Q: Childhood Contribute to My BP Illness?
Dear Dr. Phelps,
Growing up my step-brother and I endured constant screaming rows between my
mother and step-father. There was never any predictability. Dad always
late by a couple of hours for any important event and when he finally showed up
there would be a screaming match between my parents.
Not only that, but he was a womanizer as well. Instead of being protected
from this, my mother drew me in to her arguments, even getting me on the phone
when I was about 12 so that I could swear that she wasn't lying when one of
Dad's girlfriends calling saying she was pregnant.
There was also a sick inuendo coming from my step-dad and too much curiousity
about my dating.
Does this contribute to my bipolar illness? My (step) brother is an
alcohlic and has wild mood swings.
I am now 54 and when my meds are working I can put my energy into something
productive, but when my meds are being regulated a deep rage surfaces and it is
Dear Anne --
You can imagine the difficulty involved in answering this as a research question
-- i.e. how would one begin to sort out the relative contribution in an
experience like yours of genetic risk for bipolar symptoms versus how much had
been contributed by the growing-up experience. There are some very general
ways to approach that question, comparing the "concordance rate" in
mono- and dizygotic twins: meaning that one compares how often one twin
gets it versus the other, in "identical twins", who share all their
genetic information, versus in "fraternal twins" who share only
In these studies one finds that the "concordance
rate" in bipolar disorder (how often does twin B get it if twin A has it)
is around 80% in identical twins, but down around 50%, as I recall, for
dizygotic twins. One can infer from these data that, very roughly, subject
to many caveats, the relative contribution of genes versus environment is
about 80/20. However, that is an extremely rough way to
guess, with so many potentially confounding variables that one really should
take this as an educated guess more than a statement. Here is an example
of such a study if you want to pursue that further.
Meanwhile, the real-life question for you might be
"how much can I gain from a really good effort at psychotherapy targeting
my experience nowadays (e.g. rage), and looking at my growing up experience to
the extent that it seems to inform my current experience?" Note
that's a separate question from "how much can I gain from a really good
effort at psychotherapy targeting my rage, using techniques developed
specifically for handling rage?" You may have done both already (the
latter would be called "cognitive-behavioral therapy" (CBT) by most,
or "anger management").
However, if you still have mood cycling, most of my
patients seem to have great difficulty applying CBT tools when they are in a
clear manic or mixed state, or even a severe depressed state; it's like working
uphill, way uphill sometimes. So there the key is to keep trying with
medications to get greater mood stability (sorry, I'm sure that one is obvious
and surely something you've been working on and are probably still working
Finally, to properly answer your particular question:
it does seem fairly clear that early childhood developmental stress is one of
the "environmental" factors that can contribute to a genetic
susceptibility actually manifesting itself in symptoms. In other words,
"yes". The problem, as you can see, is that "yes" alone
doesn't necessarily clearly help you a great deal. I wouldn't want it to
increase your sense of hopelessness, for example, because even though it might
sound like it, "yes" doesn't really change your circumstances at
all. The three tools (CBT, or a more "dynamically oriented"
psychotherapy as above, or medication efforts) all still stand to help and should
be maximized before you turn to "acceptance" methods (another
psychotherapy approach, as well as a philosophy/spiritual stance), which also
have benefited people a great deal.
Some one of my patients is going to read this and say
to me: but doc', you haven't tried all this with me! (because
sometimes I'll focus on the medication approach first, or refer folks out for
the therapy piece) It's a long, long process. Good luck to you in
Published October, 2001