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Journal of Abnormal Child Psychology

, Volume 43, Issue 3, pp 453–463 | Cite as

Physical and Sexual Abuse and Early-Onset Bipolar Disorder in Youths Receiving Outpatient Services: Frequent, but Not Specific

  • Tina Du Rocher Schudlich
  • Eric A. Youngstrom
  • Maria Martinez
  • Jennifer KogosYoungstrom
  • Kelly Scovil
  • Jody Ross
  • Norah C. Feeny
  • Robert L. Findling
Article

Abstract

The objective of this study was to determine if physical and sexual abuse showed relationships to early-onset bipolar spectrum disorders (BPSD) consistent with findings from adult retrospective data. Participants (N = 829, M = 10.9 years old ± 3.4 SD, 60 % male, 69 % African American, and 18 % with BPSD), primarily from a low socio-economic status, presented to an urban community mental health center and a university research center. Physical abuse was reported in 21 %, sexual abuse in 20 %, and both physical and sexual abuse in 11 % of youths with BPSD. For youths without BPSD, physical abuse was reported in 16 %, sexual abuse in 15 %, and both physical and sexual abuse in 5 % of youths. Among youth with BPSD, physical abuse was significantly associated with a worse global family environment, more severe depressive and manic symptoms, a greater number of sub-threshold manic/hypomanic symptoms, a greater likelihood of suicidality, a greater likelihood of being diagnosed with PTSD, and more self-reports of alcohol or drug use. Among youth with BPSD, sexual abuse was significantly associated with a worse global family environment, more severe manic symptoms, a greater number of sub-threshold manic/hypomanic symptoms, greater mood swings, more frequent episodes, more reports of past hospitalizations, and a greater number of current and past comorbid Axis I diagnoses. These findings suggest that if physical and/or sexual abuse is reported, clinicians should note that abuse appears to be related to increased severity of symptoms, substance use, greater co-morbidity, suicidality, and a worse family environment.

