Trauma Related Manic-Depressive Bipolar Disorder
Bipolar Disorder could be related to early childhood trauma, much like stressful events have been shown to trigger other kinds of physical illness. The destabilizing effects that stressful events have on biological rhythms, is a possible hypothesis, while recent evidence suggests that other variables like cognitive and personality factors may interact with events in determining the potential for bipolar episodes. A plausible explanation could include a response to early traumatic events as well as biological components. With the prevalence of child abuse rising, childhood bipolar disorder could reflect that ascent. Manic-depression may be seen as defense mechanisms for dealing with stressors, therefore, an examination of thought processes should precipitate pharmacological therapy, which treats symptoms rather than underlying causes.
“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). 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).
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 continuing important factor in those who had more episodes of illness. Another study found that patients with more prior episodes were more likely to have an episode after a stressful event. A recent study found that severe negative events caused patient recovery to take three times longer than a patient without a severe negative event; with minor negative events also increasing recovery time. Severe stressful life events are clearly predictive of depression, with new occurrences of stressors making recurring depression more probable (Carson, 218, 219). Therapy attempts 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 also. 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 could 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 spontaneously 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 trauma triggering manic-depressive episodes. Memory impairment associated with electroconvulsive therapy may mimic the dissociative memory loss in individuals who have experienced traumatic events 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 reactivates the traumatic memory acting as a reminder.
Manic-depression may be seen as defense mechanisms for dealing with severe stressors. Manic episodes seem to be an escape route from the reality of negative events by the expenditure of energy in the distractions of a myriad 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 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 an elevated self-esteem, this seems to be essentially a defensive pose. When their defense mechanisms break down, a looming depression occurs. Yet when the depressed person rebounds and emerses himself 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 events in determining the potential for initial bipolar episodes or a relapse. Personal feelings of guilt and self-devaluing deliberations associated with childhood neglect and abuse may be important factors in this manic-depressive cycle. When perceived personal responsibility for debilitating circumstances such as a rape becomes despairing to the individual, depression usually follows unless some form of intervention takes place. Modification of guilt-ridden thought processes must take place in order to over come 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 causes.
Beck’s Cognitive Theory supports the idea that precipitating stressful events when perceived negatively, can lead to depressive episodes. These negative cognitions are integral to depressed states of mind (Carson, 234). The negative thinking patterns of pessimistic persons 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 abuse can contribute to depressive symptoms in children, as well as in adults. Thoughts and beliefs of personal dejectedness are thought to develop during childhood and adolescence based on these 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 dejectedness 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 develops. These negative automatic thoughts occur just below the level of 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 cognition. Some of these misrepresentations include patterns of all or none thinking, selectively focusing on a negative aspect, jumping to negative conclusions, and overgeneralizations of sweeping proportions. 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 is, the more likely depression is. This negative thinking that Beck describes occurs in all cases of depression, as depressed people tend to recall negative events more frequently and more 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 magnitude, may in fact be a precursor to bipolar disorder.
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