title: Dissociation in bipolar disorder: Relationships between clinical variables and childhood trauma.
abstract: OBJECTIVE
  The dissociative experiences of patients with bipolar disorder (BD) differ from those of patients with other psychiatric disorders with regard to certain features. The primary goal of this study was to evaluate the relationship between the clinical variables of BD and childhood trauma using the factor structure, psychometric features, and potential subdimensions of the Dissociative Experience Scale (DES).
  
  
  METHODS
  This study included 200 BD patients who were in a remission period and 50 healthy volunteers. The BD patients were recruited from two psychiatry clinic departments in Turkey. The sociodemographic data of the two groups and their scores on the DES and Childhood Trauma Questionnaire (CTQ)-28 were compared.
  
  
  RESULTS
  The overall DES scores and the scores for each DES item accurately and reliably measured dissociation in the BD patients (item-total correlation r scores: >0.20, Cronbach's alpha: 0.95), and a factor analysis revealed two subdimensions of the DES for BD: identity confusion/alteration (SubDES-1) and amnesia and depersonalization/derealization (SubDES-2). Although age at onset of BD was significantly correlated with both subdimensions, illness duration was significantly correlated only with the SubDES-2. Of all the subjects, 19.5% (39/200 patients) were identified as having dissociative experiences by the DES-Taxon (DES-T), and subjects in this subscale (DES-T-positive) had significantly higher total scores on the CTQ-28 as well as higher scores on each subgroup of this scale. The highest CTQ-28 subgroup score was emotional neglect, which was followed by emotional abuse and physical neglect and then sexual abuse and physical abuse. There was a significant correlation between total scores on the CTQ-28 and SubDES-2 but none of the CTQ-28 subscale scores was significantly correlated with either SubDES-1 or SubDES-2.
  
  
  CONCLUSIONS
  The DES sufficiently and reliably identified the experience of dissociative symptoms on the part of BD patients, and a factor analysis revealed two subdimensions of BD on this scale. In particular, DES-T-positive subjects experienced a greater amount of childhood trauma and, as a result, had an earlier age at onset of BD. Additionally, SubDES-2, which was associated with amnesia and depersonalization/derealization, was closely related to illness duration.
authors.affiliation: Psychiatry Department, Maltepe University, Istanbul, Turkey.
authors.forename: Aytül Gursu
authors.initials: AG
authors.lastname: Hariri
authors.affiliation: Erenkoy Psychiatry and Neurological Disorders Research and Training Hospital, 34736 Kadikoy, Istanbul, Turkey. Electronic address: yazicimedine@yahoo.com.
authors.forename: Medine Yazici
authors.initials: MY
authors.lastname: Gulec
authors.affiliation: Haseki Research and Training Hospital, Istanbul, Turkey.
authors.forename: Fatma Fariha Cengiz
authors.initials: FF
authors.lastname: Orengul
authors.affiliation: Erenkoy Psychiatry and Neurological Disorders Research and Training Hospital, 34736 Kadikoy, Istanbul, Turkey.
authors.forename: Esra Aydin
authors.initials: EA
authors.lastname: Sumbul
authors.affiliation: Erenkoy Psychiatry and Neurological Disorders Research and Training Hospital, 34736 Kadikoy, Istanbul, Turkey.
authors.forename: Rumeysa Yeni
authors.initials: RY
authors.lastname: Elbay
authors.affiliation: Erenkoy Psychiatry and Neurological Disorders Research and Training Hospital, 34736 Kadikoy, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Gulec
mesh_terms: D000293:Adolescent; D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000523:psychology*; D017668:Age of Onset; D001714:Bipolar Disorder / Q000150:complications / Q000523:psychology*; D016022:Case-Control Studies; D003861:Depersonalization / Q000523:psychology; D004213:Dissociative Disorders / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067073:Psychological Trauma / Q000150:complications / Q000523:psychology*; D011594:Psychometrics; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Bipolar disorder; CTQ-28; Childhood trauma; DES; Dissociation