Research published in the Journal of Affective Disorders indicates that familial dysfunction is common in those with childhood-onset bipolar disorder, and that these effects extend into adulthood.

Family functioning was quantified using the Family Assessment Device in 116 individuals with childhood-onset bipolar disorder (70 youths, 46 adults) and in 108 healthy controls (46 youths, 62 adults). Participants with bipolar disorder demonstrated significantly higher impairment in all family functioning domains compared with healthy controls, including problem solving, communication, roles, affective responsiveness, affective involvement, behavior control, and general functioning (all P <.01). This trend was significant regardless of age, IQ, or socioeconomic status.

Adults with bipolar disorder had worse affective responsiveness (P <.01) and behavior control (P <.05) compared with their youth counterparts. A significant diagnosis-by-age interaction was observed for family problem solving and communication when excluding patients taking lithium; children and adolescents with bipolar disorder demonstrated worse scores in both domains compared with healthy controls. As such, a higher discrepancy was observed between children and adolescents with bipolar disorders vs child and adolescent healthy controls, compared with adults with bipolar disorders vs adult healthy controls. Post-hoc analyses indicated no predictive impact of mood state, global functioning, or comorbidity on family functioning; familial dysfunction was apparent for bipolar disorder regardless of mood state or subtype.

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The cross-sectional study design and report-based data collection may limit the generalizability of these results. Researchers also acknowledged the clinical differences between children and adolescents and adults as a potential limitation. Further investigation into the family-based mechanisms of childhood-onset bipolar disorder may assist in the development of future targeted, effective therapies. 


MacPherson HA, Ruggieri AL, Christensen RE, et al. Developmental evaluation of family functioning deficits in youths and young adults with childhood-onset bipolar disorder. J Affect Disord. 2018;235;574-582.

This article originally appeared on Psychiatry Advisor