DID Vs. Schizophrenia: What Is The Difference Between These Disorders?
Despite significant differences in their causes and presentations, dissociative identity disorder (DID) and schizophrenia may be confused with one another due to some overlapping symptoms involving changes in mood and behavior. Only licensed professionals can offer official diagnoses. However, recognizing the differences between DID and schizophrenia may help you advocate for yourself by arming you with the knowledge necessary to accurately discuss your symptoms and experiences with professionals. While treatment for these disorders often differs, it usually involves regular therapy sessions, which can take place online or in your local area.
What is dissociative identity disorder?
Individuals living with DID or dissociative identity disorder may have multiple identities or personality states (hence this disorder’s previous name, “multiple personality disorder”). These identities, often referred to as “alters,” can have distinct ways of thinking and acting, with memories that are often separate from other personality states.
Specific identities may have different manners of speaking, attitudes, lifestyle preferences, and perceptions of their body or overall appearance. Some individuals may have as few as two alters, while others may have dozens or even hundreds.
Symptoms of dissociative identity disorder (DID)
Aside from the presence of multiple personalities, an individual living with DID may experience symptoms like the following:
- Feelings of anxiety or depression
- Delusions
- Memory loss
- Disorientation
- Mood swings
- Difficulty sleeping
- Co-occurring disorders, such as post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD)
DID is generally considered a dissociative disorder. Other dissociative disorders can include dissociative amnesia, which typically involves an inability to recall information about oneself, and depersonalization/derealization disorder, which often manifests as feelings of detachment from oneself or one's surroundings. A doctor may need to rule out these disorders, as well as schizophrenia, before a diagnosis of DID can be provided.
What is schizophrenia?
Individuals living with schizophrenia may experience changes in their thought patterns, perceptions, and behaviors. In many cases, schizophrenia may make it difficult for an individual to distinguish between reality and the symptoms of their disorder, which may include those discussed below.
Negative symptoms: Low energy, loss of motivation, and more
The negative symptoms of schizophrenia may affect the level of motivation or interest an individual experiences in their daily life. These symptoms can make it difficult to participate in social functions or essential activities, such as buying groceries, completing projects at work, or attending school. Negative symptoms may also include low energy, difficulty showing emotion, and limited facial expressions, which may further complicate social interactions.
Positive symptoms: Hearing voices, delusions, and more
Sometimes referred to as psychotic symptoms, positive symptoms usually have a direct impact on the thoughts, behaviors, and experiences of an individual living with schizophrenia. These symptoms typically include hallucinations, delusions, disordered thoughts, and changes in movement.
- Hallucinations can create false sensory experiences that may affect sight, hearing, taste, smell, or touch. A common manifestation of this symptom can involve hearing voices of individuals or entities that are not actually there.
- Delusions may cause a person to believe in situations that may not be logical, rational, or true. For example, a person experiencing delusions may see someone walking behind them and believe they are a government agent tracking them.
- Disordered thoughts can make it difficult for an individual to stick to a specific topic or clearly communicate what they are thinking. This symptom may also cause a person to stop talking before finishing their sentence or use words that don’t exist or don’t make sense to others.
- Changes in movement can include repetitive or involuntary motions, often in the limbs or facial muscles.
Cognitive symptoms of schizophrenia
Cognitive symptoms: Cognitive schizophrenia symptoms can affect a person’s attention span, memory, and ability to concentrate. These symptoms may negatively impact decision-making, create information processing difficulties, and make it difficult to function in certain settings, such as work or school. Cognitive symptoms may also interfere with treatment, as it could be difficult to remember appointments or use the information learned during treatment sessions.
DID vs. schizophrenia: Understanding the differences
While DID and schizophrenia can be similar in some ways—and it may be possible to experience both simultaneously—they are usually seen as distinct and separate mental health disorders. Those who confuse the two may do so due to certain symptomatic similarities. These shared symptoms may include changes in behavior, thought patterns, and emotions.
Different symptoms of DID vs. schizophrenia
Risk factors for schizophrenia vs. DID
Another differentiating factor between these disorders may be their cause. While the precise causes of schizophrenia aren’t yet known, research suggests that certain factors may increase the likelihood that an individual will develop schizophrenia:
- Substance misuse: Certain substances, such as LSD, amphetamines, cocaine, and cannabis, may increase the risk of developing schizophrenia or experiencing a relapse after a period without an episode. However, research hasn’t concluded whether the use of these substances causes symptoms, or if individuals with schizophrenia are simply more likely to engage in substance use.
- Genetics: Individuals with a family history of schizophrenia may be more likely to develop the disorder, though a single gene may not be responsible. However, having a close relative with schizophrenia does not necessarily guarantee that an individual will develop the disorder. In addition, changes in the genetic material of chromosomes (specifically duplications or deletions) may be linked to an increased risk of schizophrenia.
