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Dissociative Identity Disorder Is Not Schizophrenia

One of the most persistent myths about Dissociative Identity Disorder is that people with it are schizophrenic. Schizophrenia and DID are generally considered synonymous with each other. In fact, they’re two entirely different disorders. There’s no relationship between Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) and Schizophrenia at all. People more educated than I could write entire books about the differences between these two chronically misunderstood disorders. I focus on what I see as the dead giveaway: the issue of identity.

Photo by Alcino

Photo by Alcino

People don’t talk about mental illness. Schizophrenia is the most hidden of all, and there’s lots of misinformation out there. Even some doctors, social workers, and therapists are ill-informed. A psychology professor once asked my sister how many personalities I had. – People Say I’m Crazy, John Cadigan

Dissociative Identity Disorder Is Marked by Profound Identity Disturbance

DID was formerly labeled Multiple Personality Disorder for a reason: the disorder is marked by identity disturbance so severe that the sufferer experiences himself not as one person, but many. Rather than the normal levels of identity confusion and identity alteration we all experience, people with Dissociative Identity Disorder live with such profound degrees of both that they appear to have multiple personalities.

In simple terms, what that means is that all the various aspects that make up a person’s identity are separated and walled off from each other in those with Dissociative Identity Disorder. Each aspect of the dissociative identity is real. The disorder isn’t that we’re perceiving the existence of people who don’t actually exist. DID isn’t a thought disorder like Schizophrenia is. It’s a dissociative disorder. In other words, what makes DID a disorder is not these pieces of identity, but how separated those pieces are.

Identity Disturbance Is Not Intrinsic to Schizophrenia

I imagine a diagnosis like Schizophrenia might provoke a certain amount of questioning, “Who am I?” Reconciling oneself to any serious mental illness is bound to involve some initial identity confusion. But this falls within the normal range of dissociation. Schizophrenia itself, as I understand it, really has nothing at all to do with identity, though I can guess at the likely source of the confusion: the name itself.

schizo means “to split”
phrenia means “mind”

It’s easy to see how Schizophrenia and Dissociative Identity Disorder got all tangled up together. A split mind sounds at first like an apt descriptor for multiple personalities. But the mind splitting that the name Schizophrenia refers to really has nothing to do with personality, with identity. Instead, it references the fractures in cognitive functioning that are the essence of this thought disorder.

Dissociative Identity Disorder Is Not Schizophrenia

The clues to the differences between these two disorders are right there in their names. Dissociative Identity Disorder is characterized by a severely dissociative, or separated, identity. Schizophrenia is characterized by the splitting, or breaking, of the mind’s capacity to function. They are not even remotely the same thing. Continuing to treat them as such perpetuates gross misunderstandings that isolate people with both of these disorders.

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9 Responses to Dissociative Identity Disorder Is Not Schizophrenia

  1. While the two disorders specifically are not related in the way people are familiar with or assume them to be, it’s not entirely accurate to say that there is no connection at all. It’s starting to become clear that people of the schizotypal spectrum or a high number of schizotypal traits are more prone to dissociation than others.

    A couple studies showing the progression of this hypothesis can be found here:
    http://www.ncbi.nlm.nih.gov/pubmed/11241363
    http://www.ncbi.nlm.nih.gov/pubmed/18043521

    I’m not saying it’s wrong to make such a distinction between the two, because I agree that they’re very different and the assumption people make that they are the same and confusing them with each other is very harmful to both spectrums and the people within. But the line isn’t as clear as some of us may think.

    From personal experience, schizotypy can contribute to identity confusion. This is something I’ve been trying to write about for a little while now, though it’s been slow because the words have been escaping me. If you’d like, I can forward you a link when I’ve published it.

  2. Holly Gray says:

    Hi SN,

    I think it’s pretty safe to assume that almost anyone with a serious mental illness is more prone to dissociation than others. And though those with Schizophrenia may be even more inclined to dissociate than people with other mental health conditions, that really isn’t a link between DID and Schizophrenia. Many people with chronic pain disorders experience much higher than normal degrees of dissociation … but that doesn’t mean pain disorders are in any way related to DID.

    I understand what you mean, I think. People with schizotypal traits are more dissociative than usual, people with dissociative identity disorder are more dissociative than usual, therefore the two disorders are related in some way. But I respectfully disagree. Dissociation is common and found in higher degrees in various subsets of the population, particularly the mentally ill. But DID and Schizophrenia are fundamentally different and using the two interchangeably is inaccurate.

