de Filippis Renato, Menculini Giulia, D'Angelo Martina, Carbone Elvira Anna, Tortorella Alfonso, De Fazio Pasquale, Steardo Luca
Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Department of Psychiatry, University of Perugia, Perugia, Italy.
Front Psychiatry. 2022 Jul 29;13:953621. doi: 10.3389/fpsyt.2022.953621. eCollection 2022.
Dissociative symptoms have been recently related to bipolar disorder (BD) symptomatology. Moreover, the disease burden carries on a share of perceived self-stigma that amplifies the BD impairment. Internalized stigma and dissociative symptoms often seem overlapping, leading toward common outcomes, with reduced treatment seeking and poor adherence. We hypothesize a potential relationship between dissociation and self-stigma in patients suffering from BD.
In this cross-sectional study we enrolled a total of 120 adult clinically stable BD outpatients. All participants completed the Internalized Stigma of Mental Illness (ISMI), Dissociative Experiences Scale-II (DES-II), and Manchester Short Assessment of Quality of Life (MANSA).
Average age and age at BD (BD-I = 66, 55%; BD-II = 54, 45%) onset were 46.14 (±4.23), and 27.45 (±10.35) years, with mean disease duration of 18.56 (±13.08) years. Most participants were female ( = 71; 59.2%) and 40 (33%) of them experienced lifetime abuse, with an average of 1.05 (±0.78) suicide attempts. DES scores (mean 31.8, ±21.6) correlated with ISMI total-score, with significant association with spikes in Alienation (13.1, SD±3.1) ( < 0.001) and Stereotype (13.8, SD±3.9) ( < 0.001). Linear regression analysis has shown a significant association between DES total score and alienation ( < 0.001), stereotype ( < 0.001) and MANSA total-score ( < 0.001).
For the first time, our data suggests that self-stigma is associated to dissociative symptoms, reducing overall quality of life in BD. The early identification of at-risk patients with previous lifetime abuse and high perceived stigma could lead the way for an ever more precise tailoring of treatment management.
解离症状最近被认为与双相情感障碍（BD）的症状学有关。此外，疾病负担还包括一部分感知到的自我污名，这加剧了BD的损害。内化污名和解离症状常常似乎相互重叠，导致共同的结果，即寻求治疗的意愿降低和依从性差。我们推测BD患者的解离与自我污名之间存在潜在关系。
在这项横断面研究中，我们共纳入了120名临床稳定的成年BD门诊患者。所有参与者均完成了精神疾病内化污名量表（ISMI）、解离体验量表第二版（DES-II）和曼彻斯特生活质量简短评估量表（MANSA）。
平均年龄和BD发病年龄（BD-I = 66，占55%；BD-II = 54，占45%）分别为46.14（±4.23）岁和27.45（±10.35）岁，平均病程为18.56（±13.08）年。大多数参与者为女性（n = 71；59.2%），其中40人（33%）有过终生受虐经历，平均自杀未遂次数为1.05（±0.78）次。DES得分（平均31.8，±21.6）与ISMI总分相关，与疏离感（13.1，标准差±3.1）（P < 0.001）和刻板印象（13.8，标准差±3.9）（P < 0.001）的峰值有显著关联。线性回归分析显示，DES总分与疏离感（P < 0.001）、刻板印象（P < 0.001）和MANSA总分（P < 0.001）之间存在显著关联。
我们的数据首次表明，自我污名与解离症状相关，会降低BD患者的整体生活质量。早期识别有终生受虐史且自我污名感高的高危患者，可能为更精准的治疗管理定制指明方向。
