Although many clinicians depending on their experience will agree that childhood trauma history will cause treatment resistance regardless of the diagnosis, studies investigating this issue directly are scarce. During our search of literature we have found publications on the relationship between childhood trauma and treatment resistance in a few disorders such as obsessive compulsive disorder (OCD), major depression, and bipolar affective disorder. One study reported that 82% of OCD cases had a history of childhood trauma. In this study 39% of the cases met the criteria for post traumatic stress disorder (PTSD) and half of those who had a history of trauma met the PTSD criteria. It is noticeable that those who had major depression or borderline personality disorder, in addition to OCD, had a higher risk of having comorbid PTSD. Treatment resistant OCD cases should be screened for PTSD and having comorbid major depression and/or borderline personality disorder helps to predict PTSD and may help to determine the severity of the illness.
An indirect approach is looking for comorbidity of trauma related disorders in treatment resistant cases. One study has pointed out that OCD cases with comorbid PTSD have worse treatment outcomes. A meta-analysis study has revealed that childhood trauma not only effects lifetime risk of major depression, it also negatively effects severity of clinical parameters and results of treatment. This particular study, which included 16 epidemiological studies (23544 cases), showed that childhood abuse is related to recurrent and persistent depressive episodes. Another meta-analysis of 10 clinical studies with a total of 3098 cases, found that childhood abuse is related to absence of remission and absence of treatment response in depression.
In bipolar disorder, those who have had childhood trauma, had earlier onset of illness, more severe current symptoms of mania or depression and more frequent episodes of depression. Half of adult bipolar disorder patients were found to have severe childhood trauma.
In patients with early childhood trauma such as early loss of parents and physical or sexual abuse or neglect, psychotherapy alone had favorable results compared to monotherapy of antidepressants, while interestingly combination of psychotherapy and pharmacotherapy was slightly more effective than psychotherapy alone. Researchers have stressed that psychotherapy must be included in the treatment of chronic depression patients with childhood trauma.
Studies which directly investigate the relationship of treatment resistance and childhood trauma are scarce. Some comorbid conditions, such as personality disorders, that complicate treatment of depression are known to be related to childhood trauma.
As a result, we can with great confidence state that childhood trauma is related to treatment resistance in most psychiatric conditions. Especially in cases of treatment resistance, childhood trauma should be investigated and appropriate treatment modalities should be added to the treatment regime.