AUTHOR=de Filippis Renato , Menculini Giulia , D'Angelo Martina , Carbone Elvira Anna , Tortorella Alfonso , De Fazio Pasquale , Steardo Luca 

TITLE=Internalized-stigma and dissociative experiences in bipolar disorder

JOURNAL=Frontiers in Psychiatry

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.953621

DOI=10.3389/fpsyt.2022.953621

ISSN=1664-0640

ABSTRACT=<sec><title>Introduction</title><p>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.</p></sec><sec><title>Materials and methods</title><p>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).</p></sec><sec><title>Results</title><p>Average age and age at BD (BD-I <italic>n</italic> = 66, 55%; BD-II <italic>n</italic> = 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 (<italic>n</italic> = 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) (<italic>p</italic> &lt; 0.001) and Stereotype (13.8, SD±3.9) (<italic>p</italic> &lt; 0.001). Linear regression analysis has shown a significant association between DES total score and alienation (<italic>p</italic> &lt; 0.001), stereotype (<italic>p</italic> &lt; 0.001) and MANSA total-score (<italic>p</italic> &lt; 0.001).</p></sec><sec><title>Discussion</title><p>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.</p></sec>