Abstract
Dear Editor:
Interpersonal violent behavior (IVB), as defined by the World Health Organization, involves the intentional use of force that may result in physical or psychological harm.
Bipolar disorder (BD), characterized by periods of acute illness (mania, depression, or mixed) and well-being (euthymia), stands out as one of the psychiatric disorders most strongly associated with IVB (Torrey et al., 2008).
Despite the near equal gender distribution in BD and the known influence of gender on IVB in the general population, existing literature often overlooks the role of gender (Verdolini et al., 2018). Concurrently, BD is linked with higher rates of comorbidities such as personality disorders (PDs), alcohol abuse (AA), and substance abuse (SA) that are also associated with IVB (Garno et al., 2008). Yet, the interaction between these comorbidities, gender, and different BD phases in relation to IVB remains underexplored.
Understanding the complex association between BD, IVB, and gender has critical implications, extending from direct harm to victims, through to wider social and economic consequences (Ballester et al., 2014). The underestimation of potential IVB in women with psychiatric disorders notably compromises the accuracy of violence risk assessments within mental health and correctional settings (Robbins et al., 2003).
Our study aims to investigate the role of gender on IVB in BD patients across different illness phases.
Over 10 months, our mood disorder unit recruited a preliminary sample of 155 consecutively admitted BD type 1 inpatients, with 97 females (F) and 58 males (M). We collected comprehensive data about IVB, AA, SA, and PD through clinical documentation, scales, and interviews (Table 1).
Clinical and Demographic Characteristics of the Sample
Student's t-test.
Chi-squared test.
SD, standrad deviation.
Preliminary results indicate a higher prevalence of IVB in M during periods of euthymia (F vs. M, 1.03% vs. 6.90%, p = 0.045). During the active phases of BD, the gender difference in IVB rates converges (F 12.37% vs. M 12.07% p = 0.956). An in-depth analysis of risk factors revealed an association of AA with IVB, regardless of gender, during active phases (no-AA vs. AA, 10.96% vs. 33.33%, p = 0.047). SA was significantly associated with IVB in M during both active (no-SA vs. SA, 6.38% vs. 36.36%, p = 0.006) and euthymic phases (no-SA vs. SA, 0% vs. 36.36%, p < 0.001). Interestingly, a significant association between IVB and PD surfaced in F during euthymia only (no-PD vs. PD, 0% vs. 5.26%, p = 0.042).
Given the high prevalence of BD and its significant impact on the population, our study provides crucial insights into the complex interplay between BD, IVB, and gender.
We observed higher IVB rates in males during euthymic periods, reflecting general population trends. However, acute BD phases seemed to neutralize this gender disparity, suggesting a direct link between BD psychopathology and IVB. Furthermore, AA and SA during active BD phases underscore their role as IVB mediators.
These findings underline the importance of understanding BD considering its intricate interaction with IVB, gender differences, and the influence of AA and SA. This comprehensive view is key for devising effective preventive and management strategies for the disorder.
Moreover, acknowledging the significance of aggressive behavior in females, often understated yet linked to crimes, worst clinical outcome, and familial and social issues, provides a broader perspective into the gender-specific complexities within BD.
Footnotes
Authors' Contributions
L.F. contributed to conceptualization, methodology, and writing—reviewing and editing; F.A. was involved in conceptualization, writing—original draft preparation, and formal analysis; G.T. was in charge of supervision and data curation; and C.C. took charge of project administration.