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Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature

Published online by Cambridge University Press:  10 December 2014

J. Cotter ,
M. Kaess  and
A. R. Yung
J. Cotter*
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
M. Kaess
Affiliation:
Department of Child and Adolescent Psychiatry, University of Heidelberg, Heidelberg, Germany
A. R. Yung
Affiliation:
Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK Orygen Youth Health Research Centre, University of Melbourne, Parkville, Australia
*
*Address for correspondence: J. Cotter, Institute of Brain, Behaviour and Mental Health, University of Manchester, Room 3.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. (Email: jack.cotter@manchester.ac.uk)
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Abstract

Objectives

We aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.

Methods

Narrative review of the peer-reviewed English language literature in the area.

Results

High rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment.

Conclusions

Routine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

Keywords

Bipolar disorderborderline personality disorderchild abusechildhood traumafunctioningpsychosisschizophrenia
Type
Review Articles
Information
Irish Journal of Psychological Medicine , Volume 32 , Issue 1: Special Issue: Youth Mental Health , March 2015 , pp. 21 - 30
Copyright
© College of Psychiatrists of Ireland 2014 

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