Table 1.
Studies examining the association between dissociative symptoms or disorders and bipolar disorder, with a summary of their key findings.
| References | Study population and sample size | Variables or outcomes studied | Results |
|---|---|---|---|
| Nijenhuis et al. (18) | Patients with BD (n = 41) and DD (n = 51) |
DS severity across groups, rated using DES | DES scores higher in DD than in BD; significant DS in 10% of BD patients. |
| Nijenhuis et al. (19) | Patients with BD (n = 23), DD (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), and other psychiatric diagnoses (n = 45) | DS severity across groups, rated using DES; somatoform DS severity across groups, rated using SDQ-20; | DES and SDQ-20 positively correlated; DES scores significantly lower in BD than in DD; DES comparable in BD and somatoform disorders; SDQ-20 significantly lower in BD than in somatoform disorders and DD. |
| Hlastala & McClellan (20) | Youth with psychotic BD (n = 22), schizophrenia (n = 27) and atypical psychosis (n = 20) | DS severity across groups, rated using DES | DES scores higher in atypical psychosis than in BD or schizophrenia. |
| Johnson et al. (21) | Community-dwelling adults (n = 658) | Prevalence and comorbidities of dissociative disorders as per DSM-IV | Diagnosis of dissociative disorder 2.4 times more likely in those with a mood disorder (unipolar depression or BD). |
| Oedegaard et al. (22) | In- and out-patients with BD-II (n = 24) and MDD (n = 41) |
DS severity across groups, rated using DES; association with temperament and comorbid diagnoses. | DES scores higher in BD-II than in unipolar depression; cyclothymic temperament associated with higher DES scores; pathological dissociation associated with comorbid OCD |
| Savitz et al. (23) | Patients with BD-I (n = 31), BD-II (n = 16), and their first-degree relatives with MDD (n = 64), other psychiatric diagnoses (n = 17) or no psychiatric diagnosis (n = 50) | DS severity across groups, rating using DES; association with childhood trauma and polymorphisms of BDNF, COMT, DAT, DRD4, and SERT genes. | DES scores higher in BD-I and BD-II than in relatives with no or “other” diagnoses; significant interaction between COMT genotype and childhood trauma associated with DES score; additive effect of BDNF genotype on DES score. |
| Mula et al. (24) | Patients with BD-I (n = 43) and BD-II (n = 48), euthymic |
DS severity rated using DES; depersonalization symptom severity using SCI-DER; association with temperament, illness course and comorbidities | DES and SCI-DER scores comparable in BD-I and BD-II; no association of DES or SCI-DER scores with temperament; DES and SCI-DER scores associated with earlier AAO; higher SCI-DER scores in BD with comorbid panic disorder. |
| Latalova et al. (25) | Patients with BD, euthymic (n = 23) | DS severity rated using DES; association with illness course, tests of attention, verbal fluency and executive function, and quality of life. | DES scores associated with higher number of manic episodes, higher mean mood stabilizer dosage, and lower quality of life in the “social activities” domain. No correlation between DES and cognition. |
| Mula et al. (26) | Patients with mood and anxiety disorders (n = 258) including BD-I (n = 43) and BD-II (n = 48) | Depersonalization symptom severity using SCI-DER; distinction between depersonalization and anhedonia | SCI-DER scores higher in BD than in unipolar depression; SCI-DER score associated with earlier AAO in BD. |
| Chien et al. (27) | College students (n = 2,731) | Psychiatric symptoms as per DSM-IV using the Adult Self Report Inventory-4 | Significant positive correlation between symptoms of bipolar and dissociative disorders independent of gender. |
| Latalova et al. (28) | Patients with BD, euthymic (n = 41), healthy controls (n = 198) | DS severity rated using DES; association with demographic variables and illness course. | Significant dissociation (DES > 30) in 51.2% of BD patients; DES total and sub-scores significantly higher in BD than in controls; pathological dissociation associated with earlier AAO. |
| Weber et al. (29) | Discharge records of patients with BD (n = 27,054) compared to those with other diagnoses (n = 2,325,247) | Presence of comorbid “anxiety, dissociative and somatoform disorders” in BD; comparison of morbidity between BD and those with other diagnoses | “Anxiety, dissociative and somatoform disorders” identified in 11.4% of BD discharge records; “anxiety, dissociative and somatoform disorders” associated with 2.8 times greater morbidity in BD than in those with other diagnoses. |
| Souery et al. (30) | Patients with BD-I (n = 104), BD-II (n = 64), and MDD (n = 123; 53 with family history of BD) |
Depersonalization symptom severity across groups, rated using item 19 of HAM-D | Depersonalization symptom severity greater in BD-I than in BD-II or MDD. |
| Macri et al. (31) | Outpatients with BD (n = 17), MDD (n = 18), anxiety disorders (n = 32), adjustment disorders (n = 11) and somatoform disorders (n = 5) |
