Bipolar disorder is a mental health condition characterized by extreme shifts in mood and energy levels. People with bipolar disorder experience periods of mania (elevated moods and energy) and periods of depression, with normal moods in between. Bipolar disorder is a chronic, lifelong condition that often requires ongoing treatment and management. The exact causes of bipolar disorder are not fully understood, but research suggests it results from a combination of genetic, biological, environmental, and psychological factors. One question that is sometimes raised is whether trauma or stressful life events can cause someone to develop bipolar disorder. This article will examine the complex relationship between trauma and bipolar disorder.
What is trauma?
Trauma refers to any disturbing or distressing event that causes intense fear, helplessness, or horror. Traumas can be one-time incidents like accidents, natural disasters, or assaults. Trauma can also be ongoing, such as repeated abuse or exposure to violence. Not everyone who experiences trauma will develop lasting effects. Those who do can develop post-traumatic stress disorder (PTSD) or other trauma-related mental health problems like anxiety, depression, or substance abuse disorders. Childhood trauma, especially chronic trauma like abuse or neglect, can have lasting impacts on brain development and mental health.
The link between trauma and bipolar disorder
There are several ways trauma could potentially interact with bipolar disorder:
Trauma as a trigger
For people who already have bipolar disorder, traumatic experiences can trigger the onset of manic or depressive episodes. Stress is one of the most commonly reported triggers for mood episodes in people with bipolar disorder. Trauma represents an extreme form of stress. Events like the death of a loved one, a bad accident, or relationship problems could push someone from a stable mood state into mania or depression.
Trauma unveiling an underlying condition
In some cases, trauma appears to unleash or unveil an underlying bipolar disorder that was previously undetected. The first manic or depressive episode is often preceded by a stressful life event. For example, someone might have a genetic predisposition for bipolar disorder that has not yet manifested. A traumatic event could then initiate the mood dysregulation of bipolar disorder. The trauma did not cause the bipolar disorder per se, but rather triggered the onset of a condition that was already there.
Shared risk factors
Bipolar disorder and trauma/PTSD have some overlapping risk factors including anxiety sensitivity, neurotransmitter dysregulation, and family history of mood disorders. These shared vulnerabilities could predispose someone to both bipolar and trauma-related problems. For example, the same genetic variations that make someone prone to bipolar may also make them more susceptible to developing PTSD after trauma.
Misdiagnosis
There are some similarities between the symptoms of bipolar disorder and PTSD, like mood swings, insomnia, irritability, and concentration problems. Someone with PTSD may therefore be misdiagnosed as having bipolar disorder. Proper screening and assessment is important to distinguish between these two conditions.
Trauma worsening course of illness
For people who already have bipolar disorder, trauma could potentially worsen the course of the illness. Trauma makes people more likely to experience severe manic and depressive episodes. The chaos and stress of trauma can also make it harder for people to maintain consistent treatment and self-care regimens. Patients with PTSD in addition to bipolar disorder tend to have more mood episodes, lower quality of life, and higher suicide risk.
Evidence on trauma causing bipolar disorder
While trauma can influence the course of bipolar disorder in the ways described above, most research indicates trauma does not directly cause someone to develop bipolar who would not otherwise get it. Here is some of the key evidence:
Genetic link
Twin studies show bipolar disorder is highly heritable. Even if one identical twin has bipolar disorder, the other twin only has a 40-70% chance of developing it too. This suggests non-genetic factors like trauma only play a minor role.
Onset typically precedes trauma
Many studies find bipolar symptoms generally start before a traumatic event occurs. This temporal sequence suggests bipolar disorder is already developing or active before trauma strikes.
No dose-response relationship
There is no clear dose-response relationship between trauma and likelihood of developing bipolar disorder. More severe trauma is no more likely to cause bipolar than lower level trauma. The lack of a dose-response effect implies there is not a direct causal connection.
Most people with trauma don’t develop bipolar
If trauma directly caused bipolar disorder, most people who experienced trauma should develop bipolar. However, the majority of trauma survivors do not go on to be diagnosed with bipolar. Rates of bipolar disorder in trauma victims are not substantially higher than general population levels.
Sudden onset of mania unlikely
In most psychiatric disorders caused by trauma (like PTSD), symptoms tend to begin right after the traumatic event. However with bipolar disorder, it is very uncommon to suddenly develop mania or depression immediately following trauma exposure. The delayed connection suggests a more indirect relationship.
| Study | Key Finding |
|---|---|
| Meta-analysis in Acta Psychiatrica Scandinavica, 2020 | No overall association between childhood adversity and development of bipolar disorder. |
| Study in Comprehensive Psychiatry, 2014 | Rates of trauma similar in bipolar patients and general population. |
| Survey of 9,282 U.S. adults in Journal of Affective Disorders, 2005 | No link between childhood trauma and increased risk of bipolar disorder. |
Conclusion
In summary, the evidence indicates traumatic experiences do not directly cause bipolar disorder in someone without pre-existing susceptibility. However, trauma can have indirect effects on the course and symptoms of bipolar disorder. Trauma may trigger the onset of manic or depressive episodes or worsen the overall progression of the illness. Someone with bipolar disorder may also be at heightened risk of developing PTSD following trauma. Accurately diagnosing trauma-related problems versus bipolar disorder can be challenging. Patients with both bipolar and PTSD tend to experience poorer outcomes. Effectively treating trauma and PTSD in bipolar patients through medications or psychotherapy can improve the overall trajectory of bipolar disorder.