Keywords

Bipolar disorder Sexual abuse Physical abuse Children Adolescents 

Notes

Acknowledgments

This research was supported by NIH 5R01 MH066647 (PI: E. Youngstrom). Dr. Findling receives or has received research support, acted as a consultant and/or served on a speaker’s bureau for Alexza Pharmaceuticals, American Academy of Child & Adolescent Psychiatry, American Physician Institute, American Psychiatric Press, AstraZeneca, Bracket, Bristol-Myers Squibb, Clinsys, Cognition Group, Coronado Biosciences, Dana Foundation, Forest, GlaxoSmithKline, Guilford Press, Johns Hopkins University Press, Johnson & Johnson, KemPharm, Lilly, Lundbeck, Merck, NIH, Novartis, Noven, Otsuka, Oxford University Press, Pfizer, Physicians Postgraduate Press, Rhodes Pharmaceuticals, Roche, Sage, Seaside Pharmaceuticals, Shire, Stanley Medical Research Institute, Sunovion, Supernus Pharmaceuticals, Transcept Pharmaceuticals, Validus, and WebMD.Dr. E. Youngstrom has received travel support from Bristol-Myers Squibb and consulted with Lundbeck.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington: University of Vermont.Google Scholar
  2. Agresti, A. (2002). Categorical data analysis. New York: Wiley.CrossRefGoogle Scholar
  3. Algorta, G. P., Youngstrom, E. A., Frazier, T. W., Freeman, A. J., Youngstrom, J. K., & Findling, R. L. (2011). Suicidality in pediatric bipolar disorder: predictor or outcome of family processes and mixed mood presentation? Bipolar Disorders, 13, 76–86. doi: 10.1111/j.1399-5618.2010.00886.x.CrossRefPubMedCentralPubMedGoogle Scholar
  4. Alloy, L. B., Abramson, L. Y., Urosevic, S., Walshaw, P. D., Nusslock, R., & Neeren, A. M. (2005). The psychosocial context of bipolar disorder: environmental, cognitive, and developmental risk factors. Clinical Psychology Review, 25, 1043–1075. doi: 10.1016/j.cpr.2005.06.006.CrossRefPubMedGoogle Scholar
  5. Alloy, L. B., Abramson, L. Y., Walshaw, P. D., Keyser, J., & Gerstein, R. K. (2006). A cognitive vulnerability-stress perspective on bipolar spectrum disorders in a normative adolescent brain, cognitive, and emotional development context. Development & Psychopathology, 18, 1055–1103. doi: 10.1017/S0954579406060524.CrossRefGoogle Scholar
  6. Althoff, R. R., Faraone, S. V., Rettew, D. C., Morley, C. P., & Hudziak, J. J. (2005). Family, twin, adoption, and molecular genetic studies of juvenile bipolar disorder. Bipolar Disorders, 7, 598–609. doi: 10.1111/j.1399-5618.2005.00268.x.CrossRefPubMedGoogle Scholar
  7. Axelson, D. A., Birmaher, B. J., Brent, D., Wassick, S., Hoover, C., Bridge, J., & Ryan, N. (2003). A preliminary study of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children mania rating scale for children and adolescents. Journal of Child and Adolescent Psychopharmacology, 13, 463–470.CrossRefPubMedGoogle Scholar
  8. Axelson, D. A., Birmaher, B., Strober, M. A., Goldstein, B. I., Ha, W., Gill, M. K., & Keller, M. B. (2011). Course of subthreshold bipolar disorder in youth: diagnostic progression from bipolar disorder not otherwise specified. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1001–1016), e1003. doi: 10.1016/j.jaac.2011.07.005.Google Scholar
  9. Birmaher, B., Axelson, D., Strober, M., Gill, M. K., Valeri, S., Chiappetta, L., & Keller, M. (2006). Clinical course of children and adolescents with bipolar spectrum disorders. Archives of General Psychiatry, 63, 175–183. doi: 10.1001/archpsyc.63.2.175.CrossRefPubMedCentralPubMedGoogle Scholar
  10. Bremner, J. D., Randall, P., Vermetten, E., Staib, L., Bronen, R. A., Mazure, C., & Charney, D. S. (1997). Magnetic resonance imaging-based measurement of hippocampal volume in posttraumatic stress disorder related to childhood physical and sexual abuse–a preliminary report. Biological Psychiatry, 41, 23–32.CrossRefPubMedCentralPubMedGoogle Scholar
  11. Brown, G. R., McBride, L., Bauer, M. S., & Williford, W. O. (2005). Impact of childhood abuse on the course of bipolar disorder: a replication study in U.S. veterans. Journal of Affective Disorders, 89, 57–67. doi: 10.1016/j.jad.2005.06.012.CrossRefPubMedGoogle Scholar
  12. Carlson, G. A., & Meyer, S. E. (2006). Phenomenology and diagnosis of bipolar disorder in children, adolescents, and adults: complexities and developmental issues. Development & Psychopathology, 18, 939–969.CrossRefGoogle Scholar
  13. Carlson, G. A., Bromet, E. J., & Sievers, S. (2000). Phenomenology and outcome of subjects with early- and adult-onset psychotic mania. American Journal of Psychiatry, 157, 213–219.CrossRefPubMedGoogle Scholar
