The mediation role of impulsivity between childhood trauma and dissociative symptomatology in bipolar disorder

Background. In bipolar disorder (BD) patients, trauma has been associated with emotion-al dysregulation, potentially leading to an increase in impulsivity and dissociative symptomatology. We aimed to investigate the relationship between child-hood trauma, impulsivity, and dissociative symptom-atology in BD with a special focus on the role of impulsivity as a mediator between childhood trauma and dissociative symptomatology. Methods. We administered the Childhood Trauma Questionnaire (CTQ), Barratt Impulsivity Scale (BIS-11), Dissociative Experience Scale (DES-II), and Alda scale. Spearman correlation analysis assessed the independent vari-ables associated with CTQ and DES-II. We performed a mediation analysis using the bootstrapping tech-nique to verify the hypothesis that impulsivity rep-resented an intervening variable between childhood trauma and dissociation. Results. CTQ and DES-II scores in 100 BD patients were both significantly associated with the number of lifetime affective episodes, a clinical course of mania-depression-eu-thymia, suicidal ideation, a history of antidepres-sant-induced manic switch, poor response to mood stabilizers, mixed features, psychotic symptoms, aggressive behavior, and BIS-11 (p<0.01). At the re-gression analysis, CTQ was associated with DES-II (p<0.001), while DES-II was associated with the CTQ (p <0.001) and BIS-11 (p< 0.001), as well as with ag-gression (p=0.002). The mediation analysis showed that impulsivity significantly mediated the effect of childhood trauma on dissociative symptomatol-ogy (z=25.71; 0.930-1.084). Conclusions. Impul-sivity might play a key role in onset and prognosis of BD patients. Our findings may help in increasing the knowledge about the possible association be-tween impulsivity, childhood traumatic experiences and dissociative symptomatology. BD patients with dissociative symptoms might benefit from a tailored treatment which could include a training based on emotional and behavioral regulation.