“Crazy” thoughts and feelings – Dissociative Identity Disorder and Psychotic spectrum symptoms

Can someone have both Schizophrenia & Dissociative Identity Disorder?
Yes, this is possible, or another psychotic or schizophrenia spectrum condition can exist with DID. It isn’t a particularly common combination (compared to, for example, Borderline Personality Disorder or an Anxiety Disorder existing alongside DID).

What are the key differences between Dissociative Identity Disorder and Schizophrenia?

Some people with DID find their symptoms are never confused with the psychotic symptoms found in Schizophrenia – but others may be misdiagnosed with Schizophrenia, or diagnosed only with Schizophrenia when DID is also present. Experiences like ‘hearing voices’, ‘seeing things which aren’t there’ (pseudo-hallincinations caused by flashbacks) can cause a lot of confusion.
The DSM-5 (full version, p297) gives some limited guidance on differences:

  • Individuals with dissociative identity disorder experience these [psychotic-like] symptoms as caused by alternate identities, do not have delusional explanations for the phenomena, and often describe the symptoms in a personified way (e.g., “I feel like someone else wants to cry with my eyes”).
  • Persecutory and derogatory internal voices in dissociative identity disorder associated with depressive symptoms may be misdiagnosed as major depression with psychotic features.
  • Chaotic identity change and acute intrusions that disrupt thought processes may be distinguished from brief psychotic disorder by the predominance of dissociative symptoms and amnesia for the episode, and diagnostic evaluation after cessation of the crisis can help confirm the diagnosis.

Dissociative Identity Disorder is also a dissociative disorder, meaning that symptoms are primarily dissociative in nature – even when it was known by the name Multiple Personality Disorder, DID was classified as a Dissociative Disorder; Schizophrenia is classified as a psychotic disorder, meaning in involves one or more of: delusions, hallucinations, disor­ganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms (flat emotions or severe lack of will).

Survivors of organized or ritual abuse may have some highly unusual beliefs which are not caused by any kind of delusions or psychosis, but result from the highly unusual abuse they have survived – including abuse designed to discredit survivors who tell.

Elizabeth Howell explains:

Kluft reported that patients with DID endorse 8 of the first-rank Schneiderian symptoms (Schneider, 1959, as cited in Kluft, 1987a) that are considered pathognomonic of schizophrenia.
These symptoms are voices arguing, voices commenting on one’s action, influences playing on the body, thought withdrawal, thought insertion, made impulses, made feelings, and made volitional acts.
In DID, rather than as indications of schizophrenia, the hallucinated voices and the made actions are understood as due to the activities of a dissociative identity. The psychotic person is more likely to attach a delusional explanation, such as “The CIA has implanted a chip in my brain.” In contrast, the person with DID, although probably unaware of the source, often knows that these experiences are not normal and does not seek to explain them in a delusional way (Dell, 2009c). In addition, the person with DID—as opposed to someone who is psychotic—often has the ability to be in two states of mind at once: While the person experiences the self as having the “crazy” thought, the person is able to hold the tension and know that it is just that, a crazy thought.
Of course, this knowledge that one is having thoughts that others would consider crazy only tends to contribute to the highly dissociative person’s fear or belief that he or she is crazy!

DID IS CONFUSING TO EVERYONE

The phenomena of full and partial dissociation are highly confusing to the person with DID as well as to those who notice them. Unlike someone who suffers primarily from depression or anxiety and who can label the problem, the person with DID generally suffers from amnesia about the very symptoms experienced and often cannot specfically identify the problem…
Understanding and Treating Dissociative Identity Disorder, Elizabeth Howell (2011)

CIA, Dissociative Identity Disorder and Ritual Abuse Survivors
While high profile organizations like the C.I.A. are often referred to by people who are experiencing psychotic symptoms (e.g., delusions of persecution), many people are unaware that the CIA has historically been involved in child abuse, including child abuse with the purpose of creating dissociative identity disorder. The involvement of the CIA in these human rights abuses is not a ‘conspiracy theory’ but is well documented, with hearings in the U.S. Senate held in the 1970s to investigate this, and other related abuse.
Karl Douglas Lehman and Ellen Lacter have produced guidelines to help clinicans differentiate between Schizophrenia and Dissociative Identity Disorder which may be helpful, see Ritual Abuse in the Twenty-First Century (2008) – chapter 4.

