{"id":986,"date":"2013-10-23T03:54:47","date_gmt":"2013-10-23T03:54:47","guid":{"rendered":"https:\/\/skepticink.com\/gps\/?p=986"},"modified":"2013-10-21T04:01:48","modified_gmt":"2013-10-21T04:01:48","slug":"distinguishing-dissociative-identity-disorder-and-schizophrenia","status":"publish","type":"post","link":"https:\/\/skepticink.com\/gps\/2013\/10\/23\/distinguishing-dissociative-identity-disorder-and-schizophrenia\/","title":{"rendered":"Distinguishing Dissociative Identity Disorder and Schizophrenia"},"content":{"rendered":"

This post is part of a series of guest posts on GPS by the graduate students in my\u00a0Psychopathology<\/a>\u00a0course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare three 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.<\/em><\/p>\n

______________________________________________<\/p>\n

Distinguishing Dissociative Identity Disorder and Schizophrenia\u00a0<\/em>by Kelley R. Bailey<\/strong><\/p>\n

I remember the first time I saw the movie Sybil<\/em> with Sally Fields.\u00a0 It creeped me out.\u00a0 It was the portrayal of abuse that happened to Sybil as a little girl that freaked me out.\u00a0 That scene with her mother giving her ice enemas while she tied little Sybil to the piano and played and played banging on the keys screaming at Sybil to hold it.\u00a0 Creeeeee-py!\u00a0 For years I thought multiple personalities were just a form of schizophrenia and that trauma was related to both and that both were creepy.\u00a0 I thought the movie was the way “crazy” people acted, all crazy people had schizophrenia, and a schizophrenic was a person with multiple personalities because of the abuse that happened to them as a little kid.\u00a0 It was the homeless man wandering the streets talking to himself.\u00a0 It was all those people in the psych ward at hospitals.\u00a0 It was all those people who believed in ghosts or who talked in tongues and danced with snakes.\u00a0 The movie totally shaped my perception of mental disorders generally, but multiple personality disorder and schizophrenia in particular.<\/p>\n

\"\"<\/a>
Sally Fields as Sybil<\/figcaption><\/figure>\n

The book Sybil<\/em> came out in 1973 and instantly shot to the top of the best seller list, selling over 6 million copies.\u00a0 I guess the public liked creepy.\u00a0 Within a few years of publication, cases of multiple personality — now known as dissociative identity disorder — rapidly jumped from less than <\/a>100 diagnoses<\/a>\u00a0total\u00a0to\u00a0thousands in the United State alone.\u00a0 Although Sybil\u2019s diagnosis of DID is disputed today, it did catapult the recognition of the disorder into a mental health category into the Diagnostic and Statistical Manual (DSM).\u00a0 The first comprehensive articles<\/a> began to appear in psychiatric literature in 1980, largely thanks to the publication of the book Sybil<\/em>\u00a0and the subsequent movie.<\/p>\n

The disorder no longer creeps me out, as a matter of fact I\u2019ve become highly interested in the brain, how it works, and how there remains the possibility, given the right scenario, that we have no control over our thoughts.\u00a0 I guess that\u2019s why I\u2019ve chosen the field of counseling.\u00a0 It gives me the opportunity to understand or try to understand the workings of the brain and how it affects us so deeply, and dissociative identity disorder (DID) has all the intriguing aspects of the brain, personality, and disfunction.\u00a0 Attempting to understand DID not only causes confusion for general public, but for the mental health field as well.\u00a0 Some doubt even it\u2019s existence<\/a>, others doubt the cause<\/a>, but one leading etiology has emerged – trauma and specifically posttraumatic disorder, which in turn manifest into DID.\u00a0 The posttraumatic model<\/a> (PTM) states the dissociation is a defense response to childhood trauma, specifically severe sexual and physical abuse, often repeated abuses.\u00a0 This model is easily understood, in that a child who has been traumatized by repeated physical or sexual abuse dissociates from the event as a defensive mechanism from the trauma.\u00a0 PTM holds that DID is a form or variant of post-traumatic stress disorder<\/a> (PTSD) and is a coping reaction to the childhood trauma. (It is important at this point to note that there is a growing number of researchers who posit a different model – an sociocultural model to explain DID<\/a>\u00a0and that they are increasing in influence.)<\/p>\n

Because of the link with trauma, people often confuse DID and schizophrenia. Often dissociative identity disorder is mistaken as schizophrenia, but it doesn\u2019t generally go the other way (people mistaking dissociative identity disorder for schizophrenia). Importantly, though, the two are categorically different both behaviorally (see this link<\/a> for a breakdown of those differences) and at the biological level, in both brain function and structure.<\/p>\n