  14. Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multi-site, randomized controlled trial for sexually abused children with PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 393–402.CrossRefPubMedCentralPubMedGoogle Scholar
  15. Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., & Van der Kolk, B. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.Google Scholar
  16. Danielson, C. K., Youngstrom, E. A., Findling, R. L., & Calabrese, J. R. (2003). Discriminative validity of the general behavior inventory using youth report. Journal of Abnormal Child Psychology, 31, 29–39.CrossRefPubMedGoogle Scholar
  17. Depue, R. A., Slater, J. F., Wolfstetter-Kausch, H., Klein, D., Goplerud, E., & Farr, D. (1981). A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: a conceptual framework and five validation studies. Journal of Abnormal Psychology, 90, 381–437.CrossRefPubMedGoogle Scholar
  18. Edvardsen, J., Torgersen, S., Roysamb, E., Lygren, S., Skre, I., Onstad, S., & Oien, P. A. (2008). Heritability of bipolar spectrum disorders. Unity or heterogeneity? Journal of Affective Disorders, 106, 229–240. doi: 10.1016/j.jad.2007.07.001.CrossRefPubMedGoogle Scholar
  19. Etain, B., Mathieu, F., Henry, C., Raust, A., Roy, I., Germain, A., Leboyer, M., & Belliver, F. (2010). Preferential association between childhood emotional abuse and bipolar disorder. Journal of Traumatic Stress, 23, 376–383.PubMedGoogle Scholar
  20. Fergusson, D. M., & Lynskey, M. T. (1997). Physical punishment/maltreatment during childhood and adjustment in young adulthood. Child Abuse & Neglect, 21, 617–630.CrossRefGoogle Scholar
  21. Findling, R. L., Gracious, B. L., McNamara, N. K., Youngstrom, E. A., Demeter, C., & Calabrese, J. R. (2001). Rapid, continuous cycling and psychiatric co-morbidity in pediatric bipolar I disorder. Bipolar Disorders, 3, 202–210.CrossRefPubMedGoogle Scholar
  22. Findling, R. L., Frazier, T. W., Youngstrom, E. A., McNamara, N. K., Stansbrey, R. J., Gracious, B. L., & Calabrese, J. R. (2007). Double-blind, placebo-controlled trial of divalproex monotherapy in the treatment of symptomatic youth at high risk for developing bipolar disorder. Journal of Clinical Psychiatry, 68, 781–788.CrossRefPubMedGoogle Scholar
  23. Findling, R. L., Jo, B., Frazier, T. W., Youngstrom, E. A., Demeter, C. A., Fristad, M. A., & Horwitz, S. M. (2013). The 24-month course of manic symptoms in children. Bipolar Disorders. doi: 10.1111/bdi.12100.Google Scholar
  24. Garno, J. L., Goldberg, J. F., Ramirez, P. M., & Ritzler, B. A. (2005). Impact of childhood abuse on the clinical course of bipolar disorder. British Journal of Psychiatry, 186, 121–125. doi: 10.1192/bjp.186.2.121.CrossRefPubMedGoogle Scholar
  25. Geller, B., Zimerman, B., Williams, M., Bolhofner, K., Craney, J. L., DelBello, M. P., & Soutullo, C. (2001). Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 450–455.CrossRefGoogle Scholar
  26. Goldstein, B. I., & Levitt, A. J. (2006). Further evidence for a developmental subtype of bipolar disorder defined by age at onset: results from the national epidemiologic survey on alcohol and related conditions. American Journal of Psychiatry, 163, 1633–1636. doi: 10.1176/appi.ajp.163.9.1633.CrossRefPubMedGoogle Scholar
  27. Goldstein, B. L., Shamseddeen, W., Axelson, D. A., Kalas, C., Monk, K., Brent, D. A., Kupfer, D. J., & Birmaher, B. (2010). Clinical, demographic, and familial correlates of bipolar spectrum disorders among school-aged offspring of parents with bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 388–396.Google Scholar
  28. Hall, M. B. (1952). Our present knowledge about manic-depressive states in childhood. The Nervous Child, 9, 319–325.Google Scholar
  29. Hammersley, P., Dias, A., Todd, G., Bowen-Jones, K., Reilly, B., & Bentall, R. P. (2003). Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. British Journal of Psychiatry, 182, 543–547.CrossRefPubMedGoogle Scholar
  30. Haslam, N., Holland, E., & Kuppens, P. (2012). Categories versus dimensions in personality and psychopathology: a quantitative review of taxometric research. Psychological Medicine, 42, 903–920. doi: 10.1017/S0033291711001966.CrossRefPubMedGoogle Scholar
  31. Hollingshead, A. B. (1975). Four Factor Index of Social Status. Unpublished working paper, Department of Sociology, Yale University, New Haven, CT.Google Scholar
  32. Hyun, M., Friedman, S. D., & Dunner, D. L. (2000). Relationship of childhood physical and sexual abuse to adult bipolar disorder. Bipolar Disorders, 2, 131–135.CrossRefPubMedGoogle Scholar
