The effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms and suicidal ideation in females with bipolar disorder: emotion dysregulation as a mediator

Abstract

Objectives

The relations of childhood emotional maltreatment and alexithymia to the clinical course of bipolar disorder (BD) have been widely recognised. Difficulties in regulating emotions may explain these relationships. The current study evaluated the effects of childhood emotional maltreatment and alexithymia on depressive and manic symptoms as well as suicidal ideation in female patients with BD. Emotion dysregulation was evaluated as a mediating factor.

Methods

Three hundred hospitalised female patients with a diagnosis of BD provided information regarding their history of childhood emotional maltreatment, alexithymia, difficulties in emotion regulation, depressive and manic symptoms, and suicidal ideation. A series of structural equation models (SEMs) were calculated to assess the associations between these variables.

Results

Childhood emotional abuse and difficulty in identifying feelings were indirectly associated with depressive and manic symptoms as well as suicidal ideation. This association was mediated by emotion dysregulation. This association remained significant after depressive and manic symptoms were controlled in the model.

Conclusions

This study indicates that patients with BD who experienced emotional abuse during childhood and have difficulties identifying emotions report greater emotion dysregulation. These individuals, in turn, are more likely to experience more severe depressive and manic symptoms as well as suicidal ideation.

Key points

• Childhood emotional maltreatment and emotional and clinical factors in bipolar disorder were assessed.

• Childhood emotional abuse indirectly affected clinical factors via emotion dysregulation.

• Difficulty in identifying feelings was linked to clinical factors via emotional dysregulation.

• Emotional dysregulation affected the links of childhood emotional maltreatment and difficulty in identifying feelings on suicidal ideation after controlling for clinical symptoms.

• Emotional dysregulation dimensions of impulse, strategies, and goals emerge in relation to suicidal ideation.

Keywords:

• Childhood emotional maltreatment
• alexithymia
• suicidal ideation
• emotion regulation
• bipolar disorder
• depression

Acknowledgements

The authors thank the Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran for their support, cooperation, and assistance throughout the period of study. MB is supported by a NHMRC Senior Principal Research Fellowship [1156072].

Author contributors

All authors contributed substantively to the preparation of the manuscript. All authors contributed to and have approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research has been supported by the Behavioural Sciences Research Centre, Shahid Beheshti University of Medical Sciences (SBUMS) and approved by the Medical Ethics Committee of Shahid Beheshti University of Medical Sciences, Tehran, Iran.