Miscellany

Schizophrenia vs DID (dissociative Identity disorder)

Thanks to Becca’s comment on my previous genesis post, I thought it would be useful to post a quick explanation of the differences.

People who are schizophrenic hear voices. So do people with DID. What’s the difference?

The voices that a person with DID hears are rooted in reality and only feel separate because of a lack of self-awareness. The voices that someone with schizophrenia hears are external voices. Schizophrenia is a neurological condition biologically based. In other words it exists independent of what’s going on in the outside world and is a disconnect from reality.

By contrast, DID is a developmental coping mechanism that is caused by early trauma. It shapes identity (multiple) and memory (compartmentalized) and is really an extension of the normal process of having different parts. For example, you have your work part and your doting grandma part. In and of itself it isn’t damaging. It’s a way of managing a difficult reality. It’s the PTSD from the trauma, the nightmares, triggers, anxieties and flashbacks that are damaging.

The good news for people with DID is much better than for schizophrenia, which is little understood and hard to treat because it is a problem with the brain. People with DID have healthy brains which adapted to difficult environments. As people realize that the current environment is safe and desensitize from early conditioning, the PTSD symptoms diminish.

Conditioning is something that most people have to wrestle with, so people with DID have a lot to teach. And about living together as well, because people who are multiple become experts in internal negotiation.

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17 thoughts on “Schizophrenia vs DID (dissociative Identity disorder)”

    1. Becca, Julia & Beth–thank you. I’m so glad it was useful. I was in a rush when posting and so didn’t say as much about alters/parts as might be needed. But then I wrote a whole novel!

  1. That’s very clear, Lilian, thank you. Through blogging I’ve got to know some people who suffer from DID and it is quite fascinating how clever and how difficult their minds are. The condition is a sliding scale with, as you point out, a normal counterpart. Lots of people dissociate – or compartmentalise, or put difficult experiences in a separate, denied realm of the mind. I find it very interesting how close I am to a DID mentality without having DID in any way. It’s excellent that your novel will promote awareness of the condition.

    1. It would be wonderful if there was a better vocabulary for this and if people could just be all of who they are. There is so much richness in DID besides the pain of what causes the adaptation.

  2. While Lilian’s post repeats what most people are told about DID versus “schizophrenia” voices, the actual fact is that there is no clear cut distinction. This topic is well covered in the article “hearing voices and dissociation” available at http://www.hearingvoicesmaastricht.eu/page12.php

    As for schizophrenia being a neurological disorder, that is someone’s theory, not a proven fact. There is no neurological way to diagnose schizophrenia. True, people diagnosed with schizophrenia are more likely to have brain differences compared with the average person, but so, they are finding out, are traumatized people generally.

    I’m a therapist who works with people diagnosed with both schizophrenia and DID, and I see people have all sorts of experiences, including voices that at first seem to be something very external and fantastic, and then years later, as the person recovers, seem clearly to be just dissociated parts of the person which become allies and well integrated. Diagnostic categories are really not very helpful in understanding voices.

    1. Hi Ron, Thank you for taking the time to contribute your perspective. New research shows some interesting results on schizophrenia which indicate that the clinical diagnoses of schizophrenia based on symptoms is likely coming from a number of different conditions all termed schizophrenia. On the level of microbiology these differences are showing up and providing promising leads for quite different treatment, eg psychotherapy for some vs medication for others. Aches in the body can also be symptomatic of quite different things–even flu-like symptoms can be indicative of anything from influenza to an autoimmune disorder. Similarly DID is often misdiagnosed for years. What I do know are many people who are multiple–I know them in a different way than a clinician does, on a daily personal basis. And the people I know are living full, ordinary lives with partners, children and jobs, while at the same time grappling with the burden of a painful past. That double duty is all the harder because they have to be in the closet about who they are. And Web of Angels, I hope will make that less burdensome by being a gripping story that gives readers an understanding and comfort-level with DID.

  3. The first novel that I wrote is about a woman with delusional disorder. (It’s actually about her daughter, who goes looking for her, because like many people with mental illness, the mother ends up homeless ). It was fascinating research for me, because I needed to make the distinction between someone with schizophrenic delusions and someone with delusional disorder. Most people with DD don’t hear voices, but they do invent stories. And those stories, although not true, could be true. It was very interesting to explore this in a novel…the fine line between imagination and delusion.

  4. Hi Lilian,

    I am all for your effort to humanize peoples perceptions of those with DID. That’s great. My fear though is that you are doing it by adding to the dehumanization of those diagnosed with schizophrenia, i.e.,suggesting that to understand them we need to look at microbiology and not what they say, that they mostly need medication and not therapy, that their voices are just a symptom of their illness and not parts of themselves, etc. True, you aren’t saying anything that isn’t being said by the mainstream mental health system, but this is a system that has systematically dehumanized those with the schizophrenia diagnosis.

    You talk about knowing people personally with a DID diagnosis. I know people personally who have had a schizophrenia diagnosis, and there is no reason to say that the diagnosis was mistaken – they fully met the criteria for the diagnosis at the time. Yet they are now leading full lives, and they aren’t taking medication to do so. They got better in part because they were lucky enough to find people to help them who were interested in them as people with psychological issues that could be understood.

    The truth is, that when people are really distressed, they are likely to see voices as something external to them, and to be “psychotic.” With decent treatment though, they can learn to make peace with the voices. Eleanor Longden is a voice hearer who has told her story publicly. When she was psychotic, “paranoid schizophrenic” she once was so disturbed that she seriously planned to use a power drill to open up her skull to get the voices out – this wasn’t a suicide attempt, just a crazy plan to relieve her distress. Later, she learned to see even the really scary voices as parts of herself, she made peace with them, and she is now an award winning psychologist.

    1. Hi Ron,
      I’m so glad we’re having this conversation and especially to have a chance to think more deeply about these issues prior to Web of Angels being released (March 3/2012). You’re absolutely right that there is no reason to dehumanize anyone or anything else in my commitment to bringing public understanding to DID. I will respond to that question differently because of this conversation.

  5. Multiple personalities don’t exist. Schizophrenia does. Please don’t relate the two.

    People with schizophrenia need all the funding and support society has to offer. To lump them in with multiple personalities is wrong and does a disservice to people with a legitimate mental illness.

    1. Wow Jeanette–that is quite a big statement. I have no objection to funding for anyone who needs it. And I certainly agree that schizophrenia is different. I’d also agree that DID isn’t a mental illness, it’s a coping mechanism, one that comes from crimes committed against children. I personally know 2 dozen people with DID. I am very close to some of them. I know their alters, their spouses, and their children.

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