So much misinformation and misunderstanding exist about DID and schizophrenia – many studies show they both affect around 1% of the population world-wide, yet schizophrenia is diagnosed more often whereas DID takes an average of 6 years of obvious symptoms until diagnosis.
A key difference here is that the only known cause of Dissociative Identity Disorder however is extreme childhood abuse beginning at a young age, this history exists in around 95% of those diagnosed with DID. DID is one of a range of Dissociative Disorders: including Dissociative Amnesia, Dissociative Fugue, Depersonalization Disorder and Dissociative Disorder not otherwise specified.
While both psychotic episodes/schizophrenia and dissociative identity disorder commonly feature hearing voices these typically appear external with schizophrenia and internal with DID (i.e. thoughts).
Mood disorders are not part of the diagnostic criteria for DID and can be very much a red herring. Signs of amnesia are key though – forgetting things like who people are, not recognizing familiar places, not knowing always what the year is, finding thing they don’t remember buying, contradicting themselves in conversation and then denying it.
With DID symptoms of PTSD are very common, dissociative amnesia and of course the absence of the thought disorders found in psychosis/schizophrenia. With DID having very childlike emotions or behaviors is also a key indicator.
DID – all these criteria to be met
A. Disruption of identity characterized by two or more distinct personality states or an experience of possession. This involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in effect, 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 impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. (Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.)
E. The symptoms are not attributable to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or another medical condition (e.g., complex partial seizures).
Specify if: With prominent non-epileptic seizures and/or other sensory-motor (functional neurologic) symptoms
The SCIDD screening tool, which needs training to apply, is a reliable diagnostic tool for DID.
Alternative and excellent diagnostic criteria exist in A new model for DID by Paul Dell (see page 10), this also totally refutes the iatrogenic theory of DID.
Schizophrenia is characterized by delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction.
For a diagnosis, symptoms must have been present for six months and include at least two active symptoms over at least one month.
A spectrum of Schizophrenia and Psychotic disorders exist, including Delusional, Schizo-affective and Catatonia.
Schizo-affective disorder includes a mood disorder, I’ve heard it informally described as bipolar with schizophrenia.
These vary a great deal, which is why diagnosis is so key. Anti-psychotics will not improve dissociative symptoms for example.
Long-term psychotherapy and trauma work is the recommended treatment for DID, anti-depressants may help if depression or anxiety are present, although interestingly they will not affect all personality parts in the same way.