“…Furthermore, it has been suggested that childhood sexual abuse may produce a cascade of neurobiological sequelae that have the potential to persist into adolescence or adulthood, providing the neurobiological framework through which childhood abuse might increase the risk for suicidality (102), substance abuse (103, 104), and psychosis (85). Alternatively, it is also possible that psychological distress resulting from childhood sexual abuse may lead victims who have (or will have) bipolar disorder to self‐injure or use drugs or alcohol as a coping strategy or self‐medication mechanism (105–107) employed temporarily to avoid, reduce, anesthetize, interrupt, or alleviate painful internal states (such as thoughts, memories, feelings, affects, or cognitions) associated with the victimization experience (64, 70, 76, 78, 80, 108–110). Because such painful internal states, as well as such strategies employed to avoid or control these re‐experiencing phenomena, may be conceived as subclinical or subsyndromal symptoms of posttraumatic stress (111), it is possible that, even in the absence of posttraumatic stress disorder, the relationship between childhood sexual abuse and increased severity of bipolar disorder could be driven by subclinical or subsyndromal symptoms of posttraumatic stress.…”