Stress in Bipolar Disorder

Environmental experiences play an important part in the development and maintenance of bipolar spectrum disorders (BSDs). Consequently, in this chapter, we review evidence on the role of life stress in the onset and course of BSDs. We begin with methodological issues relevant to demonstrating life stress’s role in the development and course of BSDs. We consider the effects of exposure both to recent life events and childhood stressors, as well as whether the influence of stressor exposure changes over the course of BSDs. We also address whether the effects of different types of life event exposure depend on mood episode polarity (hypomanic/manic versus depressive episodes) and whether there are specific theoretically relevant types of life events that are particularly likely to trigger bipolar episodes or symptoms. We end with suggestions for future research that may lead to a more complete understanding of the bipolar disorder–stress association.