(PS3-C52) The Prevalence of PTSD in a Bipolar Specialty Clinic and a Preliminary Exploration of Cognitive Processing Therapy Tailored to Co-morbid Bipolar Disorder and PTSD

The prevalence of PTSD in people with bipolar disorder ranges from 16% to 40% which is, at least, double the lifetime prevalence estimate of 8% in the general population. Much of this data comes from samples of individuals with bipolar disorder who received primarily pharmacological treatments nearly 30 years ago. Ideally, individuals with bipolar disorder should receive evidence-based pharmacotherapy and psychotherapy which generally occur in bipolar specialty clinics. As society has undergone recent seminal events such as the COVID-19 pandemic and social justice movements including Black Lives Matter, PTSD prevalence data on a more recent sample could point to the impact of these events. We examined the prevalence of PTSD in a sample of individuals receiving recent bipolar specialty clinic treatment, involving intensive evidence-based pharmacotherapy and psychotherapy, by examining PCL-5 scores and responses on the Childhood Trauma Questionnaire.

Trauma-based treatments are underutilized in bipolar psychotherapy and could reduce the burden of traumatic events. Co-morbid PTSD in individuals with bipolar disorder is thought to worsen the trajectory of this potentially debilitating condition. Evidenced-based approaches such as cognitive processing therapy (CPT) have been shown to be effective for individuals with PTSD and co-morbid bipolar disorder. In this preliminary exploration, we examine qualitative data from an individual with co-morbid bipolar I and PTSD, who wrote an impact statement about bipolar disorder and index trauma experiences. Themes for potential stuck points are explored indicating a combination of “traditional” index trauma thoughts and those specific to bipolar disorder. To our knowledge, only one case report exists in the literature around modifying CPT for patients with bipolar disorder. Bipolar disorder is a leading cause of years lost to disability worldwide. For this reason, individuals with bipolar disorder often find the symptoms and the diagnosis itself to be traumatic. In addition to criteria A trauma, we explore how CPT can challenge cognitions related to living with bipolar disorder. Expertise in bipolar psychotherapy and CPT may be needed to work effectively with this important bipolar sub-population.