Affective instability, childhood trauma and major affective disorders

• Published in: Journal of affective disorders Vol. 190; pp. 764 - 771
• Main Authors: Marwaha, S., Gordon-Smith, K., Broome, M., Briley, P.M., Perry, A., Forty, L., Craddock, N., Jones, I., Jones, L.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.01.2016
• Subjects: Adult; Adult Survivors of Child Adverse Events - psychology; Adult Survivors of Child Adverse Events - statistics & numerical data; Affect; Affective instability; Affective symptoms; Bipolar disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - psychology; Depressive disorder; Depressive Disorder, Major - diagnosis; Depressive Disorder, Major - psychology; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Male; Middle Aged; Mood disorders; Mood Disorders - psychology; Psychiatric Status Rating Scales; Psychiatry; Retrospective Studies; Self Report; Stressful events; Mood disorders; Affective instability; Bipolar disorder; Affective symptoms; Stressful events; Depressive disorder
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2015.11.024

Affective instability (AI), childhood trauma, and mental illness are linked, but evidence in affective disorders is limited, despite both AI and childhood trauma being associated with poorer outcomes. Aims were to compare AI levels in bipolar disorder I (BPI) and II (BPII), and major depressive disorder recurrent (MDDR), and to examine the association of AI and childhood trauma within each diagnostic group. AI, measured using the Affective Lability Scale (ALS), was compared between people with DSM-IV BPI (n=923), BPII (n=363) and MDDR (n=207) accounting for confounders and current mood. Regression modelling was used to examine the association between AI and childhood traumas in each diagnostic group. ALS scores in descending order were BPII, BPI, MDDR, and differences between groups were significant (p<0.05). Within the BPI group any childhood abuse (p=0.021), childhood physical abuse (p=0.003) and the death of a close friend in childhood (p=0.002) were significantly associated with higher ALS score but no association was found between childhood trauma and AI in BPII and MDDR. The ALS is a self-report scale and is subject to retrospective recall bias. AI is an important dimension in bipolar disorder independent of current mood state. There is a strong link between childhood traumatic events and AI levels in BPI and this may be one way in which exposure and disorder are linked. Clinical interventions targeting AI in people who have suffered significant childhood trauma could potentially change the clinical course of bipolar disorder. •We examine affective instability and childhood trauma in major affective disorders.•Affective instability was higher in bipolar disorder than unipolar depression.•Childhood traumas were associated with affective instability in bipolar disorder I.•Affective dysregulation may link trauma in childhood to future bipolar disorder I.•Affective instability is a target for clinical interventions in bipolar disorder.