Psychological disorders are malfunctions in the mind that involve one’s thoughts, behaviors, or emotions that cause an individual significant distress and dysfunction over a period of time. Psychological disorders may interfere with a person’s ability to function in everyday life; they may be unable to meet their own personal needs, and/or be a danger to themselves or others. Psychological disorders are hard for people to understand, even more so when one is unaware that they are suffering from a disease. Considered to be the worst of psychological disorders, Multiple Personality Disorder (MPD) and Schizophrenia are two such disorders; patients are often diagnosed with less severe disorders before the true diagnosis reveals itself. The reason for the misdiagnosis is that MPD and Schizophrenia are often confused with each other, and patients who suffer from these disorders very often suffer from a variety of comorbid disorders. However, DID and Schizophrenia are two completely separate psychological disorders with their own symptoms and treatments. In this paper, I will discuss the diagnostic criteria for both DID and Schizophrenia, and I will discuss rather or not people with Schizophrenia suffer from DID.
What is a Psychological Disorder?
All Psychologists, in the United States, use the Diagnostic and Statistical Manual, Fifth Edition, (DSM_IV) to diagnose psychological disorders. The DSM-IV is a nationally recognized central resource, written by a variety of experts in their field. The DSM-IV lists five criteria that patients must meet to be diagnosed with a psychological disorder; these are known as the five d’s, and they are: deviance, dysfunction, distress, danger, and duration (Davis, 2009). Deviance is a behavior that causes a person to deviate from societies norms, or rules. Dysfunction is a behavior, or, more likely, multiple behaviors that interfere with one’s daily life, normally across the many faucets of their life. Distress is the related stress and issues the dysfunction causes the individual; distress is relative, as a person may have a great deal of dysfunction, but it may cause them very little distress, or vice versa. Danger relates to the individual’s ability or inclination to harm other people or his or herself. Everyone may experience some or all of these symptoms for a period of time in their lives, what makes it a psychological disorder is how long has the symptoms persisted. If the symptoms have persisted for a prolonged period of time, Psychiatrists will give a diagnosis of a psychological disorder (Davis, 2009). There are many psychological disorders, however, two of the worst disorders are Dissociative Identity Disorder and Schizophrenia.
What is Dissociative Identity Disorder?
Dissociative Disorders are listed in the DSM-IV as: Dissociative Amnesia Disorder, Dissociative Identity Disorder, and Depersonalization/Derealization Disorder (LeFrancois, 2016). Dissociation is when a part of a person’s mind splits away from the rest of his or her mind, leaving part of the mind to function independently. Dissociative Identity Disorder (DID), or Multiple Personality Disorder (MPD), is a severe form of dissociation disorder characterized by the appearance of two distinct identities present within one individual; the patients psyche has broken and fractured into different people, and these different identities have distinct, complex personalities (LeFrancois, 2016). Usually, the dominance of one identity is complete, and amnesia occurs regarding the other identities, but, sometimes, identities may be aware of one another. Shifts from one identity to another may be sudden and dramatic (LeFrancois, 2016). Psychologists usually refer to the identity that pursued therapy as the host identity, and the dissociative identities, which can number in the hundreds for some patients, as the alter identities (Ringrose, 2012).
Prevalence of Dissociative Identity Disorder
Dissociative Identity Disorder is a rare disorder, only one to ten percent of the psychiatric community present with symptoms of DID. “More recently, studies of randomly selected females, age sixteen to fifty-four, of psychiatric inpatients, were found to suffer from DID, using the Structured Clinical Interview for Dissociative Disorders” (Ringrose, 2012. Pg. 4). The vast majority of patients with DID are female (eighty-eight percent), and the average age of diagnosis is between twenty-nine and thirty-five (Ringrose, 2012). Patients with DID always have stories of extreme child abuse, with seventy-six percent reporting childhood sexual abuse, usually by a parent or other close relative. DID is one disorder that appears to be caused entirely by human action, as no connection to genetic disposition, or hereditary histories in patients can be found.
Background of Patients with Dissociative Identity Disorder
A typical background of a patient with Dissociative Identity Disorder reveals that these patients have suffered from extreme trauma and abuse, usually starting at a very early age. Patients will have a poor, insecure, or unpredictable attachment to a parent(s), an emotionally abusive or physically absent mother, torture, physical, sexual, and emotional abuse, repeat admissions to emergency care for suicide attempts – usually in short time frames, such as two in one weekend, continuous contact with mental health services – usually since teenage years, and diagnoses of anxiety, depression, borderline personality disorder, schizophrenia, etc. and a history of alcohol and drug addiction (Ringrose, 2012. Pg.13).
