A lot of my patients, diagnosed with Schizophrenia, ask me questions: what is then different from DID? Also, they have questions about inheritance. Therefore I already wrote an article a few months ago. To make it clearer, I try to explain, what is meaning of these disorders, what they have in common and what causes such mental diseases.
Schizophrenia is a psychotic disorder. It can cause behavior changes and symptoms such as hallucinations — instances in which a person sees, hears, or feels things that are not really there. It can also cause people to experience delusions, meaning they believe things that are not true. Schizophrenia affects how a person thinks, feels, and experiences reality.
DID — which experts referred to as multiple personality disorder or split personality disorder until 1994 — is a dissociative disorder in which a person has multiple identities that function independently. They are separate personality states with different memories and behaviors, and they may even have different voices, language, or perceived appearance.
The two disorders have symptoms and causes that may overlap, including a disconnection from reality. However, while people with schizophrenia have false ideas and delusions, they do not experience different personality states. Many people confuse the two disorders because they have overlapping criteria. Studies suggest that 9–50% of people with schizophrenia also meet the criteria for DID. Hearing voices in one’s head may seem or feel similar to having multiple identities in one’s head.
The two conditions share the following symptoms:
• hallucinations, which can be visual or auditory
• suicidal ideation
• delusions
• dissociation
Sometimes doctors or mental health professionals may mistakenly assume that a person who believes they have multiple personalities is experiencing delusions. Delusions differ from having multiple identities, as they can be ideas or beliefs that have no grounds in reality.
Symptoms that may occur in both DID and schizophrenia include:
• amnesia, or memory loss
• hearing voices
• a sense of disconnection from other people
However, the two disorders also have differing symptoms, as the table below illustrates.
Hallucinations, which involve hearing voices or seeing people who are not thereFeelings of detachment from reality. Delusions, such as strong beliefs in things or ideas that are not true memory loss. Amnesia issues with cognitive functions such as attention, memory, and reasoning an inability to cope with stressful life situations. Reduced emotional expression: a feeling that nothing is real. Negative symptoms such as withdrawal from society, issues with identity, including having multiple personality states that a person cannot integrate. Depersonalization, or the feeling of being outside oneself.
Studies have found that hallucinations, such as hearing voices, occur less often in DID than in schizophrenia.
The causes of DID and schizophrenia differ. Experts do not know the exact cause of schizophrenia, but it may be a combination of genetic, environmental, and psychological factors. DID and other dissociative disorders are often the result of trauma. Dissociation is how the mind can cope with traumatic experiences or extreme stress. According to the American Psychiatric Association, 90% of people with DID in the United States, Canada, and Europe have experienced severe neglect and childhood abuse. Other traumatic experiences that may result in DID include:
• war or military combat
• physical abuse
• sexual abuse
• emotional abuse
Switching off from reality is a standard way of responding to something that the body or mind feels it cannot cope with. The United Kingdom’s National Health Service (NHS) describes this as a sense of denial, as if the event or situation is not happening to the person. It becomes an issue when this sense of switching off remains even when a person’s environment is no longer threatening. Treatments for the two disorders differ. For example, doctors may prescribe antipsychotic medication to manage hallucinations in schizophrenia, but they do not treat DID with antipsychotics.
Treatment for both disorders involves psychotherapy, which can include:
• talking therapies such as cognitive behavioral therapy (CBT), which can help manage hallucinations, symptoms such as anxiety, and episodes of dissociation
• support from mental health professionals
• medications for accompanying symptoms such as anxiety and depression.With treatment, people with DID and schizophrenia can live healthy, fulfilling lives. Both schizophrenia and DID are rare disorders. Schizophrenia affects just 1% of adults worldwide. The World Health Organization (WHO) estimates that it affects 1 in 300 people globally. Males are more likely to receive this diagnosis than females. DID affects 1.5% of people globally, and females are more likely to receive this diagnosis. According to the National Alliance on Mental Illness, up to 75% of people may experience depersonalization or derealization at least once in their lifetime. This can feel like a person is outside their body or that the world does not seem real. It can result from stressful or traumatic situations. DID and schizophrenia have some overlapping symptoms, but they are separate conditions. While people with either condition may experience delusions, depression, and suicidal thoughts, people with DID experience multiple identities or personalities, while those with schizophrenia do not.
The causes of both disorders may stem from trauma, but experts do not know the exact cause of schizophrenia. Treatment for both conditions includes talk therapy such as CBT.
When does schizophrenia typically develop?