DS severity rated using DES; association with severity of depression and psychopathological domains on SCL-90-R | No association between DS severity and depression severity; total DES score positively correlated with all nine domains of SCL-90-R and with overall global severity of illness across diagnoses. |
| Dorahy et al. (32) | Patients with dissociative disorder (n = 39), complex PTSD (n = 13) and mood disorders (n = 21) |
DS severity across groups, rated using DES | Dissociative symptoms higher in the dissociative disorder group than in the complex PTSD or mood disorder groups. |
| Eryilmaz et al. (33) | Patients with BD-II, euthymic (n = 33), healthy controls (n = 50) |
DS severity across groups, rated using DES; association with childhood trauma and obsessive-compulsive symptoms | Significant dissociation (DES > 30) in 15.2% of BD-II patients; dissociative symptoms higher in BD-II than controls; DES correlated with scores for childhood trauma and OCD symptoms in BD-II |
| Hariri et al. (34) | Patients with BD, euthymic (n = 200), healthy controls (n = 50) | DS severity across groups, rated using DES | Significant dissociation (DES > 30) in 19.5% of BD patients; depersonalization/amnesia symptoms associated with earlier AAO and longer duration of BD; absorption/identity symptoms associated with earlier AAO. |
| Yayla et al. (35) | Patients with conversion disorder (n = 54) |
Prevalence of DSM-IV DD and comorbidities | 27.8% of patients with DD had comorbid BD; BD more common in patients with DD. |
| Bayes et al. (36) | Patients with BD or borderline personality disorder (n = 226) | Depersonalization symptoms (self-reported) | Depersonalization symptoms more common in borderline personality disorder than in BD. |
| Yilmaz et al. (37) | Patients with BD-euthymic (n = 70), healthy controls (n = 70) | DS severity across groups as rated using DES; association with childhood trauma, illness course and alexithymia | DES scores higher in BD than in healthy controls; DES score significantly associated with episode frequency and alexithymia but not with childhood trauma. |
| Chatterjee et al. (38) | Patients with BD-depression (n = 35) and recurrent MDD (n = 36) | DS severity as rated using DES-II | DS more severe in BD than in unipolar depression; no correlation of DES-II with AAO, illness duration or number of episodes in BD. |
| Kefeli et al. (39) | Patients with BD-I-euthymic (n = 40), healthy controls (n = 40) | DS severity as rated using DES-II; association with number of manic and depressive episodes | Significant dissociation (DES > 30) in 20% of BD-I as against 2.5% controls; absorption/imaginative symptoms negatively associated with BD-I; somatoform dissociation associated with number of depressive episodes. |
| Tekin et al. (40) | Patients with BD, euthymic (n = 51), healthy controls (n = 49) | DD diagnosis as per DSM-IV criteria; DS severity across groups as rated using DES; association with illness course | 35.4% of BD patients qualified for a diagnosis of comorbid DD (depersonalization disorder 17.6%, DD-NOS 15.6%, dissociative amnesia 7.8%, DID 3.9%, dissociative fugue 1.9%); DES scores significantly higher in BD than in controls; DES total score associated with number of suicide attempts and earlier AAO in BD group. |
| Tuineag et al. (41) | Outpatients with BD-I (n = 41), BD-II (n = 27) or other BD (n = 5) | DS severity as rated using CDS; association with childhood trauma and symptoms of mania, depression and anxiety. | CDS valid for the assessment of DS in BD; CDS total score associated with childhood trauma and symptoms of depression, social anxiety, and panic disorder. |
| Steardo et al. (42) | Outpatients with BD-I (n = 55) and BD-II (n = 45) | DS severity as rated using DES-II; association with demographic variables, illness course and treatment response. | DES scores significantly higher in BD-I than in BD-II; DES score significantly associated with number of episodes, presence of mixed or psychotic features, history of suicide attempts or aggressive behavior, symptoms of anxiety, seasonality, antidepressant-induced mania, and poorer treatment response. |
| Stone et al. (43) | Patients with psychotic BD (n = 53) or schizophrenia (n = 47), healthy controls (n = 51), recruited during the COVID-19 pandemic | DS severity as rated using DES-II; association with childhood trauma and pandemic-related adversities. | DES scores significantly higher in BD and schizophrenia than in healthy controls; significant dissociation (DES > 30) in 17% of BD; no significant association between DES and childhood trauma or pandemic-related adversities. |
| Li et al. (44) | Inpatients with BD-depression (n = 32) and MDD (n = 59) |
DS severity as rated using CADSS; association with parenting style, betrayal trauma and psychotic symptoms | DS of equal severity in BD and unipolar depression; DS associated with betrayal trauma and severity of psychotic symptoms. |