title: Impact of childhood abuse on the clinical course of bipolar disorder.
abstract: BACKGROUND
  Few investigations have examined the impact of childhood trauma, and domains of childhood abuse, on outcome in bipolar disorder.
  
  
  OBJECTIVE
  To evaluate the prevalence and subtypes of childhood abuse reported by adult patients with bipolar disorder and relationship to clinical outcome.
  
  
  METHODS
  Prevalence rates of childhood abuse were retrospectively assessed and examined relative to illness complexity in a sample of 100 patients at an academic specialty centre for the treatment of bipolar disorder.
  
  
  RESULTS
  Histories of severe childhood abuse were identified in about half of the sample and were associated with early age at illness onset. Abuse subcategories were strongly inter-related. Severe emotional abuse was significantly associated with lifetime substance misuse comorbidity and past-year rapid cycling. Logistic regression indicated a significant association between lifetime suicide attempts and severe childhood sexual abuse. Multiple forms of abuse showed a graded increase in risk for both suicide attempts and rapid cycling.
  
  
  CONCLUSIONS
  Severe childhood trauma appears to have occurred in about half of patients with bipolar disorder, and may lead to more complex psychopathological manifestations.
authors.affiliation: Department of Clinical Psychology, Long Island Unversity, Brooklyn, New York, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Garno
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Goldberg
authors.forename: Paul Michael
authors.initials: PM
authors.lastname: Ramirez
authors.forename: Barry A
authors.initials: BA
authors.lastname: Ritzler
mesh_terms: D000328:Adult; D017668:Age of Onset; D001714:Bipolar Disorder / Q000453:epidemiology / Q000209:etiology*; D016009:Chi-Square Distribution; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies