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All Journal Medicor : Journal of Health Informatics and Health Policy Psychosocia : Journal of Applied Psychology and Social Psychology
Pramesta, Linda Ramadhanty
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Health Professions Medicine & Pharmacology Public Health Social Sciences

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Rapid Cycling Bipolar and Trauma-Related Personality Traits: Bridging the Gap Between Affective Dysregulation and Early-Life Adversity Septina, Egy Atthahirah; Halimatus Sakdyah; Pramesta, Linda Ramadhanty; Muhammad Ikhsan; Alsa Shafira; Budi Cahyono; Hafid Algristian
Medicor : Journal of Health Informatics and Health Policy Vol. 3 No. 1 (2025): January 2025
Publisher : Indonesian Scientific Publication

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61978/medicor.v3i1.740

Abstract

Rapid cycling bipolar disorder (RCBD) represents a severe and treatment-resistant subtype of bipolar disorder in which patients experience at least four mood episodes within a year, often accompanied by greater psychiatric comorbidity, functional impairment, and suicide risk compared to non-rapid cycling cases. Childhood trauma and early-life adversity have been identified as critical contributors to emotional dysregulation, impulsivity, and treatment resistance, yet their role is frequently underrecognized in clinical practice. This case report describes a 30-year-old woman diagnosed with RCBD and a history of emotional and physical abuse in childhood, aiming to illustrate the complex interaction between trauma and affective instability while integrating neurobiological, psychological, and clinical perspectives. The patient underwent four weeks of inpatient evaluation that included structured interviews, collateral history from caregivers, psychometric assessments using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), and Difficulties in Emotion Regulation Scale (DERS), as well as daily multidisciplinary observation. Over the past year, she experienced six distinct mood episodes with severe deficits in emotional clarity and impulse control, elevated DERS scores, and only partial response to pharmacological treatment with valproate and quetiapine. Clinical patterns and supporting literature suggest that trauma-induced dysregulation, involving amygdala hyperactivation and hypothalamic–pituitary–adrenal (HPA) axis disruption, played a central role. Improvement was achieved only after trauma-focused psychotherapy and psychosocial support were incorporated into her care. This case highlights the necessity of early trauma screening and integrative, trauma-informed management to improve diagnostic accuracy, treatment engagement, and long-term outcomes in complex bipolar presentations.
Hallucinations in Bipolar Disorder: A Spectrum Between Psychotic Features and Affective Intensification Pramesta, Linda Ramadhanty; Sakdyah, Halimatus; Egy Atthahirah Septina; Ikhsan, Muhammad; Shafira, Alsa; Winaryani; Algristian, Hafid
Psychosocia : Journal of Applied Psychology and Social Psychology Vol. 3 No. 1 (2025): January 2025
Publisher : Indonesian Scientific Publication

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61978/psychosocia.v3i1.757

Abstract

Hallucinations, while traditionally associated with schizophrenia spectrum disorders, are increasingly recognized in individuals with bipolar disorder, particularly in rapid cycling forms. Such manifestations complicate diagnosis and, if overlooked, may lead to poorer prognoses. This case report describes the clinical course and management of a 30-year-old female with bipolar I disorder, rapid cycling subtype (≥6 episodes/year), presenting with impulsivity, emotional instability, and mild auditory hallucinations. Her history included childhood emotional and physical abuse. Assessments involved DSM-5 structured interviews, the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), and Difficulties in Emotion Regulation Scale (DERS). Findings indicated pronounced affective lability, trauma-related personality traits overlapping with borderline personality disorder, and partial resistance to prior pharmacological treatment. During inpatient care, she was treated with valproate and low-dose quetiapine, complemented by psychoeducation and trauma-focused psychotherapy, producing notable improvement despite residual mood instability. This case underscores the interaction between trauma, affective dysregulation, and psychotic-like features in rapid cycling bipolar disorder (RCBD). Hallucinations here may reflect affective intensification rather than primary psychosis, stressing the need for careful differential diagnosis and trauma screening. The implications advocate routine trauma-informed assessments in bipolar disorder and highlight the efficacy of multimodal strategies combining pharmacological stabilization with targeted psychotherapy. Integrating trauma-focused care with mood management can enhance long-term outcomes in RCBD, particularly where conventional treatment shows partial resistance.
Co-Authors Alsa Shafira Budi Cahyono Egy Atthahirah Septina Hafid Algristian Halimatus Sakdyah Muhammad Ikhsan Sakdyah, Halimatus Septina, Egy Atthahirah Shafira, Alsa Winaryani