“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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Dissociative Identity Disorder: Skepticsm decreases with information and education about Dissociative Disorders 

Many studies have shown the majority of both psychiatrists and clinical psychologists view the diagnosis of Dissociative Identity Disorder (Multiple Personality Disorder) as valid. As understanding of Dissociative Disorders increases world-wide, skepticism decreases.

Warwick Middleton: Australian psychiatrist

Transcript

Now when the [trauma and dissociation] unit first started, there were psychiatrists in the hospital that was established who had the sort of reactions that were talked about here this morning, with raised eyebrows and shaking of heads, like borderline hell had just moved in. In fact, it’s sort of interesting that by not attacking, by not being overly defensive, by being warm, inviting, encouraging dialogue, giving appropriate information, research material, articles, books, et cetera, if they were requested, but certainly never attacking anyone for being a disbeliever or having a different paradigm, it’s very interesting over the years just how many of those psychiatrists that were openly incredulous and dismissive, have become stalwart admittants to the unit.  In fact, I can remember one psychiatrist … this is going back more than a decade and a half, who rang me, at that stage he was a senior registrar … it says something about the ambivalence about this area, he rang me saying he doesn’t believe that DID exists, but nevertheless he has a patient with it that he’s like to refer.

Research (Newest articles first)

Leonard, D., Brann, S., & Tiller, J. (2005). Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact. Australian and New Zealand journal of psychiatry, 39(10), 940-946.
Abstract
Results: Of the 250 clinicians, 21% reported experience with more than six cases on average of any one of the dissociative disorders, 38% with less than six, 42% with none; 55% regarded them as valid diagnoses, 35% dubiously valid and 10% invalid. Of the 55 patients, 76% reported delays in diagnosis (57%, ❤ years and 25%, <10 years) with adverse consequences in 64%; 80% had experienced sceptical or antagonistic attitudes from clinicians, rated as destructive by 48%. They were disabled (60% rated as <50% impaired) and were heavy consumers of health services (48% hospitalized, 68% <5 times). There was considerable comorbidity including moderate or severe depression (96%), self-harm (68%), suicide attempts (69%), panic disorder (53%), eating disorders (75%), substance abuse (25%), poor physical health (44%), major interpersonal (70%) and sexual problems (90%). Patients rated individual psychotherapy as the most helpful treatment (90%) but medications, such as antidepressants, were also valued (60%). Conclusions: Although over half of the responding Australian clinicians thought that dissociative disorders were valid, the rest were dubious about their validity with 10% believing them to be invalid. Only 21% had considerable experience with the disorders. These findings may relate to some of the difficulties perceived by patients, which included delays in diagnosis, suboptimal treatment and negative experiences with clinicians. http://www.tandfonline.com/doi/abs/10.1080/j.1440-1614.2005.01700.x

Somer, E. (2000). Israeli mental health professionals’ attitudes towards dissociative disorders, reported incidence and alternative diagnoses considered. Journal of trauma & dissociation, 1(1), 21-44.
Results: Years  in clinical  practice  (including postgraduate  and registrar  training)  did not  differ  between psychologists  (mean =  16.1 years, SD  =  9.68)  and psychiatrists  (mean =  18.8 years, SD  =  10.05). Overall, there  was  a  greater  tendency to believe  in the  existence  of  the  condition with 48 (55.8%) respondents  replying “Yes,”  and 32 (37.2%)  replying “No”  to the  reality of  DID. Five  (5.8%) participants  replied “unsure,”  and one  did not  respond to this  item. Excluding the  unsure responses  and one  missing value, a  chi-square  analysis  between psychologists  and psychiatrists for  this  item  showed a  significant  relationship between profession and belief  (chi-square  =  13.00, p  <  .001). Psychologists  showed a  greater  tendency to believe  in the  existence  of  DID  (23 yes, 3 no), while  the  slight  majority of  psychiatrists  did not  believe  in the  clinical  reality of  DID  (25 yes, 29 no).

