Hariri Aytül Gursu, Gulec Medine Yazici, Orengul Fatma Fariha Cengiz, Sumbul Esra Aydin, Elbay Rumeysa Yeni, Gulec Huseyin
Psychiatry Department, Maltepe University, Istanbul, Turkey.
Erenkoy Psychiatry and Neurological Disorders Research and Training Hospital, 34736 Kadikoy, Istanbul, Turkey.
J Affect Disord. 2015 Sep 15;184:104-10. doi: 10.1016/j.jad.2015.05.023. Epub 2015 May 21.
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).
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.
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.
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.
双相情感障碍（BD）患者的分离体验在某些特征上与其他精神障碍患者不同。本研究的主要目的是利用分离体验量表（DES）的因子结构、心理测量特征和潜在子维度，评估BD的临床变量与童年创伤之间的关系。
本研究纳入了200名处于缓解期的BD患者和50名健康志愿者。BD患者从土耳其的两个精神科门诊招募。比较了两组的社会人口统计学数据以及他们在DES和儿童创伤问卷（CTQ）-28上的得分。
DES的总体得分以及每个DES项目的得分准确且可靠地测量了BD患者的分离情况（项目-总分相关r得分：>0.20，克朗巴哈系数：0.95），因子分析揭示了BD患者DES的两个子维度：身份混淆/改变（SubDES-1）和失忆及人格解体/现实解体（SubDES-2）。虽然BD的发病年龄与两个子维度均显著相关，但病程仅与SubDES-2显著相关。在所有受试者中，19.5%（39/200名患者）被DES分类法（DES-T）确定为有分离体验，该子量表（DES-T阳性）的受试者在CTQ-28上的总分以及该量表各亚组的得分均显著更高。CTQ-28亚组得分最高的是情感忽视，其次是情感虐待和身体忽视，然后是性虐待和身体虐待。CTQ-28的总分与SubDES-2之间存在显著相关性，但CTQ-28各亚量表得分与SubDES-1或SubDES-2均无显著相关性。
DES充分且可靠地识别了BD患者的分离症状体验，因子分析揭示了该量表上BD的两个子维度。特别是，DES-T阳性受试者经历了更多的童年创伤，因此BD的发病年龄更早。此外，与失忆及人格解体/现实解体相关的SubDES-2与病程密切相关。