\"\"<\/a>In schizophrenia there is an augmentation in the ventricular system that has been seen in 45 to 50 out of 60 studies<\/a>\u00a0conducted using computed tomography (CT) scanning. \u00a0What does that mean? Basically the ventricular system holds our cerebrospinal fluid (CSF), which protects our brains from impact, acts as a shock absorbers<\/a> for the central nervous system, and feeds the brain with nutrients while at the same removing “junk” from the brain.\u00a0 It\u2019s unknown if enlarged ventricles of the brain cause schizophrenia (that old chicken and the egg problem), but it can be an indicator.\u00a0 You\u2019d think an enlarged ventricle system with all it\u2019s benefits wouldn\u2019t be harmful but apparently that\u2019s not the case, at least as far as researchers can tell.\u00a0 Presently the only thing enlargement of the ventricles does tells us is if there is disease. It is also helpful in studying and differentiating mental disorders, but that\u2019s about it.<\/p>\n

On the biochemical level, excessive dopamine is linked to schizophrenic symptoms. \u00a0Antipsychotic drugs used to treat schizophrenia unequivocally block dopamine, which helps decrease the positive symptoms.<\/a>\u00a0 It is also known that when people take amphetamines or cocaine, which are drugs that increase dopamine transmission, they have an increased probability of experiencing psychosis<\/a>. As in, when dopamine is supplemented in the brain you can literally make someone psychotic (or a while, at least).<\/p>\n

Markedly different biological makers occur in patients with DID, in particular in the amygdalar and hippocampal volumes.\u00a0 The amygdala regulates our fight\/flight response and it also plays a role in storing memories that are associated with an emotional event among other functions.\u00a0 One of the tasks of the hippocampus is long term memory storage.<\/p>\n

\"\"When the amygdala is removed<\/a>, animals \u00a0become indifferent to stimuli that would have otherwise have caused fear and \u00a0sexual responses. If the hippocampus is damaged<\/a>, a person cannot build new memories, and lives instead in a strange world where everything they experience just fades away, even while older memories from the time before the damage are untouched. We can see some connection with these areas and the presentation of DID.\u00a0 In persons with dissociative identity disorder, we generally see smaller hippocampal and amygdalar volumes.\u00a0 The hippocampus and amygdala are needed for activating our feelings of fear or the need to get out of a situation.\u00a0 Both have been shown<\/a> to be smaller in those with PTSD as well. This makes sense, as the majority of patients with DID also have a diagnosis of PTSD.\u00a0 Again, research is unclear if smaller regions indicate a propensity for developing PTSD or if trauma is the culprit in decreased volumes of both the hippocampus and amygdala.\u00a0 This is significant in that there is a strong correlation of trauma and dissociative identity disorder.\u00a0 Studies<\/a> are emerging suggesting the volume of the hippocampus and amygdala, if smaller to begin with, may indicate a person could be at risk for development of PTSD or DID should trauma occur.<\/p>\n

So what do we do?\u00a0 First recognize the differences.\u00a0 Gaining a correct diagnosis early can mean a much more effective treatment plan and productive life for the patient.\u00a0 Practitioners, even if not working with this population extensively, need to have a broad understanding of the two for recognition and referral.\u00a0 Dissociative identity disorder and schizophrenia are classified differently in the DSM, present differently, have different etiologies, and the two are functionally and structurally different in the brain.\u00a0 There are many other areas to discuss on the dissimilarities between these two disorders other than what was presented here, but the brain differences highlight the structural and some functional disparities between the two.\u00a0 Seeing the varying areas of the brain which are impacted within each disorder is another means of dispelling public opinion on the similarities of schizophrenia and dissociative identity disorder.<\/p>\n

\"\"<\/a>
T-shirts like these display a distinct lack of knowledge about how DID and schizophrenia differ<\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"

In which one of my students helps you learn how DID and schizophrenia differ at a biological level.<\/p>\n","protected":false},"author":25,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[104,29,12,52],"tags":[271,269,268,267,264,272,265,266,270],"class_list":["post-986","post","type-post","status-publish","format-standard","hentry","category-medicine","category-mental-health","category-psychology","category-teaching","tag-amygdala","tag-biology","tag-brain","tag-differences","tag-dissociative-identify-disorder","tag-hippocampus","tag-multiple-personality-disorder","tag-schizophrenia","tag-ventricles"],"_links":{"self":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/posts\/986","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/users\/25"}],"replies":[{"embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/comments?post=986"}],"version-history":[{"count":0,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/posts\/986\/revisions"}],"wp:attachment":[{"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/media?parent=986"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/categories?post=986"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/skepticink.com\/gps\/wp-json\/wp\/v2\/tags?post=986"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}