Alison Miller, a psychotherapist specializing in therapy for ritual abuse survivors, comments that that one lie about abuser’s power and knowledge (that children are told) is that “There is a microchip implanted in the survivor’s body that tells the abusers where s/he is and / or what s/he is thinking” Healing the Umimaginable, p122

Miller also points out that even if such as object was found, “that does not mean it is capable of collecting complex information and sending it back to abusers, or even sending them signals, for twenty or more years, as some survivors belief.” (p205)

Diagnostic and Screening Tools
A variety of different diagnostic and screening tools are available to help determine if a person has Schizophrenia or Dissociative Identity Disorder. Diagnostic interviews can give a definite diagnosis, and determine whether both or neither are present, for example the Structured Clinical Interview for Dissociative Disorders, or the Dissociative Disorder Interview Schedule, but these can only be carried out by clinicians (both involve a degree of observation).

Two screening tools which can be used to determine if a dissociative disorder is likely to be present are the SDQ-20 and the Dissociative Experiences Scale – both of which are mentioned in the Dissociative Identity Disorder Treatment guidelines for adults. Both of these questionnaires give a typical score for Dissociative Identity Disorder, Schizophrenia, Dissociative Disorder Not Otherwise Specified and other conditions – but they are actually intended to highlight of a clinical diagnostic interview is likely to be helpful rather than giving a specific diagnosis. Both questionnaires result in a single score, making it impossible to rule out or confirm a diagnosis of Schizophrenia in people likely to have Dissociative Identity Disorder.

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Life After Abuse: What No-one Tells You

It’s easy to assume that the end of an abusive relationship means the end of the problems caused by abuse. This may happen for a few people, but it’s not true for everyone!

Life After Abuse: What No-one Tells You. "Your old life doesn't just snap back into place immediately. You changed, and others changed along with you. - Thomas Fiffer, The Good Men Project

Your old life doesn’t just snap back into place immediately. You changed, and others changed along with you. – Thomas Fiffer


The lingering effects of abuse, and the extent of the damage that it is caused may only become apparent some time later. You will also find that coping with the abuse has changed your way of interacting with others, lowered your self-esteem and distanced you from those close to you (or, those who were close to you but no longer are.

If this sounds overwhelming and depressing then remember that recovering is both possible, and worthwhile. You can begin to have the good life you deserve. You might find it helpful to read the excellent article below – and to share it with those close to you, to help them understand that possible reactions after the end of the abuse – and what can be done to help.

    The Unspoken Secrets about Life After Abuse by Thomas Fiffer (The Good Men Project)

Related Links

It’s my fault, it’s always my fault: Self-Blame (traumadissociation.wordpress.com)
Posttraumatic Stress Disorder (traumadissociation.com)
Denial: A psychological defense against trauma (traumadissociation.wordpress.com)
If the Abuse is Ongoing (traumadissociation.wordpress.com)
Being male and a survivor (traumadissociation.wordpress.com)
The Misconcepts of Misandry (hatred against men) (rhsroyalreport.wordpress.com)
Signs of being in a pscyhologically abusive relationship (violencehurts.wordpress.com)

20 Internal Beliefs common in those with Borderline Personality Disorder #bpd

Many people find Borderline Personality Disorder hard to understand, and struggle to make sense of reactions or behavior of friends of loved ones with BPD.

This amazing blog post gives 20 ‘Rules’ for Understanding BPD, and explains the significance of emotional memories of past hurts.

http://www.anythingtostopthepain.com/20-rules-for-understanding-bpd/

With understanding, we can help reduce the stigma.

