The Difference Between Dissociative Disorder and Schizophrenia

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There’s a popular misconception that people with schizophrenia switch from personality to personality—each with its own name, thoughts, and voices. That's not the case, however.

People who believe that are confusing schizophrenia with a dissociative disorder known as dissociative identity disorder (formerly called multiple personality disorder).

Schizophrenia and dissociative disorders are both serious mental health disorders that involve different symptoms and different treatments.

Characteristics of Schizophrenia

Schizophrenia is likely the more well-known of the two mental illnesses; however, it’s widely misunderstood.

In order to meet the criteria for schizophrenia, an individual must experience two or more of the following symptoms (and at least one of the symptoms must be one of the first three items on the list):

  1. Delusions – Delusions include false beliefs. For example, someone may believe aliens are talking to him through a certain radio program or that someone is spying on him even though there is no such evidence.
  2. Hallucinations – Someone may see things that others don’t see, hear things that no one else hears, or smell things that no one else smells.
  3. Disorganized Speech – This may include things such as using made-up words or phrases that only have meaning to the individual, repeating the same words or statements, using meaningless rhyming words together, or jumping from topic to topic without being able to hold a conversation.
  4. Grossly Disorganized or Catatonic Behavior – Individuals may exhibit bizarre behavior that interferes with their ability to function. Individuals with catatonic behavior may appear unresponsive even though they are awake.
  5. Negative Symptoms – Individuals with schizophrenia do not exhibit certain things that healthy people do. For example, an individual with schizophrenia might not interact socially or the individual might not show an emotional reaction to either good news or bad news.

Some individuals with schizophrenia exhibit inappropriate affect, such as laughing in the absence of anything funny.

Sleep issues are also common, including a disturbed sleep pattern. An individual with schizophrenia may sleep during the day and stay awake all night, for example. A lack of interest in food may also be present.

Many people with schizophrenia have cognitive deficits, such as memory problems and slower processing speeds. This can make it difficult to work or complete daily living tasks.

People with schizophrenia may lack insight into their disorder. Individuals who do not think they have a problem are less likely to be compliant with their treatment. That may mean higher relapse rates, increased involuntary admissions to psychiatric hospitals, and poorer psychosocial functioning.

Some individuals with schizophrenia are able to live independently and maintain jobs with the help of treatment. Others require much more intensive support and they may struggle to live on their own due to the difficulties they have caring for themselves.

Characteristics of Dissociative Disorders

There are three main types of dissociative disorders in the DSM-5: depersonalization disorder, dissociative amnesia, and dissociative identity disorder. All three are characterized by a disruption in consciousness, memory, identity, emotion, perception, motor control, behavior, and body representation. Here are the differences between the three disorders:  

  • Depersonalization Disorder – People with depersonalization disorder feel detached from their actions or feelings like they’re watching a movie. They might also experience derealization, which is feeling like other people and things aren’t real. A person might only experience depersonalization, only derealization, or both.
  • Dissociative Amnesia – Those with dissociative amnesia have trouble remembering information about themselves, whether it’s a lack of memory of a particular traumatic event or, in rare cases, about their identity or past.
  • Dissociative Identity Disorder – A person with dissociative identity disorder will alternate between multiple identities, which might have their own names, voices, and characteristics. These personalities might seem like they’re trying to take control in a person’s head. With DID, a person will have memory gaps of daily events, personal information, and trauma that they have experienced.

Individuals with dissociative disorders may function normally part of the time. Then, their symptoms may create difficulties for them, by making it hard to work, maintain relationships, or continue with education.

Who Is Affected?

Both schizophrenia and dissociative disorders are uncommon, affecting around 1 percent and 2 percent of Americans, respectively. Those with schizophrenia—estimated at more than 21 million people across the globe—typically begin to experience symptoms in their late teens or early 20s for men and late 20s to early 30s for women.

An individual living with schizophrenia is more likely to experience other conditions, too, including posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and major depressive disorder, as well as a higher risk of substance abuse.

Women are more likely than men to be diagnosed with a dissociative disorder, though almost half of all adults in America experience at least one depersonalization or derealization episode in their lives. But only 2 percent have chronic episodes that are necessary for the diagnosis.

Each type of dissociative disorder has different average onsets and frequency, though amnesic episodes can happen at any time, at any age, and last anywhere from minutes to years. The average onset age for depersonalization is 16, though it can come on earlier.

Women are more likely than men to be diagnosed with dissociative identity disorder, but only because they present symptoms that are more easily identified. Men often deny symptoms and exhibit violence, making it more difficult to recognize.

Potential Causes

There isn’t one single cause of schizophrenia. Research has noted a possible genetic link, as a family history of psychosis significantly increases a person’s risk of the disease. If someone has a first-degree relative with schizophrenia, such as a parent or sibling, the chances of it occurring is roughly 10 percent.

Schizophrenia has also been linked to exposure to viruses or malnutrition during a mother’s first or second trimester of pregnancy, as well as altered brain chemistry involving the neurotransmitters dopamine and glutamate.

Finally, substance abuse can increase the risk of schizophrenia when mind-altering drugs are taken during teenage or young adult years. This includes smoking marijuana, as it increases the risk of psychotic incidents.

Dissociative disorders, on the other hand, typically develop in response to a traumatic event. This might be military combat or physical abuse, memories of which the brain tries to control. The disorder may grow worse when an individual feels overwhelmed by stress. 

Treatment Options

Neither schizophrenia nor dissociative disorders can be cured, but they can be managed in a variety of ways. Standard treatment for schizophrenia includes antipsychotic medications, along with psychotherapy and community support services. 

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With proper medication, hallucinations and delusions can subside. Hospitalization might be necessary for the safety of both the person with schizophrenia as well as those around them.

Individuals with schizophrenia are also at a higher risk of suicide—20 percent attempt suicide at least once, while 5 to 6 percent die from suicide.

Suicide can also be a serious issue for individuals with dissociative disorders, particularly dissociative identity disorder. More than 70 percent of individuals with dissociative identity disorder who are treated in an outpatient setting have attempted suicide. Multiple suicide attempts are common and self-injury may be frequent.

Dissociative disorders are commonly treated with talk therapy. Treatment options may include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), eye movement desensitization and reprocessing (EMDR), and antidepressants or other medications.

A Word From Verywell

Both schizophrenia and dissociative disorders are highly misunderstood conditions. With proper treatment, people living with schizophrenia or dissociative disorder can lead productive, rewarding lives.

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