Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC; Bipolar Collaborative Network, Bethesda, MD.
Bipolar Disord. 2015 May;17(3):323-30. doi: 10.1111/bdi.12268. Epub 2014 Oct 13.
Physical or sexual abuse in childhood is known to have an adverse effect on the course of bipolar disorder, but the impact of verbal abuse has not been well elucidated.
We examined the occurrence and frequency (never to frequently) of each type of abuse in childhood in 634 US adult outpatients (average age 40 years). Patients gave informed consent and provided information about their age of onset and course of illness prior to study entry.
Verbal abuse alone occurred in 24% of the patients. Similar to a history of physical or sexual abuse, a history of verbal abuse was related to an earlier age of onset of bipolar disorder and other poor prognosis characteristics, including anxiety and substance abuse comorbidity, rapid cycling, and a deteriorating illness course as reflected in ratings of increasing frequency or severity of mania and depression.
A lasting adverse impact of the experience of verbal abuse in childhood is suggested by its relationship to an earlier age of onset of bipolar disorder, other poor prognosis factors, and a deteriorating course of illness. Verbal abuse is a common confound in comparison groups defined by a lack of physical or sexual abuse. Ameliorating the impact of verbal abuse on the unfolding course of bipolar disorder appears to be an important target of therapeutics and worthy of attempts at primary and secondary prophylaxis. Family-based treatments that focus on psychoeducation, enhancing intra-family communication, and coping skills may be particularly helpful.
已知儿童时期的身体或性虐待会对双相情感障碍的病程产生不利影响，但言语虐待的影响尚未得到充分阐明。
我们在 634 名美国成年门诊患者（平均年龄 40 岁）中检查了童年时期每种类型虐待（从未到经常）的发生和频率。患者在研究入组前自愿签署知情同意书，并提供了关于其发病年龄和疾病病程的信息。
单独的言语虐待发生在 24%的患者中。与身体或性虐待史一样，言语虐待史与双相情感障碍发病年龄较早以及其他预后不良特征有关，包括焦虑和物质滥用共病、快速循环和疾病恶化，表现为躁狂和抑郁严重程度或频率的增加。
言语虐待与双相情感障碍发病年龄较早、其他预后不良因素以及疾病恶化有关，这表明童年时期的言语虐待经历会产生持久的不良影响。言语虐待是缺乏身体或性虐待的对照组中的一个常见混杂因素。减轻言语虐待对双相情感障碍发病过程的影响似乎是治疗的一个重要目标，值得尝试进行初级和二级预防。以心理教育、增强家庭内沟通和应对技能为重点的家庭治疗可能特别有帮助。