- Complications during pregnancy or birth: Individuals who experienced complications before or during their birth may be more likely to develop schizophrenia. These complications can vary but may include premature labor, a lack of oxygen during birth, or a low birth weight.
On the other hand, DID may be primarily caused by trauma during key developmental stages of childhood, which is frequently referred to as “developmental traumatization.” One article reviewed scientific research on the etiology of DID, linking it to traumatic experiences in childhood, certain family dynamics, and specific attachment styles. Research suggests that a child may develop DID when exposed to a chaotic or coercive environment that may include physical and/or sexual abuse. These children are often neglected or have a disorganized attachment to their caregivers. The development of multiple self-states may be a way for a child to compartmentalize the thoughts and feelings related to the trauma they’ve experienced.
In addition, researchers believe secondary sources of DID may be related to cognitive functioning and neurobiological anomalies that may emerge in tandem with the primary factor of developmental traumatization.
If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.
How are schizophrenia and dissociative identity disorder treated?
While some treatments may be effective for both DID and schizophrenia, each disorder typically requires a unique treatment plan. One form of treatment can involve the use of medications prescribed by a doctor or psychiatrist. Depending on the disorder being treated, these medications may include antipsychotics, antidepressants, or anti-anxiety medicines. However, while antipsychotic medication may be recommended for those with schizophrenia, there may be no medications specifically designed to treat DID.
Please note that the information in this article does not constitute medical advice. Always talk to your doctor before starting, stopping, or changing the way you take any form of medication.
Therapy may be used for both serious mental health conditions
Psychosocial interventions, such as therapy, may be used as a treatment for both schizophrenia and DID. According to the National Institute of Health (NIH), recent approaches to the treatment of DID include dialectical behavioral therapy (DBT) and trauma-focused cognitive behavioral therapy (CBT).
The NIH states that DBT, which was originally developed to treat borderline personality disorder (BPD), can be used due to the overlapping symptoms that may present in both BPD and DID. Other therapeutic approaches, such as eye movement desensitization and reprocessing therapy (EMDR), may also be effective.
Schizophrenia, on the other hand, may respond to psychosocial interventions that include cognitive behavioral therapy, cognitive remediation therapy, family intervention, psychoeducation, social skills training, and assertive community treatment. While newer research may be necessary, according to one study, these approaches resulted in short- to medium-term control or reduction of symptoms, improved levels of functioning, and satisfactory relapse rate levels.
Finding support for mental illness in online therapy
While therapeutic approaches may be helpful for individuals experiencing these disorders, in-person therapy may not be available to everyone. For example, some areas may lack a sufficient number of mental healthcare providers. These regions are often called Health Professional Shortage Areas (HSPAs). For those who live in an HSPA, it may be necessary to travel a significant distance to find a provider or specialist. In these situations, or for individuals who want a more convenient option, it may be beneficial to try alternatives like online therapy.
Effectiveness of online therapy for various conditions
Research suggests that video-delivered psychotherapy (VDP) and in-person psychotherapy (IPP) may be equally effective. One meta-analysis found that significant and substantial improvement usually occurred between the pre- and post-phases of video-delivered psychotherapy, concluding that videoconferencing therapy seemed to be no less effective than its in-person counterpart. While many individuals with DID and schizophrenia may benefit from online therapy, please note that individuals experiencing acute psychosis may need to seek care in person.
Takeaway
Is hearing voices a symptom of schizophrenia?
Yes, researchers estimate that around 75% of people diagnosed with schizophrenia experience auditory hallucinations, or hearing voices. These auditory hallucinations can significantly affect a person’s quality of life. Treatments like therapy and medication can help manage this symptom.
Is there a treatment for psychosis?
There are treatment options for psychosis. In addition to a strong support system and self-care strategies, a combination of medication and therapy can help the person manage their symptoms.
What is the difference between dissociative identity disorder and schizophrenia?
Some people confuse dissociative identity disorder (DID) with schizophrenia spectrum disorders. These disorders have several unique and overlapping symptoms. Some of the major differences include:
- Schizophrenia: This disorder is characterized by positive symptoms, like hallucinations or delusions, grossly disorganized thoughts, and negative symptoms, like apathy and social withdrawal.
- Dissociative identity disorder: DID, formerly called multiple or split personality disorder, is listed in the DSM-5 as a disorder causing disruption of identity, with at least two distinct personalities present. People with DID often have a history of childhood trauma, and many present with self-harm or self-injurious behavior.
These mental disorders are primarily differentiated by type. Schizophrenia is a psychotic disorder. Whereas DID is classified as a dissociative disorder.
