Bipolar Disorder Adolescents are at Increased Risk of Post-Traumatic Stress Disorder and Substance Use Disorder

By Corinna Underwood
November 6, 2006

Posttraumatic Stress Disorder (PTSD) was formally recognized as a psychiatric diagnosis in 1980. Scientists now know that children and adolescents are susceptible to developing PTSD, and that PTSD has different age-specific features. Recent research, presented at the 53rd annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), revealed that adolescents who live with bipolar disorder are more likely to develop post-traumatic stress disorder (PTSD) and substance use disorder.

The research team found a higher rate of PTSD and substance use in adolescents with bipolar disorder. They also found also found significantly more substance use disorder in subjects meeting full criteria for PTSD than in cases of sub-threshold PTSD.

The team performed psychiatric assessments of study subjects using the Kiddie Schedule for Affective Disorders-Epidemiologic Version (KSADS-E). They also assessed substance use with the KSADS Substance Use module in subjects younger than 18 years and the Structured Clinical Interview for the Diagnostic and Statistical Manual IV (SCID) module for Substance Use Disorders in subjects who were 18 years or older.

In the bipolar subjects, 8% met the full criteria for PTSD and another 8% met criteria for sub-threshold PTSD. In contrast, 1 control subject met the full criteria for full PTSD and 2 met criteria for sub-threshold PTSD.

Among the 18 subjects with bipolar disorder who met the criteria for full or sub-threshold PTSD, 7 (39%) met the criteria for substance use disorder. Within the bipolar group, the investigators documented significantly more substance use in full PTSD than in sub-threshold PTSD.

Among the subjects with all 3 conditions, 3 developed bipolar disorder first, then PTSD, and then substance use disorder. Two developed PTSD first, and then bipolar disorder followed by substance abuse. The remaining 2 cases experienced the onset of bipolar disorder and substance abuse at approximately the same time. They then experienced trauma and subsequent PTSD, with worsening substance use.