Resistant anxiety and affective instability as a marker of abuses in the past: a case report.

Introduction: In our clinical practice we find patients with anxiety and mood instability that are resistant to different strategies of medical treatment and psychotherapy. It is relevant that many of them have recognized a history of abuses in their past that never before was detected neither solved. It is known that Affectiveinstability (AI), childhood trauma, and mental illness are linked, but evidence in mood disorders is limited. Objectives: The aim of this paper is to document resistant anxiety and AI cases with history of adverse childhood experiences, in order to determine refractory mood disorders as a marker of history of abuses in the past. Methods: A bibliographic search was performed from different databases (Pubmed, Ovid, ScienceDirect)about this topic, from a case series report, showing throw aspects related to mood dysregulation in adults with childhood maltreatment. Results: A remarkable percentage of the evaluated patients diagnosed with refractory anxiety or AI, had a history of childhood trauma, what might be an adaptive response to stressors and attenuate affective instability. Conclusions: Childhood-maltreatment has been shown in metaanalyses to be a major risk factor for mood and anxiety-disorders, also there is a strong link between childhood traumatic events and AI levels. For that reason, if we identify a refractive course of anxietymood disorder as amarker of vulnerability of history of trauma in the childhood, that could potentially optimize service delivery and therapy outcomes among that profile of patients. More studies are required to achieve an adequate evaluation, allowing a different inicial boarding that could modify the course, thanks to its early detection. [ABSTRACT FROM AUTHOR]