Binge Eating Disorder is the most common in America – Facts you should know about it

Binge Eating Disorder is far more common that both Anorexia Nervosa and Bulimia Nervosa in both men and women. It is also strongly linked to other mental health disorders and over half of people with it don’t seek psychological help. Post-traumatic Stress Disorder is common in people with all these forms of Eating Disorders.

Binge Eating Disorder linked to Other Mental Health Conditions

Lifetime co-morbidity of eating disorders with other core DSM disorders. Shows PTSD affects over 12% of those with Anorexia, over 45% with Bulimia, and over 26% with Binge Eating Disorder. Binge Eating Disorder is strongly associated with Specific Phobia, Social Phobia, major Depression, and Substance Use disorders. Image license: CC-SA-4.0

Lifetime co-morbidity of eating disorders with other core DSM disorders. Shows PTSD affects over 12% of those with Anorexia, over 45% with Bulimia, and over 26% with Binge Eating Disorder. Binge Eating Disorder is strongly associated with Specific Phobia, Social Phobia, major Depression, and Substance Use disorders. Image license: CC-SA-4.0

Binge Eating Disorder Myths De-bunked

Eating Disorder Awareness: You can't diagnose by appearances. Image license: all rights reserved, you are welcome to link to it instead.
Sources:
Hudson JI, Hiripi E, Pope HG, Jr., Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 2007;61(3):348–358. PMC1892232

Uher R, Rutter M. Classification of feeding and eating disorders: review of evidence and proposals for ICD-11. World Psychiatry. 2012; 11(2):80-92.

Related links:

How many types of Dissociation do you know?

Dissociation takes many different forms, some effect everyday life or affect people every now and then, and other forms of dissociation can lead to distress and/or problems in everyday life. If these other forms of dissociative experiences happen several times – or once, but for an extended period of time – then they become problematic (pathological).

Dissociation can be seen as a spectrum, or more recently tends to be categorized as Normal/Normative, or Pathological Dissociation (i.e., the diagnosable/problematic kind).

How many types of Dissociation do you know? Which are types of normal Dissociation? Which are types of problematic Dissociation?

Types of Normal Dissociation
– Day dreaming
– Spacing out (briefly)
– Absorption (e.g., in a book)
– Highway hypnosis (expected travel with gaps in memory)

Types of Pathological Dissociation
– Numbing (emotional and/or physical) – a symptom of PTSD, Depression and others
Freeze Response – a symptom of PTSD and DID and others, common during trauma
– Out of Body Experiences (form of Depersonalization) – common during trauma, sometimes happens during near-death experiences, may also happen in BPD, and DID
– ‘Wall staring’ (spacing out, common in Depression)
– Trance states (e.g., Dissociative Trance Disorder in the ICD-10 manual, can happen in other disorders)
– Maladaptive day dreaming*
Derealization (either you/the world doesn’t feel real) – a separate diagnosis but also a symptom of BPD, Dissociative PTSD, and DID
Depersonalization (part of all of you doesn’t seem like you) – also symptom of BPD, Dissociative PTSD, and DID
Amnesia (without a physical cause) -a separate diagnosis but also a symptom of PTSD and DID
Fugue states (unexpected travel, sometimes with loss of or change in identity)
– Identity alterations/switching – a symptom of Dissociative Identity Disorder, and OSDD
– Catatonia (can be present in Schizophrenia)
Pseudo Seizures/Psychogenic Non-Epileptic Seizures – dissociative reactions to stressors
Dissociative movement or sensation problems – also known as Functional Neurological Symptom Disorder (FND), or Conversion Disorder
* not currently a diagnosis

Problematic types of dissociation are recognized as mental health problems – and can be either a Dissociative Disorder or a common symptom/experience involved in another kind of mental health problem, such as depression.
Can you think of any which are missing? Leave a comment if you can.

Related Links