Could bipolarity be influenced by stressful life events? A reflection based on a case report.

INTRODUCTION Bipolar disorder (BPD) has over the last fifteen years been considered as a biological disease with genetic bases, possibly triggered by stress factors. On the basis of a clinical case, we will question this theory. SUBJECT AND METHODS Mrs. X, a patient with a history of domestic violence, has two manic episodes that corresponded with conjugal difficulties. This would lead us to believe that stressful life events may have triggered the onset and the relapse of the illness of our patient. To confirm this, we made a literature review with the keywords bipolar disorder, stress, family functioning and domestic violence on three databases: PubMed, PsycInfo and PsycArticles. RESULTS Studies show that BPD has likely genetic and biological origins. It is also established in the literature that stressful life events influence the course of the disease, with for example the "Kindling" effect. However, there is very few data regarding the precise nature of these events. It is also established that the family interactions are affected by the BPD. Nonetheless, little is known about the influence of the family's interactions on the onset of the disease. CONCLUSIONS Our clinical case raises the question of the stress factors that may influence the onset and the course of BPD. It also raises the question of the possible link between BPD and domestic violence and the question of theeffect of stressors on the genetic and biological factors, introducing a more psychodynamic view of BPD. Further research on this subject should allow us to expand the treatment to more comprehensive care.