Childhood Trauma Associated With Impulsivity in Bipolar Disorder

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Patients with bipolar disorder most often reported emotional abuse, emotional neglect, and physical neglect.
Patients with bipolar disorder most often reported emotional abuse, emotional neglect, and physical neglect.

A causal relationship was identified between childhood trauma and impulsive behavior in patients with bipolar disorder (BD), according to research findings published in the Journal of Affective Disorders. However, no similar association was identified in patients with attention-deficit/hyperactivity disorder (ADHD) or borderline personality disorder (BPD).

The patient cohort comprised patients with BD (n=276), BPD (n=168), ADHD (n=173), and healthy controls (n=47). Individuals with comorbid conditions were also recruited for sensitivity analyses, including patients with BPD and BD (n=29). Patients were recruited from the Psychiatric Specialties Service of Geneva's University Hospitals, in Switzerland; healthy controls were selected from the University of Geneva. Investigators used the Barratt Impulsivity Scale (BIS) and the Childhood Trauma Questionnaire to capture patient features of impulsivity.

Following adjustment for age and gender, the total BIS scores differed significantly between groups (P <.001). The ADHD group scored higher than the other cohorts on the total BIS scale, as well as on the Motor Impulsivity Subscale, the Anticipation Subscale, and the Cognitive Impulsivity Subscale. Patients with BPD scored significantly higher than patients with BD and healthy controls on the Cognitive Impulsivity subscale. Patients with BD had impulsivity scores similar to those of the healthy controls. In addition, sensitivity analyses found that patients with comorbid BPD and BD had impulsivity levels similar to those of patients with sole BPD, suggesting that the addition of BD had no influence on impulsivity. Per the Childhood Trauma Questionnaire, each diagnostic group differed significantly with regard to reported trauma (P <.0001). Patients with BD most often reported emotional abuse, emotional neglect, and physical neglect. Per linear regression analyses, impulsivity was positively associated with Childhood Trauma Questionnaire total score (P <.001) in patients with BD, suggesting that childhood trauma influences impulsivity rather than any inherent disease feature. No similar trend was observed in patients in other diagnostic categories, suggesting that impulsivity may be an inherent feature of BPD and ADHD.

These data suggest that impulsive behavior is not a feature of BD but is instead influenced by traumatic childhood experiences. Clinicians may find this data informative in accommodating patients with childhood trauma and BD; early intervention may reduce impulsivity and improve the treatment course.

Reference

Richard-Lepouriel H, Kung A-L, Hasler R, et al. Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder [published online August 6, 2018]. J Affect Disord. doi:10.1016/j.jad.2018.07.060

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