  33. Issac, G. (1991). Bipolar disorder in prepubertal children in a special education setting: Is it rare? Journal of Clinical Psychiatry, 52, 165–168.Google Scholar
  34. Kaufman, J., Birmaher, B., Brent, D., Rao, U., Flynn, C., Moreci, P., & Ryan, N. (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child &Adolescent Psychiatry, 36, 980–988. doi: 10.1097/00004583-199707000-00021.CrossRefGoogle Scholar
  35. Kowatch, R. A., Youngstrom, E. A., Danielyan, A., & Findling, R. L. (2005). Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescents. Bipolar Disorders, 7, 483–496.CrossRefPubMedGoogle Scholar
  36. Leibenluft, E., Charney, D. S., Towbin, K. E., Bhangoo, R. K., & Pine, D. S. (2003). Defining clinical phenotypes of juvenile mania. American Journal of Psychiatry, 160, 430–437.CrossRefPubMedGoogle Scholar
  37. Leverich, G. S., McElroy, S. L., Suppes, T., Keck, P. E., Jr., Denicoff, K. D., Nolen, W. A., & Post, R. M. (2002). Early physical and sexual abuse associated with an adverse course of bipolar illness. Biological Psychiatry, 51, 288–297.CrossRefPubMedGoogle Scholar
  38. Levitan, R. D., Parikh, S. V., Lesage, A. D., Hegadoren, K. M., Adams, M., Kennedy, S. H., & Goering, P. N. (1998). Major depression in individuals with a history of childhood physical or sexual abuse: relationship to neurovegetative features, mania, and gender. American Journal of Psychiatry, 155, 1746–1752.CrossRefPubMedGoogle Scholar
  39. Loftus, E. F., Garry, M., & Feldman, J. (1994). Forgetting sexual trauma: what does it mean when 38% forget? Journal of Consulting & Clinical Psychology, 62, 1177–1181. discussion 1182–1176.CrossRefGoogle Scholar
  40. Lucas, C. P., Fisher, P., Piacentini, J., Zhang, H., Jensen, P. S., Shaffer, D., & Canino, G. (1999). Features of interview questions associated with attenuation of symptom reports. Journal of Abnormal Child Psychology, 27, 429–437.CrossRefPubMedGoogle Scholar
  41. Maniglio, R. (2010). Child sexual abuse in the etiology of depression: a systematic review of reviews. Depression and Anxiety, 27, 631–642. doi: 10.1002/da.20687.CrossRefPubMedGoogle Scholar
  42. Maniglio, R. (2013a). The impact of child sexual abuse on the course of bipolar disorder: a systematic review. Bipolar Disorders. doi: 10.1111/bdi.12050.PubMedGoogle Scholar
  43. Maniglio, R. (2013b). Prevalence of child sexual abuse among adults and youths with bipolar disorder: a systematic review. Clinical Psychology Review, 33, 561–573. doi: 10.1016/j.cpr.2013.03.002.CrossRefPubMedGoogle Scholar
  44. Maniglio, R. (2013c). Prevalence of sexual abuse among children with conduct disorder: a systematic review. Clinical Child and Family Psychology Review. doi: 10.1007/s10567-013-0161-z. Advance online publication.Google Scholar
  45. Marchand, W. R., Wirth, L., & Simon, C. (2005). Adverse life events and pediatric bipolar disorder in a community mental health setting. Community Mental Health Journal, 41, 67–75.CrossRefPubMedGoogle Scholar
  46. McIntyre, R. S., Soczynska, J. K., Mancini, D., Lam, C., Woldeyohannes, H. O., Moon, S., & Kennedy, S. H. (2008). The relationship between childhood abuse and suicidality in adult bipolar disorder. Violence & Victims, 23, 361–372.CrossRefGoogle Scholar
  47. Petti, T., Reich, W., Todd, R. D., Joshi, P., Galvin, M., Reich, T., & Nurnberger, J. (2004). Psychosocial variables in children and teens of extended families identified through bipolar affective disorder probands. Bipolar Disorders, 6, 106–114.CrossRefPubMedGoogle Scholar
  48. Post, R. M., & Kowatch, R. A. (2006). The health care crisis of childhood-onset bipolar illness: some recommendations for its amelioration. Journal of Clinical Psychiatry, 67, 115–125.CrossRefPubMedGoogle Scholar
  49. Prisciandaro, J. J., & Roberts, J. E. (2011). Evidence for the continuous latent structure of mania in the Epidemiologic Catchment Area from multiple latent structure and construct validation methodologies. Psychological Medicine, 41, 575–588. doi: 10.1017/S0033291710001078.CrossRefPubMedCentralPubMedGoogle Scholar
  50. Rey, J. M., Singh, M., Hung, S.-F., Dossetor, D. R., Newman, L., Plapp, J. M., & Bird, K. D. (1997). A global scale of measure the quality of the family environment. Archives of General Psychiatry, 54, 817–822.CrossRefPubMedGoogle Scholar
  51. Romero, S., Birmaher, B., Axelson, D., Goldstein, T., Goldstein, B. I., Gill, M. K., & Keller, M. (2009). Prevalence and correlates of physical and sexual abuse in children and adolescents with bipolar disorder. Journal of Affective Disorders, 112, 144–150. doi: 10.1016/j.jad.2008.04.005.CrossRefPubMedCentralPubMedGoogle Scholar
