Dissociation : Vol. 9, No. 2 (June 1996)

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Dissociation : Vol. 9, No. 2, p. 104-109 : Recognizing bipolar illness in patients with dissociative identity disorder
(Ridgeview Institute and the International Society for the Study of Dissociation, 1996-06) Wills, Sharon M.; Goodwin, Jean, 1946-
Severe psychic distress and multiple symptoms are hallmarks of Dissociative Identity Disorder (DID) and are central to many diagnostic and therapeutic dilemmas for clinicians working in this field. Although comorbidities are commonplace in DID, cases in which Bipolar Illness (BPI) is comorbid with DID often escape detection because dissociative symptoms obscure and distort the individual's self-perception and self-report. In addition, the severe symptoms consistent with comorbid BPI are often misattributed to "known " borderline problems or major depression. This article describes in detail three cases in which the diagnosis of DID was well-documented and longstanding, and in which persistent symptoms led to a new diagnosis of comorbid BPI. In these individuals, undetected BPI had contributed to severe symptoms, ongoing risk of violence, and therapeutic chaos. The authors discuss problems in identifying comorbid BPI and circumstances which indicate that BPI should be included in the differential diagnosis.