Symptoms of Dissociative Identity Disorder
Patients with DID do share some common symptoms: they report losing time, having amnesia – especially when asked to recall incidences of trauma, anxiety – which may appear out of nowhere and be debilitating, auditory hallucinations – crying, muttering, and self-depreciative remarks are common, except the patient knows they are inside their head, depression, fugue episodes – where clients find themselves in unknown locations with no idea how, or when they arrived, insomnia – where an altar has taken over keeping their physical body awake, if sleep does come – nightmares are reported, mood swings that are too often to be bi-polar -often more than once in a day, numbness – the feeling of being distant, detached, or unreal, and somatoform symptoms – pain that manifests physically, but is often the bodies or altars remembrance of past trauma (Ringrose, 2012).
Co-Morbid Diagnosis
Dissociative Identity Disorder is a complicated disorder, that is usually masked by the patient’s ability to “function” in society. Often the patient is misdiagnosed because of the comorbidity of DID; patients present with symptoms of more obvious psychological disorders, such as eating disorders, obsessive compulsive disorders, and anxiety disorders (Ringrose, 2012). Often patients receive a diagnosis of “…Schizophrenia, schizoid-affective disorder, schizoid tendency, or bi-polar disorder; occasionally, patients will have another dissociative disorder, such as borderline personality disorder” (Ringrose, 2012. Pg. 12). Resulting in the diagnosis taking, on average, seven years; which is a long time when one considers that there are multiple “people” needing therapy, and that therapy is imperative to their recovery (Ringrose, 2012).
Treatment for Dissociative Identity Disorder
Treatment for Dissociative Identity Disorder can take many years, with patients being seen by a psychiatrist’s multiple times a week – usually two or three times a week, with a support team in place for weekends, and those times that the psychiatrist isn’t in available (Ringrose, 2012). Treatment for DID mainly consists of talk therapy, but drug treatment may be necessary as well, especially if the patient presents with other psychological disorders, such as OCD, or anxiety. Roger’s Client Centered Therapy (LeFrancois, 2016) has proven to be the most effective with patients who suffer from DID. However, Cognitive Behavioral Therapy, Psychoanalysis, and Family Therapy are also techniques Psychiatrists may need to use when treating a patient with DID, as often more than one type of therapy is necessary, and therapists must remain flexible when choosing to treat patients with DID (Ringrose, 2012). The goal of treatment is to bring all identities to the surface, and have them all start communicating amongst each other, making life less chaotic for the host identity, and giving a voice to the alter identities.
Treatment can take anywhere from two to eleven years, and psychiatrists must be careful of vicarious trauma, and pushing the boundaries of professionalism. Patients with DID tell the most horrific trauma and abuse stories, that may result in the doctor taking on a “mothering” position in the patient’s life, or the doctor experiencing emotional trauma due to the patients past (Ringrose, 2012). Although Dissociative Identity Disorder is an extremely complicated disorder, that causes many problems in the lives of its adult victims, one has to wonder at the abilities of the mind to survive such extreme torture and abuse, especially at such a young age. Dissociation was a life saver to these survivors, without it, they probably wouldn’t have survived the abuse they suffered through.
What is Schizophrenia?
Schizophrenia Spectrum and Other Psychotic Disorders are listed in the DSM-IV as disorders that are characterized by psychotic symptoms such as hallucinations, and delusions, that cause severe dysfunction and distress in the patient’s life (LeFrancois, 2016). Schizophrenia is a severe, sometimes chronic, psychological disorder characterized by a severe emotional, cognitive, and perceptual confusion that results in a breakdown of the patients grasp on reality, and contact with family and friends (LeFrancois, 2016). Patients may suffer from delusions of grandeur, where they think they are of someone of importance, sometimes a historical figure, such as Jesus. Patients also may have hallucinations, often where they fear they are being persecuted by the government or that somebody is “out to get” them. These hallucinations and delusions often go hand in hand (LeFrancois, 2016). Patients may spend years running from their imaginary persecutors, gathering evidence; in some cases, patients may seek to defend themselves or seek revenge, in which case they can become dangerous to themselves or others.
Symptoms of Schizophrenia
In addition, some patients with Schizophrenia may experience “…a decrease in normal functions, include withdrawal from society, the inability to show emotion or to feel pleasure or pain, total apathy, and lack of facial expression or differentiated voice tones (called flat effect)” (Piotrowski, & Tischauser, 2017. Para. 4). Patients may also suffer from periods of extreme anger – often for no reason, disconnected speech patterns, excessive body movement, and purposeless activity (Piotrowski, & Tischauser, 2017). These symptoms are not necessarily life long, as patients can go into remission, or have one psychotic break and never have another.
