Is There A Link Between Bipolar Disorder & Trauma?

This is the first part of a two-part blog post on Bipolar Disorder (BD), Trauma, and the application of Logotherapy & Existential Analysis (LTEA) – a form of Psychotherapy - as an adjunct/additional form of treatment.

In this post I will concentrate on the link between Trauma and BD as it pertains to prevalence, impact, linkages, mechanisms of connection, and aspects of treatment. The subsequent post will focus on exploring the application of LTEA in this specific context.

But before I go any further, this post does not in any way constitute medical advice; it is solely for information purposes. Please consult a relevant mental health professional if you feel that any of the issues raised are pertinent to you - further details are provided at the end of this article.  

Definitions

At the outset it is important to define what BD, Trauma, and Logotherapy & Existential Analysis are:

Bipolar Disorder

The National Institute of Mental Health (NIMH). in the USA defines BD as a mental health condition that ‘causes significant shifts in a person’s mood, energy, activity levels, and concentration.

People with bipolar disorder often experience periods of extremely “up,” elated, or energized behaviour (manic/hypomanic episodes) and very “down,” sad, indifferent, or periods of hopelessness (depressive episodes)’.

It is important to note that BD is a spectrum disorder and each individual experiences it differently.

For more detailed information on all aspects of BD, visit the NIMH website: Bipolar Disorder - National Institute of Mental Health (NIMH))

Trauma        

The Royal College of Psychiatrists (RCPsych) in the UK defines Post-Traumatic Stress disorder (PTSD) as ‘a mental health condition that can be caused when someone is exposed to a traumatic event.

Complex post-traumatic stress disorder (complex PTSD) is caused by experiencing an event or series of events that are extremely threatening. These events can happen during childhood or as an adult’.

More comprehensive information is provided on the RCPsych website: Post-traumatic stress disorder (PTSD).

Logotherapy & Existential Analysis

Alexander Batthyány from the Viktor Frankl Institute Vienna describes LTEA as follows: ‘The development of LTEA dates back to the 1930s. On the basis of Sigmund Freud's Psychoanalysis and Alfred Adler's Individual Psychology the psychiatrist and neurologist Viktor Emil Frankl (1905-1997) laid down the foundations of a new and original approach which he first published in 1938. Logotherapy/Existential Analysis, sometimes called the "Third Viennese School of Psychotherapy", is an internationally acknowledged and empirically based meaning-centred approach to psychotherapy.

In LTEA the search for a meaning in life is identified as the primary motivational force in human beings.

This topic will be explored in more detail in the second part of this article. In the meantime, Prof. Batthyány’s article is a good place to start: VFI / Logotherapy and Existential Analysis. An extended interview with Prof. Frankl is available here: Viktor Frankl Interview - 1979.

Trauma And Bipolar Disorder: The Research

Research strongly indicates a significant, bidirectional link between trauma —particularly childhood trauma — and the onset, severity, and treatment resistance of bipolar disorder (BD).

Studies show that individuals with BD are 2.6 times more likely to report childhood trauma compared to the general population. 

Here is a summary of the key findings from scientific papers and recent reviews on this topic (note – this is not exhaustive):

The High Prevalence of Trauma in BD

• Childhood Trauma (CT): Approximately 25% to 50% of patients with bipolar disorder report experiencing childhood trauma.

  
  

• Adulthood/Cumulative Trauma: Up to 80%–90% of individuals with bipolar disorder experience a traumatic event at some point in their life, often experiencing multiple, cumulative traumas (29%–82% prevalence range in studies).

  
  

• Common Types: Emotional abuse and emotional neglect are the most strongly associated subtypes with bipolar disorder. 

• 
  

What Is the Impact of Trauma on the Course of BD?

Trauma is a major factor in worsening the prognosis of bipolar disorder, leading to: 

• Earlier Age of Onset: Individuals with a history of CT develop BD significantly earlier than those without such histories. The age of onset can decrease proportionally with the number of trauma types experienced.

  
  

• Increased Severity: Trauma-exposed individuals with BD report more frequent, severe depressive and manic episodes.

