Dissociative Experience in Unipolar and Bipolar Depression: Exploring the Great Divide

Abstract

ObjectiveUnipolar and bipolar depression (UD and BD) differ strikingly in respect to neurobiology, course and management, but their apparent clinical similarity often leads to misdiagnosis resulting in chronicity of course and treatment failure. In this study we have tried to assess whether UD and BD can be differentiated on the basis of their dissociative symptoms.MethodsThrty-six UD patients and 35 BD patients in active episodes, without any psychiatric comorbidity were selected from outpatient department and compared for depressive and dissociative symptoms using Hamilton Depression Rating Scale and Dissociative Experience Scale-II (DES-II).ResultsWe found that thought the two groups didn’t differ in terms of the socio-demographic or clinical variables, BD group had significantly higher dissociative experience (U=343, p=0.001) than UD and the difference remained significant even after adjusting for the confounding factors.ConclusionOur study shows that dissociative symptoms are significantly more prevalent in the depressive episodes of bipolar affective disorder as compared to the UD and can be an important tool in differentiating between the two disorders with very similar clinical profile. The difference can be measured using a simple self-report questionnaire like DES-II.

Dissociative Symptoms and Disorders in Patients With Bipolar Disorders: A Scoping Review

“…Five studies have compared the severity of DS in patients with BD and major depressive disorder (MDD), have measured DS during depressive episodes. In four of these studies, DS were more prominent in BD than in MDD ( 22 , 26 , 30 , 38 ), while in the other, they were comparable ( 44 ). Studies comparing the severity of DS between BD and other, non-affective psychiatric disorders found that DS were significantly less in BD than in somatoform disorders and DD ( 18 , 19 , 32 ), complex post-traumatic stress disorder (PTSD) ( 32 ), atypical psychosis in adolescents ( 20 ), and borderline personality disorder ( 36 ).…”

“…This association appeared to be more specific for depersonalization-related symptoms ( 24 , 26 , 34 ). Only one study reported no association between DS and AAO in BD ( 38 ). Associations between DS severity and episode frequency ( 37 ), total number of episodes ( 42 ) and frequency of manic ( 25 ) and depressive episodes ( 39 ) have been reported in individual studies.…”

The Dilemma of Comorbidity: Borderlands between Bipolarity and Conversion

“…The neurobiological basis of the relation still remains perplexing, while it is suggested to be due to an underlying disturbance in anterior cingulate cortex (ACC) (11) dorsomedial prefrontal cortex (MdPFC) (12) and insular cortex (IC) (13) which is found to be common in both the disorder. Hence, dissociation and bipolar disorder, both being associated with early childhood trauma, anxiety symptoms as well as neurobiological underpinnings involving amygdala and other limbic structures in functional imaging, demand further heuristic exploration for any furthur underlying relations between the two (14) In view of the substantial overlap between symptoms of BPAD and dissociative (conversion) disorder, an accurate cross-sectional assessment is inevitably difficult to achieve. Considering the inherent challenge in interviewing a bipolar patient, especially one with co-morbidities, the corraboration with family member for accurate history is of utmost importance for diagnosis.…”

Dissociative Symptoms in Bipolar Disorder: Impact on Clinical Course and Treatment Response

“…Current evidence suggests that the assessment of dissociative symptoms could be useful in differentiating patients with BD from those with unipolar major depression during depressive episodes. It has been reported that patients with BD are more likely to report dissociative symptoms than those patients with unipolar depression ( 8 ). Moreover, dissociative symptoms may precede the onset of the disorder and could be a risk factor for the development of BD ( 9 ).…”