Mood disorders Dissociation and childhood trauma in patients with bipolar disorder

Objective: To determine the frequency of dissociation and childhood trauma among bipolar disorder and the effects of dissociation and childhood trauma on the prognosis.

Method: This study comprises of a group of 51 people attending to Sisli Etfal Training and Research Hospital outpatients department who had been diagnosed as bipolar disorder according to DSM-IV-TR and not in an episode of mania, depression or mixed state on the assessment. The patients were recruited between March and December, 2012. SCID-I (The Structured Clinical Interview for DSM-IV Axis I Disorders), SCID-D (The Structured Clinical Interview for DSM-IV Dissociative disorders), DES (Dissociative Experiences Scale ) and CTQ (Childhood Trauma Questionnaire) were administered to all participants with a sociodemographic form.

Results: The mean DES score was 20.73±15.09 and the frequency of any dissociative disorder was 35.4% among patients with bipolar disorder. The prevalence of dissociative disorders were as follows: 17.6% was depersonalization disorder, 7.8% was dissociative amnesia and 5.8% was dissociative disorder not otherwise specified. Furthermore, 49% of patients has had a childhood trauma. Frequency of more than two types of childhood trauma among the patient group was 31.3%. DES scores from patients with bipolar disorder had a negative correlation with the number of years of formal education and age at onset of disease. DES scores had a positive correlation with the number of suicide attempts (respectively p=0,016; 0,017; 0,043). Also in patients with bipolar disorder, CTQ total score had a negative correlation with the number of years of formal education and the number of suicide attempts (respectively p=0,006; 0,038). Among the bipolar patients, patients with high DES and CTQ total scores had earlier disease onset and more suicide attempts, and interestingly had lower education level.

Conclusion: Findings of 35.4% of dissociation and 49% of childhood trauma in bipolar disorder patients are main evidences of this study. Considering above findings, it can be saved that there is a positive correlation between existence of dissociation and childhood trauma and a poor prognosis of bipolar disorder. Moreover, more severe cognitive impairment among those patients can be seen. Co-existence of dissociation and childhood trauma with bipolar disorder is not rare and it can predict the prognosis of the disorder. Studies with more participants will help us to understand the comorbidity of dissociative disorders and the role of childhood trauma in patients with bipolar disorder.