The symptoms of schizophrenia usually emerge when a person is in their late teens or early 30s. They tend to develop earlier in males than in females. Sometimes, a person will start to show unusual behaviors from childhood, but these only become significant as they get older. In others, the symptoms may appear suddenly. Schizophrenia causes changes in a person’s thinking and behavior. Symptoms usually appear when people are in their 20s, though the average age of onset can very.
One study in 2020 found that the average age of onset for schizophrenia is between 13.78 and 29.28 years old. Environmental, genetic, and other factors may affect the age of onset. Additionally, the age of onset for schizophrenia may affect the condition’s course. Most studies show that people who develop schizophrenia in childhood or adolescence have more symptoms. In addition to the onset of schizophrenia symptoms, many people with schizophrenia experience a prodrome. This is a group of mental health symptoms, such as depression, mood shifts, and irritability, that may be present for months or even years before schizophrenia appears.
An older 2014 study suggests that the schizophrenia prodrome may appear up to 9 years prior to the onset of the condition. Knowing the average age of schizophrenia onset reveals little about whether or when an individual might develop this condition.Schizophrenia is a chronic illness that usually lasts a lifetime, though treatment can manage symptoms. Some people find full relief with treatment, while others may relapse or try several different treatments before getting any relief. While the average age of schizophrenia onset can help with determining whether a person’s symptoms may stem from schizophrenia, people of any age can have schizophrenia.
The classifications and types of schizophrenia have changed over the years. Previously, health professionals may have classified schizophrenia as one of the following five types:
• paranoid type
• disorganized type
• catatonic type
• undifferentiated type
• residual type
However, doctors no longer classify types of schizophrenia. The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) is the manual mental health professionals use to diagnose mental health conditions. The current version, DSM-V, uses these categories. This is because health experts noted that the previous types had many overlapping features and symptoms.
Schizophrenia affects people in different ways, but there are some common symptoms. These include:
• confused speech that is intact but hard for others to interpret and understand
• lack of facial expression
• lack of emotional expression
• lack of motivation
• psychosis, such as delusions and hallucinations difficulty concentratingBefore experiencing these symptoms, a person may appear
:• out of sorts
• anxious
• to lack focus
A person experiencing delusions has a fixed belief about something regardless of the evidence. For example, they may believe that:
• They are very important
.• Someone is pursuing them
• Others are attempting to control them remotely
• They have extraordinary powers or abilities.
Some people experience hallucinations. The most common type is hearing voices, but hallucinations can affect all the senses. For example, a person may also see, feel, taste, or smell things that are not really there.
A person’s thinking, and speech, may jump from one subject to another for no logical reason. It may therefore be hard to follow what the person is trying to say. There may also be memory problems and difficulty understanding and using information.
The symptoms listed above can also affect a person’s:
• Motivation: The person may neglect everyday activities, including self-care. They may also experience catatonia, during which they can barely talk or move.
• Emotional expression: The person may respond inappropriately or not at all on sad or happy occasions.
• Social life: The person may withdraw socially, possibly through fear that somebody will harm them.
• Communication: The person’s unusual thought and speech patterns can make it difficult for them to communicate with others.
Many people with schizophrenia do not realize that they are unwell. Hallucinations and delusions can seem very real to a person who is experiencing them. This can make it hard to convince the individual to seek treatment or take medication. They may fear the side effects or believe that medication will harm them.Schizophrenia usually appears in a person’s late teens or older, but it can also affect children.
Genetics: schizophrenia likely when specific genetic and environmental factors combine. For example, the following factors might all contribute to the development of schizophrenia. If there is no history of schizophrenia in a family, the chances of developing it are low. However, a person’s risk rises if one of their parents has a diagnosis of schizophrenia.
Chemical: schizophrenia appears to develop when there is an imbalance of the neurotransmitter dopamine and possibly serotonin in the brain.
Environment: environmental factors: they may increase the risk of schizophrenia include:
• trauma during birth
• malnutrition before birth
• viral infections
• psychosocial factors, such as trauma
To diagnose schizophrenia, a doctor will use the criteria from the DSM-5. This manual provides criteria for diagnosing a wide range of mental health conditions .According to the criteria, a person must have at least two of the following symptoms for a month:
1. delusions
2. hallucinations
3. disorganized speech
4. grossly disorganized or catatonic behavior
5. negative symptoms, such as lack of speech, emotional flatness, or lack of motivation
At least one of these must be 1, 2, or 3.
They must also experience considerable impairment in their ability to function in school or at work, interact with others, or carry out self-care tasks. They must also have symptoms that persist for 6 months or more. The symptoms must also not be due to another health condition, a prescribed medication, or the use of other substances.The symptoms must also not be due to another health condition, a prescribed medication, or the use of other substances.
Dr-Anne Bakhit
