Dissociative symptomatology in bipolar disorders: A systematic qualitative review

Background

Case reports and clinical studies suggest that dissociative symptoms (DS) and dissociative disorders (DD) are prevalent in bipolar disorders (BD).

Methods

We conducted a systematic qualitative review on this association. MEDLINE and PsycINFO studies published up to November 15th, 2018 were searched, with an additional search through bibliographical references. English or French articles published in peer-reviewed journals, reporting quantitative measures of DS and/or frequency of DD, and at least one group or measure of BD were included. Six hundred and seven articles were reviewed on abstracts, 22 full-text articles screened, and 15 finally included.

Results

Four studies showed that BD patients had more DS than healthy controls. DS were more frequent in BD than in unipolar depression in four studies, but less than in borderline personality disorder. DS were associated with an earlier age at onset of BD in two studies and possibly more comorbidity, while the associations with type of BD, suicidal behavior or childhood trauma need confirmation.

Conclusions

While not specific among mental disorders, our review suggests an association between DS/DD and BD. Results should incite clinicians not to exclude too early an unrecognized BD in depressed patients with DS/DD, and consider DS/DD as markers of severity in BD.