carson, 221). One study found a significant association between high levels of stress and manic-depressive episodes. Stress was a important continuing factor in those who had more and longer episodes of illness. Another study found that patients with more prior episodes were more likely to have an episode after a stressful event, such as childhood sexual abuse. A recent study found that severe negative events often caused patient recovery to take three times longer than a patient without a severe negative event; with minor negative events also increasing recovery time somewhat. Severe stressful life events are clearly predictive of depression, with new occurrences of stressors making recurring depression more probable (Carson, 218, 219). Therapeutic efforts attempt to reduce the number and severity of these stressful events, which in turn will reduce manic-depressive episodes.
These episodes of mania mixed with symptoms of depression seem to be more common in women than in men, as is the incidence of childhood sexual abuse more prevalent in women. Bipolar disorder is also prevalent among casualties of suicidal behavior, who have often been found to have experienced traumatic events such as childhood physical or sexual abuse early in life as well. Attempters and completers of suicide share common characteristics including psychic turmoil within a cyclical bipolar disorder pattern (Kelly, Cornelius, Lynch). With the prevalence of childhood abuse rising, childhood bipolar disorder will likely reflect that ascent.
Stressful life events may precipitate manic or depressive episodes early in the course of bipolar disorder. As the disorder unfolds, there seems to be less a connection between specific preceding events and particular episodes of the disease, though most studies that support this view depend on possibly unreliable patient memories (Carson, 247). The spontaneous recovery of electroconvulsive therapy (electric shock) patients resulting in sudden feelings of wellness after several treatments for some individuals seems to support the theory of earlier traumas triggering manic-depressive episodes. Memory impairment associated with electroconvulsive therapy may mimic the dissociative memory loss in individuals who have experienced traumatic events such as childhood sexual abuse, thereby allowing the patient to recover from illness. This dissociation from perceived trauma is a complex defense mechanism activated to deal with the psychologically stressful event, which is only partially recalled or totally forgotten for a period of time until some cue acting as a reminder reactivates the traumatic memory.
Manic-depression may be seen as defense mechanisms for dealing with the severe stressors a person may face. Manic episodes seem to be an escape route from the reality of negative events by the expenditure of great amounts of energy in the distractions of a multitude of activities until the depression of emotional exhaustion sets in. The full-speed-ahead action oriented high ends up in a no energy, no motivation low of an emotional rollercoaster, which results in the erratic shifts in behavior. Some highly creative individuals are known to have these kinds of extremes. Poets, writers, artists, and composers have a high frequency of bipolar disorder, with the increased level of output in the manic stages often resulting in great accomplishments. Though these individuals may appear to have a high self-esteem, this seems to be essentially a defensive stance. When their defense mechanisms break down, a menacing depression occurs. Yet when depressed people rebound and immerse themselves into activity, manic behavior takes over once again.
The destabilizing effects that stressful events have on biological rhythms, is a possible hypothesis. Sleep deprivation has been shown to precipitate manic episodes (Cogan). Recent evidence suggests that other variables like cognitive and personality factors may interact with stressful life events in determining the potential for initial bipolar episodes or a relapse of symptoms. Personal feelings of false guilt and the self-devaluing thought processes associated with childhood physical and sexual abuse may be important factors in this manic-depressive cycle. When perceived personal responsibility for devastating circumstances such as a rape becomes despairing to the individual, depression usually follows unless some form of intervention takes place. Guilt-ridden thought processes must be changed in order to over come these manic-depressive states. A thorough examination of thought processes should precipitate any form of pharmacological therapy, because these primarily treat symptoms rather than the underlying stressors which caused the symptoms.
Beck’s Cognitive Theory supports the idea that precipitating stressful life events when perceived negatively, can lead to manic-depressive episodes. These negative cognitions are integral to depressed states of mind (Carson, 234). The negative thinking patterns tend to induce depression in those individuals. Dysfunctional beliefs that are rigid, extreme, and counterproductive evidently trigger these bouts of depression. This depression may be linked to insecure attachments stemming from patterns established in early significant relationships. Death, divorce, emotional apathy, and child abuse can contribute to depressive symptoms in children, as well as in adults. Thoughts and beliefs of personal unhappiness are thought to develop during childhood and adolescence based on these kinds of experiences.
Children who have experienced the trauma of a major loss of relationship or a neglectful or abusive relationship are prone to develop varying degrees of depression later in life. The underlying depressive beliefs make a person more vulnerable to repetitive episodic depression, although they may hibernate for years in the absence of significant stressors. Feelings of unhappiness and a lack of motivation are key factors in many episodes of depression. When these dysfunctional beliefs are reactivated by new stressors, a negative pattern of automatic thought often develops. These negative automatic thoughts occur just below the level of conscious awareness, involving pessimistic predictions about the self, the world, and the future.
This cognitive triad once activated, is maintained by several biases and distortions of thought. Some of these perversions include patterns of all or none thinking, selectively focusing on a negative aspect, jumping to negative conclusions, and exaggerated overgeneralizations. If the negative views already held in the thought content are exaggerated by additional overly negative conclusions about current stressful events, then symptoms of depression are more likely to occur (Carson, 234). The more negative the thinking pattern, the more likely depression will follow. This negative thinking that Beck describes occurs in all cases of depression, as depressed people tend to recall negative events much more frequently and clearly than non-depressed individuals.
Patterns of temperament with emotional reactivity, rather than interpersonal constructs, seem to be implicated in the biological underpinnings of personalities that develop behavioral abnormalities. While one study found that highly introverted obsessive persons were especially responsive to negative stress, another found pessimistic attributes when combined with negative events increased depressive symptoms also (Carson 248). An imbalance in levels of Serotonin, the neurotransmitter associated with mood disorders and suicidal behavior, is implicated in many illnesses, including bipolar, unipolar, personality disorders and OCD’s (obsessive-compulsive disorders). While the biological predisposition cannot be ignored, psychosocial causal factors are at least as relevant as the biological causal factors in mood disorders (Carson, 229). Childhood trauma of any consequence, may in fact be a precursor to bipolar disorder. Childhood sexual abuse in particular, can have particularly devastating effects on the child, which may not appear until young adulthood due to dissociate processes. When these traumatic events are triggered back into conscious memory, bipolar disorder may result.