Abstract Clinical diagnoses of dissociative disorders (DDs), including Dissociative Identity Disorder (DID), are controversial because there are mental health professionals in North America and elsewhere who are skeptical about whether these psychiatric disorders actually exist. This paper explores the attitudes of mental health professionals in Israel toward DDs and DID through a survey of 211 practicing clinicians (return rate of 39.5%). Of the sample, 95.5% scored at or above the point on a 5-point Likert scale measuring belief in the validity of DDs (m = 4.17, SD = 0.78); 84.5% declared at least a moderate belief in the validity of DID (M = 3.5, S.D. = 0.97). The average Israeli clinician surveyed had made 4.8 career-long DD diagnoses (S.D. = 18.06) and carried an average of 1.05 DD patients in his/her caseload (S.D. = 2.86). DID had a career-long diagnosis frequency of 0.14 patients per clinician (S.D. = 0.59) and was currently seen at a frequency of 0.03 cases per clinician (S.D. = 0.20). The five most frequently considered alternative diagnoses to DID in Israel were Borderline Personality Disorder (24%), Psychotic Disorder/Schizophrenia (23%), PTSD/Anxiety Disorder (10%), Malingering (8%) and Depressive Disorder (7%). The findings suggest that attitudes of Israeli clinicians are similar to those of North American clinicians despite the geographical and cultural differences between them. Full paper – https://www.researchgate.net/profile/Eli_Somer/publication/232909347_Israeli_Mental_Health_Professionals’_Attitudes_Towards_Dissociative_Disorders_Reported_Incidence_and_Alternative_Diagnoses_Considered/links/02e7e51cef1213f1df000000.pdf

Cormier, J. F., & Thelen, M. H. (1998). Professional skepticism of multiple personality disorder. Professional Psychology: Research and Practice, 29(2), 163.
Abstract
 If you saw a patient who appeared to have more than one personality, what diagnosis would you make? And how would you vary your clinical approach? Data from 425 respondents indicated that the majority of psychologists believed multiple personality disorder (MPD) to be a valid but rare clinical diagnosis. Respondents cited extreme child abuse as the foremost cause of MPD. Approximately one-half of all respondents believed that they had encountered a client with MPD, whereas less than one-third believed that they had encountered a client who feigned MPD. http://psycnet.apa.org/journals/pro/29/2/163/
Professional attitudes to Dissociative Identity Disorder (MPD) in Britain: More on treating DID where it doesn’t exist.  Paper presented at the 4th conference of the International Society for the Study of Dissociation-UK branch. J Mcintee. 1998. and

Davis, J.D. & Davis, M.L. (1997). The prevalence of dissociative disorders within the mental health services of a British urban district.Paper presented at the Fourth Conference of the International Society for the Study of Dissociation. Chester, UK, April 19-11.

Summarized by Somer, E. (2000) A recent survey conducted in Britain sought to test the prevailing view in the United Kingdom academic press that DID either did not exist or was fashionably over-diagnosed by gullible practitioners, influenced by ill-advised North American colleagues. The survey was designed to examine British psychologists’ and psychiatrists’ attitudes towards the identification and treatment of dissociative disorders (McIntee, 1998). Dissociative disorders had been encountered by 66% of respondents, of whom 14% attributed dissociation to iatrogenesis. The 965 British mental health professionals responding to the survey reported having seen a total of 3225 clients with DDs, 526 clients diagnosed as DID, and 596 clients with Dissociative Disorder–Not Otherwise Specified. The estimated life prevalence rates for a British research sample reported a year earlier were 15.2% for DDs in general and 5.7% for DID specifically, with clinical profiles resembling those described in the North American literature (Davis & Davis, 1997).
Hayes, J. A., & Mitchell, J. C. (1994). Mental health professionals’ skepticism about multiple personality disorder. Professional Psychology: Research and Practice, 25(4), 410.
Abstract
Three studies were conducted to investigate the nature of mental health professionals’ skepticism regarding multiple personality disorder (MPD). An initial pilot study was conducted to develop a psychometrically sound survey instrument. In Study 2, the results of a national survey of 207 mental health professionals supported the hypothesis that skepticism and knowledge about MPD are inversely related, r = –.33, p < .01, although the strength of this relationship varied among professions. Moderate to extreme skepticism was expressed by 24% of the sample. Results from Study 3 supported the hypotheses that MPD is diagnosed with less accuracy than is schizophrenia and that misdiagnosis of MPD is predicted by skepticism about MPD. Findings are related to literature pertaining to mental health professionals’ skepticism about MPD and consequential effects on treatment. http://psycnet.apa.org/journals/pro/25/4/410/

