Assaultive trauma and illness course in psychotic bipolar disorder: findings from the suffolk county mental health project


Yuval Neria, Anxiety Disorders Clinic, New York State Psychiatric Institute, Unit 69, 1051 Riverside Drive, New York, NY 10032, USA.


Objective:  Little is known about the relationship of assaultive trauma to clinical and functional outcome in patients with bipolar disorder.

Method:  We assessed trauma histories in a cohort of 109 first-admission bipolar patients with psychosis using structured interviews and medical records. Assaultive trauma included rape, physical attacks, and physical threats. Outcome was assessed using standardized ratings.

Results:  Forty percent reported a history of assaultive trauma, mostly in childhood (≤16 years). Exposed patients were more symptomatic at each follow-up than unexposed. Sixteen percent of exposed patients remitted after one episode compared with 38.5% of the non-exposed. Patients exposed as adults were the most symptomatic at 6 months, while patients exposed in childhood were the most symptomatic at 24 months.

Conclusion:  Our findings supported the salient role of trauma history as a risk factor for poor course in severe bipolar disorder. Given the high prevalence of such exposure, clinical awareness in first-admission psychotic bipolar patients is critical.