Facing Past Trauma, Part V: The Bipolar-PTSD Connection
Although the link between past and present is not fully understood, a picture is emerging of a biologically vulnerable brain being rendered even more vulnerable by horrific events, making us sitting ducks for even routine stresses in our daily lives. Our brains become oversensitized to the point where our entire world feels unsafe. The Freudian view of mental illness was that our strange and often scary behaviors were maladaptive reactions to stress, fueled by early trauma. Of all things, this is reemerging as the modern view.
What's new this time is that researchers from a wide range of scientific disciplines - including genetics, epigenetics, and brain development - are making new discoveries and beginning to connect the dots. Every which way you look at it, our vulnerable brains are engaged in some kind of macabre two-step with past trauma and current stressors.
No surprise, 50 percent of those diagnosed with bipolar report incidents of childhood trauma (Garno et al, 2005). This includes emotional, physical and sexual abuse, as well as emotional and physical neglect. Throw in adult trauma - or simply the stresses of modern life - and we are certainly talking about just about all of us. Not unexpectedly, trauma substantially worsens the course of the bipolar and increases the risk of other complications, such as alcohol and drug abuse (Leverich et al, 2002) This raises the rather obvious question that maybe we should be putting a lot more emphasis on treating the trauma.
A bit of chicken-and-egg is in play, here. To work on trauma issues, first we need to get our bipolar under control. But to make headway against our bipolar, we also need to find and fix whatever it is that is driving the bipolar. No easy answers, but a lot of us are asking the rather obvious question - namely, if something works for PTSD, maybe we should be applying it - off-label, if necessary - to dealing with our own particular trauma issues, as well.
Major catch: Antidepressants, which are a first-line treatment for PTSD, may induce mania and speed up cycling in those with bipolar. Still, there are other treatment options, which we will explore in future posts. But first, a little bit about PTSD:
According to Francine Shapiro of the Palo Alto Mental Research Institute, in a recent NY Times blog, PTSD "occurs when an experience is so disturbing that it disrupts the information processing system of the brain." Memory of the incident is stored, replete with its unexpurgated emotional content. When these memories are triggered by current events, "encoded negative emotions, thoughts and sensations can emerge and color the perception of the present."
Dr. Shapiro is the originator of the PTSD therapy, eye movement desensitization and reprocessing (EMDR) which has been receiving a good deal of press lately (stay tuned for a future post). The treatment, which originated in 1987, is endorsed by the American Psychiatric Association and is deployed by the Department of Defense for treating veterans.
The DSM mandates that the individual experience a major trauma, such as rape or a battlefield experience. But Dr. Shapiro points out that for many of us, PTSD symptoms can result from less dramatic events, such as hurtful childhood experiences. I would go further by arguing the event need not have any significance. Trauma is trauma, no matter what the real world cause, just as depression is depression, mania is mania, and so on.
If I am flipping out over something that I perceive as traumatic, my condition should be recognized as such and I should be treated accordingly. This is not the way it works with PTSD. Alone amongst mental illness, the DSM demands a specific real world cause, then allows clinicians to sit in judgment on the validity of that cause.
In practice, even with obvious real world causes, clinicians fail to do their job. Here is the title of one article I pulled up on a PubMed search:
Untreated posttraumatic stress among persons with severe mental illness despite marked trauma and symptomatology.