The present of DD or DS in BD raises several important questions. A further problem is posed by patients with BD who have features of dissociation that are clinically significant, but do not fulfill criteria for DD these are referred to as “pathological dissociation” or “dissociative symptoms” (DS). DD may be underdiagnosed in patients with BD because of diagnostic criteria that do not allow DD to be diagnosed in the presence of depression ( 13), confusion arising from similar symptoms ( 14), or a reluctance to diagnose DD among mental health professionals ( 15).
BD and DD appear to share a genetic substrate to some extent ( 9, 10) and the onset of symptoms of DD may be a herald of subsequent BD in adolescents ( 11, 12). Though the comorbidity of DD and BD has been relatively under-studied ( 8), there is evidence from the literature of several potential clinical and mechanistic links between them. The presence of comorbid diagnoses in BD is associated with poorer treatment response and a more severe illness course patients with these diagnoses often require more intensive or complex treatment regimens ( 3– 6).ĭissociative disorders (DD), which are characterized by disruption or discontinuity in the integration of one's consciousness, memory, identity and behavior, are associated with risks of hospitalization, self-injury and suicide comparable to BD ( 7). Comorbidity with other psychiatric disorders is seen in over 50% of patients with BD, particularly with anxiety, attention-deficit/hyperactivity and substance use disorders ( 2).
A tentative future research agenda for this field, based on clinical, risk factor-related and neurobiological considerations, is outlined.īipolar disorders are a group of mental illnesses characterized by recurrent episodes of elevated and depressed mood, associated with significant levels of morbidity and an elevated mortality risk ( 1). Clinicians should be aware of the frequent occurrence of significant DS or DD when treating patients with bipolar disorder. The implications of these findings, and possible mechanistic pathways underlying them, are discussed based on the current literature.
Based on the available evidence, DS/DD are more common in bipolar disorder than in healthy controls or in unipolar depression, are related to childhood trauma, and are associated with psychotic symptoms, suicide attempts, and a poorer response to treatment in patients with bipolar disorder. This paper presents the results of a scoping review of the frequency and correlates of DS and DD in bipolar disorder. The co-occurrence of dissociative disorders (DD) and symptoms (DS) in bipolar disorder has been relatively understudied, but there is some evidence that this comorbidity may have significant mechanistic and clinical implications. Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Indiaĭissociative disorders are an important group of trauma-related disorders associated with significant disability.
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