  52. Russo, M., Proujansky, R., Gilbert, A., Braga, R. J., & Burdick, K. E. (2013). Initial evidence for sex-specific effects of early emotional abuse on affective processing in bipolar disorder. European Psychiatry. doi: 10.1016/j.eurpsy.2013.06.005.Google Scholar
  53. SAMHSA. (2012). Mental Health, United States, 2010. Rockville: Substance Abuse and Mental Health Services Administration.Google Scholar
  54. Schulze, T. G., Muller, D. J., Krauss, H., Gross, M., Fangerau-Lefevre, H., Illes, F., & Rietschel, M. (2002). Further evidence for age of onset being an indicator for severity in bipolar disorder. Journal of Affective Disorders, 68, 343–345.CrossRefPubMedGoogle Scholar
  55. Shaffer, D., Gould, M. S., Brasic, J., Ambrosini, P., Fisher, P., Bird, H., & Aluwahlia, S. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228–1231.CrossRefPubMedGoogle Scholar
  56. Steinberg, A., Brymer, S., Briggs, E., Ippen, C., Ostrowski, S., & Pynoos, R. (2013). Psychometric properties of the UCLA PTSD Reaction Index: Part I. Journal of Traumatic Stress, 26, 1–9.CrossRefPubMedGoogle Scholar
  57. Sugaya, L., Hasin, D. S., Olfson, M., Lin, K. H., Grant, B. F., & Blanco, C. (2012). Child physical abuse and adult mental health: a national study. Journal of Traumatic Stress, 25, 384–392. doi: 10.1002/jts.21719.CrossRefPubMedCentralPubMedGoogle Scholar
  58. Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston: Allyn & Bacon.Google Scholar
  59. Tillman, R., Geller, B., Klages, T., Corrigan, M., Bolhofner, K., & Zimerman, B. (2008). Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological). Bipolar Disorders, 10, 45–55. doi: 10.1111/j.1399-5618.2008.00480.x.CrossRefPubMedGoogle Scholar
  60. Van Meter, A., Youngstrom, E. A., Youngstrom, J. K., Feeny, N. C., & Findling, R. L. (2011). Examining the validity of cyclothymic disorder in a youth sample. Journal of Affective Disorders, 132, 55–63. doi: 10.1016/j.jad.2011.02.004.CrossRefPubMedCentralPubMedGoogle Scholar
  61. Van Meter, A. R., Youngstrom, E. A., Demeter, C., & Findling, R. L. (2012). Examining the validity of cyclothymic disorder in a youth sample: replication and extension. Journal of Abnormal Child Psychology. doi: 10.1007/s10802-012-9680-1.Google Scholar
  62. Weiss, E. L., Longhurst, J. G., & Mazure, C. M. (1999). Childhood sexual abuse as a risk factor for depression in women: psychosocial and neurobiological correlates. American Journal of Psychiatry, 156, 816–828.CrossRefPubMedGoogle Scholar
  63. Wexler, B. E., Lyons, L., Lyons, H., & Mazure, C. M. (1997). Physical and sexual abuse during childhood and development of psychiatric illnesses during adulthood. Journal of Nervous Mental Disease, 185, 522–524.CrossRefPubMedGoogle Scholar
  64. Williams, L. M. (1994). Recall of childhood trauma: a prospective study of women’s memories of child sexual abuse. Journal of Consulting & Clinical Psychology, 62, 1167–1176.CrossRefGoogle Scholar
  65. Youngstrom, E. A. (2009). Definitional issues in bipolar disorder across the life cycle. Clinical Psychology: Science & Practice, 16, 140–160.Google Scholar
  66. Youngstrom, E. A., Findling, R. L., Danielson, C. K., & Calabrese, J. R. (2001). Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory. Psychological Assessment, 13, 267–276.CrossRefPubMedGoogle Scholar
  67. Youngstrom, E. A., Meyers, O., Demeter, C., Youngstrom, J., Morello, L., Piiparinen, R., & Findling, R. L. (2005). Comparing diagnostic checklists for pediatric bipolar disorder in academic and community mental health settings. Bipolar Disorders, 7, 507–517. doi: 10.1111/j.1399-5618.2005.00269.x.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Tina Du Rocher Schudlich
    • 1
  • Eric A. Youngstrom
    • 2
  • Maria Martinez
    • 2
  • Jennifer KogosYoungstrom
    • 2
  • Kelly Scovil
    • 3
  • Jody Ross
    • 4
  • Norah C. Feeny
    • 5
  • Robert L. Findling
    • 6
  1. 1.Department of PsychologyWestern Washington UniversityBellinghamUSA
  2. 2.Department of PsychologyUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Counseling and Clinical PsychologyColumbia Teacher’s CollegeNew YorkUSA
  4. 4.Indiana University – Purdue University Fort WayneFort WayneUSA
  5. 5.Department of PsychologyCase Western Reserve UniversityClevelandUSA
  6. 6.Department of PsychiatryJohns Hopkins University and Kennedy Krieger InstituteBaltimoreUSA

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