title: Verbal abuse, like physical and sexual abuse, in childhood is associated with an earlier onset and more difficult course of bipolar disorder.
abstract: OBJECTIVE
  Physical or sexual abuse in childhood is known to have an adverse effect on the course of bipolar disorder, but the impact of verbal abuse has not been well elucidated.
  
  
  METHODS
  We examined the occurrence and frequency (never to frequently) of each type of abuse in childhood in 634 US adult outpatients (average age 40 years). Patients gave informed consent and provided information about their age of onset and course of illness prior to study entry.
  
  
  RESULTS
  Verbal abuse alone occurred in 24% of the patients. Similar to a history of physical or sexual abuse, a history of verbal abuse was related to an earlier age of onset of bipolar disorder and other poor prognosis characteristics, including anxiety and substance abuse comorbidity, rapid cycling, and a deteriorating illness course as reflected in ratings of increasing frequency or severity of mania and depression.
  
  
  CONCLUSIONS
  A lasting adverse impact of the experience of verbal abuse in childhood is suggested by its relationship to an earlier age of onset of bipolar disorder, other poor prognosis factors, and a deteriorating course of illness. Verbal abuse is a common confound in comparison groups defined by a lack of physical or sexual abuse. Ameliorating the impact of verbal abuse on the unfolding course of bipolar disorder appears to be an important target of therapeutics and worthy of attempts at primary and secondary prophylaxis. Family-based treatments that focus on psychoeducation, enhancing intra-family communication, and coping skills may be particularly helpful.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC; Bipolar Collaborative Network, Bethesda, MD.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Post
authors.forename: Lori L
authors.initials: LL
authors.lastname: Altshuler
authors.forename: Ralph
authors.initials: R
authors.lastname: Kupka
authors.forename: Susan L
authors.initials: SL
authors.lastname: McElroy
authors.forename: Mark A
authors.initials: MA
authors.lastname: Frye
authors.forename: Michael
authors.initials: M
authors.lastname: Rowe
authors.forename: Gabriele S
authors.initials: GS
authors.lastname: Leverich
authors.forename: Heinz
authors.initials: H
authors.lastname: Grunze
authors.forename: Trisha
authors.initials: T
authors.lastname: Suppes
authors.forename: Paul E
authors.initials: PE
authors.lastname: Keck
authors.forename: Willem A
authors.initials: WA
authors.lastname: Nolen
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology / Q000706:statistics & numerical data*; D017668:Age of Onset; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D002649:Child Abuse / Q000523:psychology / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data*; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000523:psychology; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology
keywords: comorbidities; early onset bipolar disorder; substance abuse