Relatively little is understood regarding the aetiology of bipolar disorder (BD) other than for the influence of a large genetic component on the development of the disorder and the impact of stressful life events on changes in current mood. However, amongst a range of psychiatric diagnoses, research consistently demonstrates a higher frequency of reports of childhood abuse and neglect compared with individuals in the general population. In addition, those who report experiences of childhood maltreatment also report high levels of internalized shame in adulthood, although there is little research demonstrating this association amongst clinical populations. An adult sample of 35 participants with a diagnosis of BD and a control group of 35 participants with no psychiatric diagnoses completed measures of childhood abuse and neglect, and internalized shame. Participants in the BD group reported a significantly greater frequency of high levels of childhood trauma compared with participants in the control group, with the reported frequency of childhood emotional abuse and neglect being particularly high. Levels of current internalized shame were also significantly higher amongst participants in the BD group. Significant correlations were observed between current internalized shame and reports of childhood emotional abuse and neglect. Clinical implications of the study's findings are discussed, and limitations of the methodology are considered.
Key practitioner message: The frequency of reports of childhood trauma would appear to be higher amongst adults with a diagnosis of BD compared with individuals with no psychiatric diagnoses. Levels of internalized shame in adulthood are also likely to be higher than those in the general population, although the current literature does not shed light on the relationship between childhood abuse and neglect, mood-related behaviour, and shame. Experiences of childhood abuse and neglect, particularly childhood emotional abuse and emotional neglect, are likely to be frequently reported by clients with a diagnosis of BD. Clinicians should therefore explicitly consider these experiences in their assessment, formulation and intervention with clients with a diagnosis of BD.
What is an adult child? As defined within the context of mental health, an adult child is someone who grew up in a dysfunctional family environment that prevented them from fully maturing emotionally. Adult child syndrome is characterized by an inability to navigate adult decisions and relationships due to the long-term impact of childhood trauma.
Adult child syndrome originally referred to the experiences and symptoms of children aged 18 and up who grew up in a home where one or more parents or caregivers suffered from alcohol use disorder. However, it is now used to describe adult children who grew up in any type of dysfunctional or abusive home. Rather than being alcoholics, the parent(s) might have had a mental health condition such as PTSD, depression, or a personality disorder, like narcissistic personality disorder, histrionic personality disorder, or borderline personality disorder.
Mental health experts have identified a set of emotional traits and behaviors that are typical of adult children of alcoholics or parents with other mental health issues. Consequently, common signs of adult child syndrome include:
Unfortunately, being raised by a parent who struggled with mental health and/or substance abuse issues increases the likelihood that an adult child will also experience these issues. Research shows that adult children of alcoholics have significantly higher rates of anxiety, depression, panic disorder, phobias, and substance use disorder.
Essentially, the volatility and stress associated with growing up in a dysfunctional environment leaves adult children with a sense of shame and a lack of trust in themselves or others. Because their needs were not met during childhood, they may struggle with recognizing and filling their emotional needs as adults. In addition, they had to suppress hard feelings, like sadness, fear, or anger, in order to survive childhood. Therefore, they may feel disconnected from their own emotions as adults.
The researchers then tracked the risk of mental health disorders for each subtype. They found that Emotionally Dysregulated and Reactive/Somatizing adults had the highest rates of major depression. The Emotionally Dysregulated adults also had the highest rates of borderline personality disorder. Externalizing adult children were more likely to be diagnosed with substance use disorder and antisocial personality disorder. Those in the Inhibited subtype had the highest rates of generalized anxiety disorder. Finally, those in the High-functioning group had the lowest rates of mental health disorders.
In addition to a higher likelihood of mental health issues, adult children often struggle with intimate relationships. Because they did not learn healthy relationship skills from parents or caregivers, they may have difficulty communicating effectively and expressing their needs to their partner. Moreover, the fear of abandonment may make it hard for them to trust others and be vulnerable with them.
Mental health treatment can effectively treat the root causes of adult child syndrome, while giving individuals new skills for coping and emotional regulation. Furthermore, treatment can support recovery from depression, anxiety, substance use disorder, and other mental health conditions arising from childhood trauma.
At Newport Institute, we view young adult mental health conditions as symptoms of underlying trauma and attachment wounds. Therefore, our treatment model directly addresses adult child syndrome, uncovering and healing both past trauma and its impact in the present.
I have come to view the above difficulties as part of a syndrome associated with a particular type of childhood emotional neglect and invalidation (Zaslav, 2018) stemming from having grown up with one or more narcissistic parents.
Further complicating the picture, at times self-absorbed parents may intrusively and thoughtlessly breach boundaries, burdening the child with their personal, private issues. A child starved for attention may thus adopt the role of parentified confidante. In this way, the child becomes the parent, simultaneously disavowing unmet childhood needs.
As is not uncommon, the impetus for Kathy to seek treatment in adulthood was the experience of having a family of her own. Like most neglected children, Kathy had assumed that she received the level of attention and care in childhood that was customary and deserved. It was only when inundated with a profound (and very normal) degree of interest and care for her own children, that she was struck with a retrospective sense of shock at the inattention to which she had accommodated in childhood. She always had a very strong undercurrent of negative feelings toward her parents, avoiding contact and feeling guilty for doing so. Suddenly, she began to question whether her chronic psychological issues might be connected to this awareness of her childhood neglect.
As we see, the adult personality of children of narcissists floats on a vague, poorly differentiated childhood sense of self compounded by systematic invalidation during later development. These problems are entirely amenable to psychological treatment. The first step is to review exactly what happened in childhood, breaking through lifelong patterns of denial fostered by a narcissistic family system.
Hero children inside feel inadequate and not good enough. They battle perfectionism and shame as children and into adulthood. Hero children struggle with intimacy as they get older. It may be hard for them to let their guard down and fully trust others. They may also struggle with negative self-worth and self-esteem.
The Mascot child is the comedic relief. The Mascot is sometimes the youngest, but not always. They have a good sense of humor and try to keep things light. They are often the class clown. Their role in the family system is to diffuse stressful and serious situations in the household. Their humor helps distract from the alcoholic and their problems.
Mascot children as adults can struggle with fear and anxiety. They may have known things were not okay growing up, but felt crazy because no one acknowledged it. They may feel insecure and unworthy as adults. Mascot children may also deny their own feelings, since they were never validated growing up. Mascot children as adults may be very unaware and detached of how they feel.
Lost children struggle with feeling forgotten. They may grow up to have negative self-worth, anxiety, and depression. They may struggle with awareness of their own thoughts and feelings. Since they were overlooked, they may have difficulties being in relationships of any kind, or feel unworthy of love or affection. These adults may struggle just to have friendships, let alone any kind of romantic relationship.
Codependency is so intertwined with ACOA roles. If you have ever been in a relationship of any kind (partner, friend, child, a parent) with someone who battles addiction, there is a chance you have fallen into some codependent patterns of behavior.
Often, adult children of alcoholics will take on the characteristics of alcoholics, even though they've never picked up a drink: exhibiting denial, poor coping skills, poor problem solving, and forming dysfunctional relationships.
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