Dissociative Identity Disorder/Multiple Personality Disorder and Schizophrenia – Clinical differences

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 diagnosis

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.

Treatment options

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.

References

http://www.dissociative-identity-disorder.net/wiki/Schizophrenia

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Childhood Abuse and Dissociative Disorders

The damage caused by child abuse

Mental health problems are often caused by childhood abuse, so raising awareness of mental health problems can help people recover and heal from such abuse. It has also been shown that survivors of abuse do sometimes become abusers, and that recovering from the own abuse is key to preventing this.

Common psychiatric diagnoses that often result from Child Abuse include Complex Post Traumatic Stress Disorder, Borderline Personality Disorder (which often has roots in emotional neglect) and Dissociative Disorders.

Why do people try to denying the damage?

This blog post raises awareness of Dr Joel Paris‘s attempt to dismiss Dissociative Disorders, which would both deny people treatment and reduce awareness of the abuse which cause the disorders.

His article suggested that one particular disorder – Dissociative Identity Disorder was a ‘fad’, despite it’s inclusion in the DSM psychiatric manual for several decades.

A letter in response to  his article, written by specialists is Dissociative Disorders can be found http://eassurvey.wordpress.com/2013/04/04/growing-not-dwindling-worldwide-phenomenon-of-dissociative-disorders-disinformation-about-dissociation-dr-joel-pariss-notions-about-dissociative-identity-disorder/

What is the reality here?

I did some research and here are some simple figures from Google Scholar which show the number of articles (excluding patents) covering the two main dissociative disorders. Sadly Google Scholar only gives approximate numbers rather than exact ones, it says ‘About 193’ for instance. It all got rather complicated so here is the graph of the results looking at articles for each 5 year period since 1998.

Academic articles found
Academic articles found

Academic articles found

Basically, these results back of the findings of the letter I’m blogging about.
In the last 5 years 2,270 out of 3130 academic articles on “dissociative identity disorder” have also included abuse, over 70%, again refuting Dr Paris’s assumptions.
So I looked at the last 5 years of academic papers written by Joel Paris, 240 appeared, none of those on the first page had a heading with Dissociative or Dissociation in it. Search for “Joel Paris” Dissociative for the last five years gave only two results with Dissociative in the title – the letter I’m blogging about, and the original article.
Not exactly his key interest then.

Some explanation of using Google Scholar in my research…
“Dissociative Identity Disorder” found about 1,920 between 1990 and 2000, increasing to 5,320 articles between 2000 and 2010.

I thought this might be a bit of an unfair search since it used to be known as “Multiple Personality Disorder” and is still called them in the main international psychiatric manual, and was called that in the older versions of the DSM manual, so I searched for that term instead, and found about 4740 results between 1990 and 2000, and about 5840 results from 2000 to 2010 – so still an increase despite the term being rarely used now.

The next disorder in severity is known as “Dissociative Disorder Not Otherwise Specified” or DDNOS for short, so I searched for both terms separately (google scholar seems unable to search for either term). The results said shows 289 articles from 1990 to 2000, increasing to 510 articles between 2000 and 2010.
The DDNOS results from about 193 to 396 results over the same periods.

In the end I just went back and searched in 5 year periods, from 2013 backwards.

No matter how many ways I looked at the data the rise in diagnosis was clear, as was the number of articles now focused on treatment rather than questioning the evidence and cause of dissociative disorders.

Please share this to raise awareness of those working against child abuse awareness.