Prevalence of Schizophrenia
The prevalence of Schizophrenia in the general population is about one percent, and symptoms usually present in adolescent or early adult hood (Nemade, & Dombeck, 2009). The disorder appears to be spread evenly throughout the sexes, although males will only be susceptible to Schizophrenia once in their life – between eighteen and twenty-five years old, and women will be susceptible twice in their life – between the ages of twenty-five and thirty, and again at age forty (Nemade, & Dombeck, 2009). The causes of Schizophrenia are unknown, although there appears to be a genetic connection, as individuals with Schizophrenia almost always have a close relative – mother, father, brother, sister, grandparent, or cousin – with the disorder. However, not all individuals who develop Schizophrenia have a relative with the disorder, leaving doctors to believe that it is a complex mixture of genetics and environmental factors that contribute to Schizophrenia (Piotrowski, & Tischauser, 2017).
Background of Patients with Schizophrenia
The background of a patient with Schizophrenia is usually unremarkable, in that no severe trauma or abuse took place. However, parents of patients with Schizophrenia may describe them as clumsy and emotionally aloof children. As children, they may have preferred to play by themselves, been late to walk, and may have wetted the bed. During adolescences, patients will typically have a noticeable change in personality, resulting in a decrease of academic, social and interpersonal functioning. Usually, a couple of years passes before the individual sees a psychiatrist, and the first “break” from reality doesn’t usually occur until late teenage years and age thirty (Frankenberg, 2017).
Treatment for Schizophrenia
Treatment for Schizophrenia usually consists of therapy, and the use of Antipsychotic drugs (Piotrowski, & Tischauser, 2017). These drugs have been found to be effective in treating Schizophrenia by blocking the creation of excess dopamine, and stimulating the production of the neurotransmitter. The main problem with the treatment is the extreme side effects they can have. Side effects include such symptoms as tardive dyskinesia (TD) (involuntary muscle movements), dystonia (the abrupt stiffening of the muscles), akathisia (the feeling of not being able to sit still) – all of which can be treated by the use of more drugs (Piotrowski, & Tischauser, 2017). As with DID, patients with Schizophrenia attend therapy sessions that usually involve their families; the aim is to help the family understand and support the individual suffering from the disorder, not cure the disorder. Rehabilitation and social skills training may be necessary to re-teach clients how to cope in society, so that they may become independent, functioning members of society again (Piotrowski, & Tischauser, 2017).
Treatment for both Dissociative Identity Disorder and Schizophrenia may not be successful, as the leading cause of premature death amongst both populations is suicide; that’s why early diagnosis and treatment is essential for both DID and Schizophrenia.
Compare and Contrast of DID and Schizophrenia
Dissociative Identity Disorder and Schizophrenia may, on the surface, appear to be the same disorder; after all, Schizophrenia literally means, “split brain,” however, the two disorders are completely different, with different causes and treatments. In regard to Schizophrenia, the “split brain” aspect does not refer to the dissociation or development of complete and separate identities, instead it refers to the way the patient experiences the world – it can appear one way to them, and be completely different in reality. Patients with DID, however, have two or more distinct identities with their own personalities, characteristics, sexual preferences, clothing preferences, and ways of dealing with life. Patients with DID have remarkably chaotic childhoods, always involving extreme, prolonged child abuse and trauma, whereas, patients with Schizophrenia have unremarkable childhoods, with (typically) no history of child abuse or trauma. Schizophrenia has been proven to have a genetic connection, where as DID is brought about by the care takers of the child. Diagnosis and treatment of both disorders are similar, except the symptoms of DID cannot be abated by the use of Antipsychotic drugs.
Conclusion
The similarities between DID and Schizophrenia do not account for the differences, and one can see that the disorders are caused by completely different factors. Patients with both disorders are often very dysfunctional, and may need family or friends to assist them with the activities of daily living. Social support is imperative to recovery, for both psychological groups. However, where patients with schizophrenia may go into remission and never experience a psychotic break again, individuals with DID will never go into remission, the only cure is long term therapy, and, hopefully, one day, having complete communication between all identities.
This is only a condensed summation of both DID, and Schizophrenia. Both disorders are extremely complicated and can take many different paths. If you feel like you, or someone you know, may suffer from either of these disorders, please contact a mental health facility in your area.
References
Frankenburg, Frances R. (2017). Schizophrenia Clinical Presentation. Retrieved from:
http://emedicine.medscape.com/article/288259-clinical
LeFrancois, G. (2016). Psychology: The human puzzle (2nd ed.). [Electronic version]. Retrieved
from https://content.ashford.edu/Links to an external site.
Nemade, Rashmi, & Dombeck, Mark. (2009). Schizophrenia Symptoms, Patterns and Statistics
And Patterns. Retrieved from: https://www.mentalhelp.net/articles/schizophrenia-
symptoms-patterns-and-statistics-and-patterns/
Piotrowski N, Tischauser L. Schizophrenia. Magill’S Medical Guide (Online Edition) [serial
online]. January 2017; Available from: Research Starters, Ipswich, MA. Accessed July
17, 2017.
Ringrose, J. L. (2012). Understanding and Treating Dissociative Identity Disorder (or Multiple
Personality Disorder). London, GB: Karnac Books. Retrieved from
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