Probing Question: How do schizophrenia and DID differ?

Nov 12, 2010
How schizophrenia and DID differ

"What will I have for dinner? Is it going to rain later? I wonder what she meant by that."

Questions or comments like these silently passing through our minds reflect how most of us think; they’re normal. When the comments heard internally are the voices of other people, however, then psychiatrists suspect schizophrenia.

Among the myths surrounding schizophrenia, one of the most persistent is that it involves a "split ," two separate and conflicting identities sharing one brain. A National Alliance on Mental Illness survey found that 64 percent of the public shares this misconception.

"It’s an extremely common misunderstanding," said Randon Welton, assistant professor of psychiatry at Penn State Milton S. Hershey Medical Center. "It’s based on the name. If you go to the Greek roots of the word -- 'schizein,' meaning 'splitting,' and 'phren,' meaning 'mind' -- you have 'split brain' or 'split mind.' However, the intended reference is to a split between rationality and emotions, not a split within a personality," said Welton.

Split personality, more properly, is an old name for multiple personality disorder, which is itself an outdated name for dissociative identity disorder (DID), an officially recognized but still controversial diagnosis. Welton said DID came to the public’s attention following the release of books and films such as "The Three Faces of Eve" and "Sybil," accounts of women who developed multiple, distinct personalities following severe abuse as children.

"I would describe DID as a trauma-based illness," Welton said. Those affected by it have "at least two and often more distinct identity states which each have fairly consistent patterns of relating to the environment." The American Psychiatric Association definition specifies that "at least two of these identities or personality states recurrently take control of the person's behavior."

By contrast, Welton describes schizophrenia as "a largely genetic illness, one that seems to be clustered within families. It seems to be more neurodevelopmental, influenced by how the brain develops. It usually presents in late teens to young adulthood and is more common than DID, with 2.2 million Americans living with the disease. Explained Welton, "You see a gradual, overall decrease in functioning with acute exacerbation, lasting weeks or months, of overtly psychotic symptoms -- unless they are caught and treated."

While trauma is associated with both disorders, Welton explained that "the traditional difference is that with schizophrenia, the trauma tends to follow the disease. It is a consequence of the illness; it is not causative. Trauma doesn’t make someone have schizophrenia, whereas for almost everyone with DID I’ve ever heard about, it is a reaction to the trauma." Schizophrenia is classified as a psychotic disorder and managed primarily through drugs, whereas DID is considered a developmental disorder that is more responsive to psychotherapy and behavioral modifications.

On the surface, the difference between the two disorders seems clear cut. But some psychiatrists, such as Brad Foote of the Albert Einstein College of Medicine, are warning their peers that it may be possible to confuse the two conditions early in the course of treatment. This may happen if voices of alternate personalities in a case of DID "leak through" and comment on events, or talk directly to the core, central personality, without completely taking it over.

"Traditionally, any time a patient reports hearing voices like this, it was a strong indication of ," Welton said. "Psychosis is not a diagnostic key for DID but it is a common finding in that they will hear one personality talking to another or a personality commenting on them."

If these observations are accurate, Welton said, "it would be very easy to put that person into a psychotic disorder category because you did not ask the right questions or you didn’t ask in the right way."

Hearing voices may be more complicated than doctors or patients knew.

Explore further: Majority of homeless adults with mental illness have high rates of cognitive deficits

add to favorites email to friend print save as pdf

Related Stories

Brain Defect Implicated in Early Schizophrenia

Sep 07, 2009

( -- In the first functional magnetic resonance imaging (fMRI) study of its kind, neurologists and psychiatrists at Columbia University have identified an area of the brain involved in the earliest ...

Incorrectly cleaved protein leads to schizophrenia

Jul 14, 2008

Schizophrenia is a disease that strikes an average of 4000 Belgians every year. The causes of this psychiatric disorder are not yet clear. But now, VIB researchers connected to the Katholieke Universiteit Leuven have discovered ...

Schizophrenia and psychotic syndromes

Aug 29, 2010

Schizophrenia and related psychotic disorders are a chronic and often disabling condition. Despite modern treatment techniques they still present an enormous burden to the patients and their relatives and take a serious toll ...

Recommended for you

Appraisal of stressful or threatening situations by the brain

4 hours ago

Researchers at the Research Center Translational Neurosciences of Johannes Gutenberg University Mainz (JGU) in Germany have advanced a generalized concept as the basis for future studies of mental resilience. Their new approach ...

Would you tell your manager you had a mental health problem?

Jan 26, 2015

Although nearly four in 10 workers wouldn't tell their manager if they had a mental health problem, half said that if they knew about a coworker's illness, they would desire to help, a new survey by the Centre for Addiction ...

Stress during pregnancy related to infant gut microbiota

Jan 26, 2015

Women who experience stress during pregnancy are likely to have babies with a poor mix of intestinal microbiota and with a higher incidence of intestinal problems and allergic reactions. This could be related to psychological ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.