DID vs bipolar
Bipolar

Dissociative Identity Disorder versus Bipolar Disorder – How You Can Tell Them Apart

 

I have Other Specified Dissociative Disorder (OSDD) and the only difference in my case and DID is that I have not had dissociative amnesia. Basically, that means having no memory of a situation. I consider my disorder a gift because it protected my fragile child’s mind from the damaging effects of severe childhood sexual abuse.  I chose to use DIssociative Identity Disorder (DID) because it is the most well-known of the dissociative disorders.

Because of the shifts in personality states, Dissociative Identity Disorder (DID) is sometimes confused with bipolar disorder. Personality states(alters) where one alter is depressed and one is in a good mood can sometimes confuse people. Especially,if they frequently alternate between the two.  Remember that people with DID can also have a mood disorder like Bipolar I Disorder. I am using the DSM 5 but have altered the language to make it easier to read.

DID is characterized by the presence of two or more distinct personality states or an experience of possession and recurrent episodes of amnesia. Individuals with dissociative identity disorder

experience with repeat voices,dissociated actions and speech, and/or intrusive thoughts/emotions/impulses. Stress often causes a temporary worsening of dissociative symptoms that makes them more obvious. DID is associated with overwhelming experiences, traumatic events, and/or abuse occurring in childhood. The full disorder may first manifest at almost any age (from earliest childhood to late life).

 

Three terms used frequently with DID are depersonalization, derealization, and dissociative amnesia. Depersonalization is characterized by experiences of unreality or detachment from your mind, self, or body.  Derealization includes experiences of unreality or detachment from your surroundings. Dissociative amnesia is the inability to recall autobiographical information such as name and birth date. This amnesia may be a specific event or a generalized period of time.

 

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Dissociative Identity Disorder Bipolar  I Disorder
Key Highlights
  • In one study, 1.5% of adults had DID
  • In the same study,  1.6% for males and 1.4% for females.
  • In the U.S, Canada, and Europe, 90% suffered childhood abuse and neglect.
  • Over 70% of outpatients with DID have attempted suicide and self-harm.
  • Cultural differences: iIn settings where possession is the norm such as rural areas in the developing world, and among certain religious groups in the U.S.and Europe, The fragmented identities may take the form of possessing spirits, deities, demons, animals, or mythical figures.
  • The 12-month prevalence estimate in the continental United States was 0.6% for bipolar I disorder as defined in DSM-IV.
  • Twelve-month prevalence of bipolar I disorder across 11 countries ranged from 0.0% to 0.6%.
  • The lifetime male-to-female prevalence ratio is approximately 1.1:1.
  • Mean age at onset of the first manic, hypomanic, or major depressive episode is approximately 18 years for bipolar I disorder.
  • Females are more likely to experience rapid cycling and mixed states, and to have patterns of comorbidity that differ from those of males, including higher rates of lifetime eating disorders and Alcohol Use Disorder.
Risk Factors Environmental:

  • Physical and sexual abuse is associated with an increased risk of DID. Other forms of trauma including childhood medical/surgical procedures, war, childhood prostitution, and terrorism, have been reported.

Course modifiers.

  • Ongoing abuse, later-life retraumatization, diagnosis of other mental disorders, severe medical illness, and delay in appropriate treatment are linked to a poorer outcome.
Environmental:

  • Separated, divorced, or widowed individuals have higher rates of bipolar I disorder

Genetic and physiological:

  • A family history of bipolar disorder with 10 times the risk of developing it.
  • Schizophrenia and bipolar disorder likely share a genetic origin

Course modifiers;

  • After an individual has a manic episode with psychotic features, subsequent manic episodes are more likely to include psychotic features.
DSM 5 Criteria

(United States)

A.  Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in

identity involves marked discontinuity in sense of self and sense of control, along with changes in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

B.  Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C.  The symptoms cause clinically significant distress or difficulty functioning in social, occupational, or other important areas.

D.  The disturbance is not a normal part of a broadly accepted cultural/religious practice.

Note:

In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

E.  The symptoms are not attributable to the physiological effects of a substance (e.g.blackouts or chaotic behavior during alcohol

intoxication) or another medical condition (e.g., complex partial seizures).

For a diagnosis of bipolar I disorder, it is necessary to meet the following criteria A-D for a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder. No other mood episode is required for diagnosis.

Criteria A:

  • A distinct period of elevated, expansive, or irritable mood and increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

Criteria B;

  • During the period of mood disturbance and increased energy or activity, three+ of the following symptoms (4 if the mood is only irritable) are present and represent a noticeable change from usual behavior:
  1. Inflated self-esteem/grandiosity.
  2. Decreased need for sleep        
  3. More talkative or pressure to talk..
  4. Flight of ideas or thoughts are racing.
  5. Distractibility.
  6. Increase in goal-directed or psychomotor agitation
  7. Excessive involvement in high risk activities.

Criteria C:.  

  • The mood disturbance is sufficiently severe to cause marked impairment in social/occupational functioning or hospitalization or there are psychotic features.

Criteria D:

  • The episode is not caused by effects of a substance

Note: A full manic episode that emerges during antidepressant treatment but persists beyond the effect of that treatment is sufficient evidence for a manic episode

Major Depressive Episode:

A.  Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous

functioning; at least one of this symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly attributable to another medical condition.

1.  Depressed mood most of the day, nearly every day

Note:In children and adolescents, can be irritable mood.

2.  Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3.  Significant 5 % unintended weight loss/weight gain or change in appetite nearly every

day.

Note:In children, consider failure to make expected weight gain.

4. Insomnia/ hypersomnia nearly every day.

5.  Psychomotor agitation/ retardation nearly every day

6.  Fatigue or loss of energy nearly every day.

7.  Feelings of worthlessness or excessive or inappropriate guilt nearly every day

8.  Diminished ability to think or concentrate, or indecisiveness, nearly every day

9.  Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

B.  The symptoms cause clinically significant distress or impairment

C.  The episode is not caused by effects of a substance or another medical condition.

Differential Diagnosis

(Differences in Diagnosing Each Disorder)

  • The relatively rapid shifts in mood in individuals with this disorder—typically within minutes or hours, in contrast to the slower mood changes typically seen in individuals with bipolar disorders—are due to the rapid, subjective shifts in mood commonly reported across dissociative states, sometimes accompanied by fluctuation in levels of activation.
  • Elevated or depressed mood may be displayed along with overt identities, so one or the other mood may predominate for a relatively long period of time (often for days) or may shift within minutes.

 

  • May have increased activity, poor concentration, and increased impulsivity, but these features are episodic, occurring several days at a time.
  • Increased impulsivity or inattention is accompanied by elevated mood, grandiosity, and other specific bipolar features.
  • Rare in preadolescents, even when severe irritability and anger are prominent

 

WRAPUP:

 

People with DID are often misdiagnosed wtih Bipolar II disorder because of the shifts in personality states (alters).  For instance, if an alter that is in a great mood is out for several days and then the person shifts to an alter with a depressed mood for several days can look like Bipolar Disorder. However, remember people with DID can also have Bipolar Disorder. It’s just more difficult to diagnose.  

I am diagnosed with OSDD and Bipolar Disorder. I have two alters that were the same age, 9 years old.  One is generally in a depressed mood and one is in a good mood. This definitely complicated diagnosis of Bipolar Disorder.

 

Thank you for reading my blog.  Check out Borderline Personality Disorder versus Bipolar Disorder for more great reading. Leave comments, questions, and prayer requests below.

 

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