  
  

• Increased Symptom Complexity: Trauma is linked to higher rates of rapid cycling, more frequent and severe depressive and manic episodes, and a greater likelihood of experiencing psychotic features (such as hallucinations or delusions).

  
  

• Increased Suicidality: Childhood trauma is strongly associated with a higher risk of suicide. There is a clear dose-response relationship between cumulative trauma and the risk of suicide attempts.

  
  

• Comorbidity: There are high rates of comorbid PTSD, anxiety disorders, and substance misuse disorders. 

  
  

• Hospitalisation: Co-occurring PTSD in BD patients further increases the risk of frequent hospitalisations.

What Are the Mechanisms Linking Trauma and Bipolar Disorder?

• Affective Instability: Research shows that childhood trauma leads to higher levels of emotional lability/dysregulation, which mediates the relationship between trauma and poor outcomes.

  
  

• HPA Axis Dysfunction/Neurobiological Factors: Early life stress causes long-term changes in the hypothalamic-pituitary-adrenal (HPA) axis, resulting in increased cortisol reactivity and heightened stress responses. Trauma is linked to lower levels of Brain-Derived Neurotrophic Factor (BDNF) and increased chronic inflammation.

  
  

• Epigenetic Changes: Trauma may induce, in combination with genetic predispositions, changes in gene expression related to stress regulation (e.g., NR3C1 or FKBP5 genes). 

What Are the Treatment and Management Implications?

• Treatment Resistance: Childhood trauma is linked to a poorer response to standard mood stabilizers, including lithium and anticonvulsants.

  
  

• Trauma-Focused Therapy: There is emerging evidence that therapies designed for PTSD, such as Eye Movement Desensitization and Reprocessing (EMDR), Trauma Focussed Cognitive Behavioural Therapy (CBT), and Dialectical Behaviour Therapy (DBT), are effective in reducing symptoms for individuals with both bipolar disorder and trauma histories.

  
  

• Trauma-Informed Care: Best practice often includes the incorporation of trauma screening into routine clinical practice for bipolar patients to improve long-term management. 

  
  

Key References

• Systematic Review: Rowe AL, Perich T, Meade T. Bipolar disorder and cumulative trauma: A systematic review of prevalence and illness outcomes. J Clin Psychol. 2024 Mar;80(3):692-713. doi: 10.1002/jclp.23650. Epub 2024 Jan 26. PMID: 38277425.

  
  

• Meta-analysis: Agnew-Blais J, Danese A. Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis. Lancet Psychiatry. 2016 Apr;3(4):342-9. doi: 10.1016/S2215-0366(15)00544-1. Epub 2016 Feb 10. PMID: 26873185.

  
  

• Review of Biological Mechanisms: Aas M, Henry C, Andreassen OA, Bellivier F, Melle I, Etain B. The role of childhood trauma in bipolar disorders. Int J Bipolar Disord. 2016 Dec;4(1):2. doi: 10.1186/s40345-015-0042-0. Epub 2016 Jan 13. PMID: 26763504; PMCID: PMC4712184.

  
  

• Review of Treatment: Hett D, Etain B, Marwaha S. Childhood trauma in bipolar disorder: new targets for future interventions. BJPsych Open. 2022 Jul 11;8(4):e130. doi: 10.1192/bjo.2022.529. PMID: 35815760; PMCID: PMC9301771.

  
  

• Longitudinal Study: Guillen-Burgos, H.F., Gálvez-Flórez, J.F., Moreno-López, S. et al. The effect of childhood trauma on bipolar depression. Sci Rep 15, 15876 (2025). https://doi.org/10.1038/s41598-025-98537-4

Where to find help - If you live in the UK, the first step (if you are not currently under the care of a mental health team), is to reach out to your GP.  If you are in crisis, call 999, go to your nearest Emergency Department, or call your mental health crisis team. Further information is provided on the NHS website. Listening and support is available 24/7 from the Samaritans – call 116 123 or email jo@samaritans.org.uk