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Posttraumatic stress disorder in patients with bipolar disorder: a review of prevalence, correlates, and treatment strategies


  • The authors would like to disclose the following relationships with industry:

    Michael W. Otto: current grant/research support (Eli Lilly and Company, GlaxoSmithKline, Pfizer); past consultant (Janssen Pharmaceutica, Pfizer, Wyeth-Ayerst).

    Carol A. Perlman: grant/research support (GlaxoSmithKline).

    Rachel Wernicke: grant/research support (GlaxoSmithKline).

    Hannah E. Reese: grant/research support (GlaxoSmithKline).

    Mark S. Bauer: consultant (Health Process Management, Inc., Pfizer Inc.).

    Mark H. Pollack: grant/research support and speaker's bureau (Eli Lilly and Company, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, Pfizer Inc., and Wyeth); grant/research support (Cephalon and UCB Pharma); speakers bureau (Solvay); consultant (Bristol-Myers Squibb, Cephalon, Novartis, Otsuka Pharmaceuticals, Roche Laboratories, and UCb Pharma).

Michael W. Otto, PhD, Boston University Center for Anxiety and Related Disorders, 648 Beacon Street-Sixth Floor, Boston, MA 02215, USA. Fax: +617 353 9610;


Objectives:  In this article, we review the evidence for, and implications of, a high rate of comorbid posttraumatic stress disorder (PTSD) in individuals with bipolar disorder.

Methods:  We reviewed studies providing comorbidity data on patients with bipolar disorder, and also examined the PTSD literature for risk factors and empirically supported treatment options for PTSD.

Results:  Studies of bipolar patients have documented elevated rates of PTSD. Based on our review, representing 1214 bipolar patients, the mean prevalence of PTSD in bipolar patients is 16.0% (95% CI: 14–18%), a rate that is roughly double the lifetime prevalence for PTSD in the general population. Risk factors for PTSD that are also characteristic of bipolar samples include the presence of multiple axis I disorders, greater trauma exposure, elevated neuroticism and lower extraversion, and lower social support and socio-economic status.

Conclusions:  These findings are discussed in relation to the cost of PTSD symptoms to the course of bipolar disorder. Pharmacological and cognitive-behavioral treatment options are reviewed, with discussion of modifications to current cognitive-behavioral protocols for addressing PTSD in individuals at risk for mood episodes.