Public disclosures of bipolar disorder diagnosis by notable figures in the society, such as actress Carrie Fisher and singer Demi Lovato have stirred a lot controversy on the biological and environmental influences on its severity. Environmental and biological influences basically constitute factors like age, gender, or substance abuse that affect the course of the subject. Bipolar disorder, previously medically referred to as manic depression, is a mental disorder “involving episodes of mood disturbance, neuropsychological deficits, immunological and physiological changes, and disturbances in functioning” (Rowland & Marwaha, 2018). Notably, the biological disorder is one of the leading causes of disability and premature mortality rates (). As such, a review of the biological and environmental influences on the severity of the bipolar disease is essential, in order to conceptualize and develop effective cure and support for this complex illness.
The skeptical high prevalence estimated rate of 1% and the controversial suggestion of higher prevalence in Caucasian people have sparked further interest on the topic, especially among health practitioners (Marquiz et al., 1985). This essay argues that the extent of the severity of bipolar disorder upon the person is heavily influenced by environmental and biological influences, particularly the aggravation effect by genetic factors, child maltreatment, psychological stressors, and substance abuse.
Genetic factors are undisputedly a significant contributing biological influencer on the severity of the bipolar disorder. Typically, genetic factors are involved in determining the onset of disease, with evidence from identical and fraternal twins’ studies indicating a monozygotic concordance of 40-70%. Additionally, individuals whose relatives are first degree patients have a lifetime risk of 5-10% (Craddock & Jones, 1999). Notably, Mendelian linkage studies have not identified any individual genes causing the disorder, hence the widespread acceptance of the disorder as a multiple component illness (Rowland & Marwaha, 2018). Even though the individuals with genetic markers for BPD may not actually develop it, they are further not spared from developing unipolar depression. The high contributory factor of genetics is further reinforced by the evidence of shared genetic risk between bipolar, schizophrenia, and autism (Lichtenstein et al., 2009). As such, bipolar disorder is a highly heritable mental illness, with persons having relatives suffering from it, especially first-degree disorder, being more predisposed to it. The high heritability is strongly the reason for the assessment of any occurrences of the illness in the family tree, especially biological parents, during its diagnosis.
Additionally, upon the onset of the illness, genetic factors primarily influence the behavior modes of the patient and are a significant culprit in the prevalence of manic episode rates. Evidence links the hospitalization and morbidity of patients during manic episodes to heavy influence by genetic factors (Kessing et al., 2004). As such, patients whose genetic factors predispose them to the disease are highly likely to commit suicide and other forms of self-harm during manic episodes. Therefore, the preceding establish that genetic factors, as a biological influencer, dramatically increases the severity of the bipolar disorder as they not only predispose an individual to it but also aggravate the manic mood shifts. The translation of genetic factors to the illness is, however, reliant on environmental factors like childhood traumatic experiences.
Child maltreatment, an environmental influence, also arguably contributes to aggravating the severity of the bipolar disorder. Constituting of emotional abuse or emotional neglect, child maltreatment has been illustrated to significantly affect not only the severity of the bipolar disorder but also trigger its onset. Research indicates that a history of childhood traumatic experiences like sexual abuse and forms of physical abuse like bullying, increased the rate of developing bipolar disorder, especially after a depressive episode (Gilman et al., 2012). Such abuse, notably, also confers some of the severity of the degree of certain forms of mental illness.
The contribution of childhood traumatic experiences to either the gravity or onset of bipolar disease is largely explainable to the alterations on the organs regulating emotions in the patient’s body. Notably, those who have undergone severe traumatic events exhibit alterations in the hypothalamic-pituitary-adrenal axis and levels of BNDF and inflammatory cytokines (Rowland & Marwaha, 2018). Additionally, neuroimaging results indicate reduced volumes of limbic grey matter (Rando et al., 2014). This explains why such patients have increased levels of affective instability, and are generally more hostile or impulsive. As such, childhood maltreatment, as afore illustrated, establishes the aggravating effect of environmental influence on the severity of the bipolar disorder. Notably, childhood maltreatment does, in a way, constitute a psychological stressor, which also affects the severity of the illness.
Psychological stressors invariably constitute another environmental influence affecting the severity of the bipolar disorder. Studies indicate the relationship between the severity of bipolar disorder with the experience of such life events. Notably, psychological stressors act as triggers of manic or hypomania episodes, hence increasing the severity of the bipolar episode. A study indicated that more life stressful events such as divorce, marriage, disability, and unemployment, were experienced prior to the hospitalization during a manic period (Kessing et al., 2004)). The hospitalization and morbidity rates for parental loss, are also considerably high, with associated indications of 3 out of 10 individuals with bipolar disorder after having lost their loved ones (Tsuchiya et al., 2003). However, the use of checkers for psychological stressors are largely under criticism
Such criticism is mostly due to the seeming disregard, during the use of those psychological stressors, of the appreciation of the details on the severity and context of such events. However, it is admissible that stressful life events greatly aggravate the severity of the bipolar disorder, majorly due to their strong provocations of the emotions of the patients, and even non-patients. For instance, most people feel depressed after losing their jobs. Additionally, psychiatrists interviewed by the media have also reported that their clients have reported higher levels of depression during this ongoing psychological stressor COVID 19 pandemic. The validity of using checkers for psychological stressors is further reinforced by their linkage as causal factors of unipolar depression, psychosis, anxiety disorders, ischemic stroke, and circulatory disorders. Therefore, as per the preceding, psychological stressors do greatly affect the severity of the bipolar disorder. Notably, the effects of psychological stressors are significantly influenced by substance abuse.
Substance abuse, another environmental influence, is also a determinant of the severity of the bipolar disease. It is common knowledge that drugs alter the emotions and moods of a person, with people mostly using drugs like cannabis, cocaine, and alcohol for recreation. The alteration of the dispositions by the drugs significantly affects the severity of the bipolar disorder. Research indicates a relationship between cannabis use and subsequent relapse of manic symptoms (Gibbs et al., 2015). This is mostly attributable to the psychological effects of the drugs, as it occasions both mania and hypomania. Research also indicates the increased risk of the first episode of bipolar by a factor of 5, after adjusting for cofounders, and additionally demonstrated evidence of a dose relationship (Van Laar et al., 2007).
Other drugs have also been implicated. The use of alcohol and its dependence before the age of 25 significantly increased the recurrence of the bipolar disorder episodes (Kenneson et al., 2013). Notably, the morbidity rates of bipolar patients are significantly related to substance abuse of opioids, cannabis, cocaine, sedatives, and alcohol (Post & Kalivas, 2013). From the preceding, it is evident that substance abuse significantly affects the severity of the disorder negatively. For instance, the altering of the moods invariably increases the likelihood of inflicting self-harm. Self-treatment using drugs like cocaine often have disheartening results for the patients, and as should be highly discouraged.
The preceding establish that biological and environmental influences attribute to the severity of the bipolar disorder, albeit negatively. This is illustrated by the foregoing analysis of biological influences like genetic factors and environmental factors such as drug abuse, emotional abuse in children, and the occurrence of stressful life events. Notably, even though genetic factors generally predispose individuals to develop the illness, environmental influences have illustrated as having a significant impact not only on the onset of the malady but also in gravity as they have shown even to cause suicide in patients. Therefore, it is recommendable that during preventive measures, greater emphasis should be laid on controlling the environmental influences.