Relationship Between Childhood Trauma, Dissociation, Attachment and Alexithymia in Patients with Bipolar Affective Disorder.

Introduction: Environmental and genetic factors, relationships and experiences established in the early years of life are involved in the etiology of bipolar affective disorder (BAD). The aim was to determine the frequency of childhood traumas, attachment styles, alexithymia and dissociative symptoms in BAD patients, to compare them with the healthy population, and to examine the direct and indirect relationships of childhood traumas with BAD. Methods: The study included 100 patients diagnosed with BAD according to DSM-IV TR diagnostic criteria and who had been euthymic for the last 2 months, and 100 healthy individuals matched for age and gender. The participants were administered the Sociodemographic Data Form, Childhood Trauma Questionnaire, Dissociative Experiences Scale, Toronto Alexithymia Scale, Experiences in Close Relationships Inventory-II, Hamilton Depression Scale and Young Mania Scale. Results: In the BAD group, childhood traumas, insecure attachment types, dissociative symptoms and alexithymia were found to be significantly higher than in healthy individuals. A positive relationship was found between physical abuse, dissociation and alexithymia levels and the number of attacks. Being physically abused was associated with earlier onset of the disease. A positive relationship was found between emotional abuse, physical neglect and total trauma score and dissociation. Trauma types other than sexual abuse were found to be associated with difficulty in recognizing and expressing emotions. It has been found that there is a relationship between emotional abuse and avoidant attachment dimensions. Alexithymia levels were found to be high in patients with early-onset BAD. It has been found that having a family history of psychopathology increases the risk of developing BAD, while externally oriented thinking and marital status protect against the disease. Conclusions: There is a relationship between childhood traumas, attachment types, dissociative and alexithymic characteristics in BAD. Our study reveals that emotional and physical abuse in childhood affects the development of BAD and the course of the disease, and the importance of holistic evaluation of the individual in terms of clinical course and treatment process.