  3. kerri says:

    I agree with you Holly that Schizophrenia and DID are very different. But I can see how many people get them confused.  I mean both illnesses can present from the outside as if the sufferer is “hearing voices”. The difference lies in what generates these voices. Either a breakdown in the minds ability to perceive reality ( and have to experience often auditory and/or visual hallucinations of a highly intimidating, unnerving, destructive and persecutory nature ), versus DID wherein we hear our alters voices that come from cordoned off sections of our psyche. It is true that  some alters can be persecutory and threatening at times, but many experience alters who are just different form the core, with absolutely no ill intent whatsoever. These conversations are not hallucinations of any sort, but rather real life conversations between different personalities that have sprung up within the same mind and body.
    I have a friend who is schizophrenic and her load in life is so heavy I would never change my circumstances for hers. She is bombarded on a daily basis with unnending ridicule, disdain and threats, and these voices constantly torment her night and day. She also goes through times of extreme paranoia where she truly believes even her loved ones are out to hurt her. And that people in the grocery store are all plotting to kidnap her. And she is incredibly frightened. 
    Anyone who has this illness and gets up out of bed to face the day truly has my respect !!
    Not that I am saying our load is not heavy also, because I know from first hand experience it is. But once diagnosed we have the opportunity to learn about our alters, to dialogue with them at some point down the track, and even negotiate with them. And even if this does not work for us, we still have the hope that it might. Whereas schizophrenics don’t have these types of options because of the nature of their illness.
    Also there are no medications specifically targeted for DID, although many are used for co-mordid disorders, i.e. OCD, Anxiety, Depression, PTSD. Whereas I don’t know of any schizophrenics who can get by for very long off their medication.
     
    The scary thing is that I have talked to quite a few people, often very knowledgeable and intelligent people about mental health issues, and they still hold the misconception that DID is schizophrenia. That they both represent TV’s Dr Jekyll and Mr Hyde. I find this unnerving actually.

    But you are very right Holly. There definitely needs to be more education out there about how these two disorders are not interchangeable nor the same.  

  4. Holly Gray says:

    I was thinking more about this, SN, and I remembered hearing about a man who has Dissociative Identity Disorder who cites his Bipolar Disorder as the cause. He explained that bipolar created so much pain and very real trauma for him that he developed DID as a way to cope. I know that’s not your point here, but it got me thinking about the myriad relationships between different disorders. It’s interesting how they can not only resemble each other, but overlap.

    But the line isn’t as clear as some of us may think.

    I think you make a very good point, in terms of those resemblances and overlaps. Identity confusion, in particular, is something I’d guess people with mental illnesses often experience to a higher degree than those without them. It’s hard enough to figure out who we are without throwing a heavy duty diagnosis like Schizophrenia into the mix.

  5. Holly Gray says:

    Hi kerri,

    I have to say, I’m with you: if given the choice between Dissociative Identity Disorder and Schizophrenia I’d take DID any day of the week and twice on Sunday. Maybe some of that has to do with DID being the devil I know and Schizophrenia being the devil I don’t, but some of it has to do with what you said here:

    “But once diagnosed we have the opportunity to learn about our alters, to dialogue with them at some point down the track, and even negotiate with them.”

    DID can be very frightening, but ultimately I know my system is me and I am my system. We are pieces of one identity and there’s real solace in that knowledge for me.

    It also seems to me that Schizophrenia is the single most misunderstood mental illness, though I most certainly put DID at a close second. It’s hard to have a disorder that is so rampantly misunderstood. I have a hard enough time with that, I don’t imagine it’s any easier for those with Schizophrenia.

  6. Glen says:

    You know what’s funny? I’ve been mis-diagnosed with both Schizophrenia and Bipolar disorder before…

    And yet, after finally being diagnosed with DID (which makes so much logical sense when I really look at it…) My reaction is to think that sounds *SO* crazy that I’d prefer to be “Just Schizophrenic” …

    =)

    I know, in retrospect it makes no sense, but it’s how I sometimes (often) feel.

  7. The Maggie says:

    before being dx’d with DID i was dx’d bipolar and/or borderline…i thought folx with borderline PD faced the most diagnosis related discrimination, but i was wrong. because although professionals discriminate against folks with bpd, the whole friggin world seems to hear DID and run the opposite way…so i can’t imagine what it must be like to be schizophrenic, because, accurate or not, many (myself included) see it as the far extreme/worst mental illness out there. i know that is all relative to what is considered “bad” but there it is…the drive some have to hide their DID must be dwarfed in comparison to the drive to hide schizophrenia…

    ppl who know nothing about either diagnosis have insisted to me that i am schizophrenic with such vigor that is it downright scary to me.

    its not impossible to see why there is confusion. heck, before i was willing to talk about/accept the insiders, i thought they were some version of hallucination. well, i kinda hoped they were, but that is a different topic.

    i think the most important thing is for people to remember to LISTEN and accept the truth that they don’t know as much as they think they do.

    thanks for the post holly!

  8. The Maggie says:

    @glen

    i had been given so many dx over the years that most of my friends/family seemed to give up caring/trying to understand but when i told/tell them about the DID, every single one gets this look/tone like i just supplied them with that word on the tip of their tongue they haven’t been able to think of…like they knew the whole time, just couldn’t quite place it….it has been…interesting? entertaining? affirming? something…

  9. Pilgrim says:

    Thanks for this article. When I 1st started hearing a lot of voices in my head back in college, and hearing them talking to me, my main worry was that I was schizophrenic. It took quite a few years to learn that that wasn’t the case.
    I don’t know if it sounds strange or not, but I’m actually more comfortable with the diagnosis of DID than I would be with the dx of schizophrenia… the latter just sounds so alone and scary.

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