My parents, scared, took me to a therapist a few years after I was attacked as a teen – I had periods of sadness, complete numbness, intense joy and escape in music. And interspersed, periods of irrationality. I found out later I really scared my friends with my mental constructs. I had some sense that my thoughts and actions were very wrong but I was dragged bodily on a roller coaster with no sense of time or space. I didn’t even ponder where the compulsion and agitation came from – I was just there, on a mission to accomplish something I didn’t truly understand and was powerless to control.

The first therapist told my mother that she thought it might be schizophrenia. My mother tells me it drove her on a secret feverish hunt to learn all she could about the frightening disease.

The advances in mental health research and treatment show that symptoms of schizophrenia and dissociative identity disorder are very similar, and DID is often misdiagnosed as schizophrenia. Sometimes people ask for the difference, and I read a paragraph in an article on the Multidimensional Inventory of Dissociation (H-MID) that might help explain it to someone not familiar with the field.

This is based on the work of Schneider (1959) and Kluft (1987), two who have advanced the field significantly.

Schneider listed 11 first-rank symptoms to diagnose schizophrenia:

(1) voices arguing
(2) voices commenting
(3) “made” feelings
(4) “made” impulses
(5) “made” actions
(6) influences playing on the body
(7) thought insertion
(8) thought withdrawal
(9) thought broadcasting
(10) audible thoughts
(11) delusional perception

Kluft (1987) reported the first 8 are common in DID but not the last three. Of the first 8: “[e]ach is a peculiar intrusion into the person’s executive functioning and/or sense of self. “

The difference is often described this way: those with DID hear voices inside their head; those with schizophrenia hear voices from outside their head. But that is such a sterile descriptor.

I like this one better:

[S]chizophrenics experience psychotic forms of intrusion (e.g., “John Ashcroft is implanting his thoughts in my head.”), whereas dissociative patients experience nonpsychotic intrusions (e.g., “Sometimes I have thoughts that do not feel like they are mine.”).

So those common symptoms – the voices commenting, arguing, etc. At least with DID, all those selves participating or not. Talking when not asked, and silent when input desired. (Although the symptoms are the same, the cause in Schizophrenia is thought to be different.)

Others of the first 8 symptoms are also pretty sterile to the lay person – the idea of “made” feelings, impulses and thoughts.

<That’s from the Sopranos when a top guy is “made.” They all gotta have DID to whacksomeone and then come home with flowers for the wife.>

Ha Ha Ha. Yeahhh. So, moving along, from the Cognitive Therapy of Schizophrenia on “made” symptoms, I find a description of my teenage experiences – compelled to behave inappropriately with no idea why.

Feeling that others or some external agency or force is making you do, think, or feel things – not just psychologically coercing you – must be profoundly disturbing and disempowering.

Back then, I reported feeling controlled by something outside myself. A female entity that was outside me but part of me somehow, and a male entity that was clearly outside me speaking directly (though writings that I still have) to that female entity. I realize now that both were probably voices inside my head. I think. But to a teen, what was the difference? A force outside me was trying mightily to control my thoughts and actions, and often succeeded in his quest to completely control me, and through me, some of my closest friends. I wonder even now, was that truly DID?

i mused and vented before about DID as a psychosis. The only evidence I found was that DID may share some “psychotic-like symptoms” and as such, can lead to an accidental diagnosis of schizophrenia- these symptoms are auditory hallucinations and visual hallucinations. [Dell] However, it is uncommon for these symptoms to be psychotic unless the individual with DID develops “reactive” dissociative psychosis – a true psychotic episode IN ADDITION to DID.

I recall quite vividly several episodes that feel much more than the worst dissociation I feel now. The uncontrollable thoughts and actions I experience now are due to something inside me. Those from my teens clearly were not. I have never admitted it, but have always suspected those were periods of insanity or psychosis.

No wonder they thought I was schizophrenic.

- ∞ -

See also:

List of all posts
Dear Ms. DID: Is someone with DID psychotic, a neurotic, or just mentally unfit?
Meet Emily: the harassing, attention-seeking manipulative stalker and computer-crasher
Review: The Willard Suitcase Exhibit Online
Standard Disclaimer: Read now and again before flaming

References

Dell PF. (2006). A New Model of Dissociative Identity Disorder, Psychiatr Clin N Am, 29 pp 1-26.

Somer E and Dell PF. (2005) Development of the Hebrew-Multidimensional Inventory of Dissociation (H-MID): A Valid and Reliable Measure of Pathological Dissociation, J of Trauma and Dissociation. Vol. 6(1), accessed November 24, 2008 from http://www.somer.co.il/articles/2005H-MID.JTD.pdf.