Do people with DID hear voices in their head?
People with dissociative identity disorder may hear voices or sounds that aren’t really there. This is known as “auditory hallucinations.” Symptoms like auditory hallucinations can complicate diagnosis, as they’re a common feature of psychotic disorders.
Can people with DID lead a normal life?
Dissociative identity disorder is a recognized mental disorder listed in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). According to the American Psychiatric Association, it’s characterized by two or more distinct personality states.
While symptoms can be distressing or interfere with daily life, people experiencing dissociative identity disorder (DID) can lead full and satisfying lives. Dissociative symptoms can often be managed with evidence-based approaches, such as:
- Medications: Antidepressants, antipsychotics, or other medications
- Talk therapy: Cognitive behavioral therapy, dialectical behavioral therapy, family therapy, and/or movement therapy with a licensed mental health professional
- Self-care: Getting enough sleep, exercising regularly, connecting with community, volunteering, and consuming a nutrient-rich diet
Can someone with DID be aware of other personalities?
Someone with dissociative identity disorder (formerly known as split personality disorder) may or may not have insight and awareness into their other identities. In many cases, even if someone has some awareness of their different personality states, they experience at least some memory gaps, called “amnesia.”
Other mental health conditions, like schizophrenia spectrum disorders, major depressive disorder, bipolar disorder, and substance use disorders also often lack awareness or insight into the disorder. This is called anosognosia, which comes from the Greek words “a-“ (without), “nosos” (disease), and “gnosis” (knowledge).
What is often mistaken for schizophrenia?
Some disorders recognized in the Diagnostic and Statistical Manual; Fifth Edition (DSM-5) that might be mistaken for schizophrenia include:
- Other psychotic disorders, such as schizoaffective disorder, delusional disorder, schizotypal personality disorders, and postpartum psychosis
- Dissociative disorders, like dissociative identity disorder (DID) or depersonalization/derealization disorder (where people experience depersonalization and detachment from the world or themselves), which may display negative symptoms like lack of emotional expression
- Bipolar disorder, which can cause similar symptoms, like psychosis, social isolation, or false beliefs
In some cases, there’s a high co-occurrence rate between schizophrenia and other mental disorders. It’s also common for these disorders to share risk factors, like surviving childhood trauma and/or physical abuse, genetic factors, environmental exposure, and brain chemistry abnormalities.
Diagnostic criteria in the DSM-5 can help licensed professionals evaluate overlapping symptoms and make an accurate diagnosis.
Do alters talk to each other?
Some people with dissociative identity disorder (DID) may have alters (different identities) that communicate with each other directly or indirectly through things like voices, internal thoughts, or conscious awareness.
For example, some people may report hearing “child voices” from a child alter, which is thought to reflect a childhood trauma history, according to the International Society for the Study of Trauma and Dissociation (ISSTD). Other people may experience more voices, which may relate to other alters or auditory hallucinations that reflect different conditions.
Can you be high functioning with DID?
Diagnostic classes for diagnosing dissociative identity disorder (DID) explain that people with DID often experience large gaps in memory, amnesia, and painful traumatic experiences, which have a significant impact on one's ability to carry out daily functioning.
With management strategies (such as talk therapy, medications, self-care, and social support), many people who begin showing DID symptoms can reach a state of resolution, though symptoms may relapse. Additionally, as researchers like Brand, B. L., find, effective treatment approaches have not yet been fully identified and it’s thought that the successful unification of self-states is unlikely.
What can mimic schizophrenia?
Some things that can mimic schizophrenia include:
- Other psychotic disorders
- Mood disorders
- Post-traumatic stress disorder
- Dissociative disorders
- Substance use disorders
- Traumatic brain injuries
- Some types of infections
- Brain tumors
- Some medications
A systematic review found that in some cases, two disorders may have high co-occurrence, making it more difficult for professionals to provide an accurate diagnosis.
According to the National Alliance on Mental Illness (NAMI), a diagnosis of schizophrenia relies on the presence of symptoms like delusions, hallucinations, disorganized speech, catatonic or grossly disorganized behavior, and negative symptoms. Treatments like first- or second-generation antipsychotics, psychotherapy, and self-care can help manage symptom onset.
What is the most misdiagnosed mental illness?
Some of the most commonly misdiagnosed mental illnesses include bipolar disorder, depression, and schizophrenia. For example, some studies find that bipolar disorder is misdiagnosed in up to 765.8% of cases, with 70.6% inaccurately diagnosed with depression.
Can you have DID without switching?
Yes, it’s possible for someone to display signs of dissociative identity disorder (DID) without signs of switching. When people do not meet all criteria for DID, such as not showing signs of clear switching, they may be diagnosed with dissociative identity disorder not otherwise specified (DDNOS).
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