Dunn, G. E., Paolo, A. M., Ryan, J. J., & Van Fleet, J. N. (1994). Belief in the existence of multiple personality disorder among psychologists and psychiatrists. Journal of clinical psychology.
Abstract
Surveyed the attitudes of 664 psychologists and 456 psychiatrists with regard to the existence of dissociative and multiple personality disorders (MPDs). 97.5% of the Ss indicated that they believed in dissociative disorders, while 80% reported a belief in MPD. 12.3% did not believe in MPD, and 7.7% were undecided. Belief in MPD was related significantly to profession, age, and years of experience. Young Ss with less professional experience believed more in MPD than did older Ss. Ss who had worked with patients with MPD would tend to believe in the entity. http://psycnet.apa.org/psycinfo/1995-21368-001

Barton, C. (1994). Backstage in psychiatry: The multiple personality disorder controversy.
Abstract
Arguments about the existence of multiple personality disorder (MPD) are creating a professional dispute. Skepticism is manifested in literary as well as behavioral forms. The most widely cited recent skeptical paper is that of H. Merskey (see record 1992-31500-001). Merskey uses arguments that are sociological in nature but with little attention to empirical evidence. Merskey’s skepticism about MPD differs from skepticism in natural science. Proponents’ research is ignored rather than being subjected to critical examination and disproof through attempted replication. His skepticism appears largely based on challenges to the integrity of MPD patients and questions about the competence of therapists. http://psycnet.apa.org/psycinfo/1995-29438-001 Mersky’s response – and Barton’s response to it

Dell, P. F. (1988). Professional skepticism about multiple personality. The Journal of nervous and mental disease, 176(9), 528-531.
Abstract
Therapists who have treated patients with multiple personality disorder (MPD) were surveyed about professional skepticism regarding the existence of MPD. Of these therapists, 78% reported that they had encountered intense skepticism from fellow professionals. Much of this skepticism appears to be explainable in terms of a) the lengthy decline of psychiatry’s interest in dissociation, b) under appreciation of the prevalence of individuals with dissociative ability, and c) misconceptions about the natural clinical presentation of patients with MPD. These factors, however, could not explain the behavior of those skeptics who deliberately interfered with the clinical care of patients and who engaged in repeated acts of harassment against the patient and/or therapist. Half of the survey respondents reported that they had encountered these latter forms of extreme skepticism. http://journals.lww.com/jonmd/Abstract/1988/09000/Professional_Skepticism_about_Multiple.2.aspx


The Cupcake incident – a personal story of Shame and Guilt

'Unlike guilt, which is the feeling of doing something wrong shame is the feeling of being something wrong.' Marilyn J. Sorensen 

Unlike guilt, which is the feeling of doing something wrong, shame is the feeling of being something wrong – Marilyn J. Sorensen

If something bad happens, do you normally think it is your fault and search for what you did wrong?

Many survivors of child abuse automatically blame themselves for anything bad, and feel guilty and ashamed most of the time – especially about anything related to their immediate family.

Can you remember how old you were when you first felt this way?

Where do our feelings of guilt and shame come from?

Darlene, a survivor of multiple types of child abuse, explains one of the things that gave her the core belief that bad things were always her fault, and that the abuse was her fault.

The Cupcake incident – How Shame and Guilt get misapplied to the Self

Related Links

Suffering and scars quote

sufferigkahlilgira

“Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.”

― Kahlil Gibran

Related links

Have you been blamed for your mental health problems? For not recovering ‘fast enough’?

Why this repeated tenancy to blame those with problems for their problems?

Why this repeated tenancy to blame those with problems for their problems? The mentally ill are likely to be told to just snap out of it. For most people who have a mental illness snapping out of it is only slightly more difficult than growing a few inches because you should be taller.

David Joel Miller’s post goes on to explain some of the difficulties overcoming problems like homelessness, addiction, and anxiety.

“all too often treatment programs are organized to meet the needs of the system not the individual”
David Joel Miller