Common mis-diagnosis’s and co-mobidies of DID

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On average a multiple will be in the mental health system for 7 years prior to diagnosis and during this time may receive several varying diagnosis’s. They often include:

Temporal lobe epilepsy’

Dissociation is more common in patients with temporal lobe epilepsy than in any other neurologic disorder. The clinician should refer patients with dissociative symptoms for a thorough neurologic workup to rule out the presence of temporal lobe epilepsy or other organic processes. The standard EEG is of little help in distinguishing MPD from temporal lobe epilepsy because a high rate of nonspecific abnormalities has been detected in patients with MPD, most commonly bilateral temporal lobe slowing.

Schizophrenic disorders

The differentiation between dissociation identity disorder and schizophrenia can be made along several lines.

Patients with schizophrenia hear voices emanating from the external world, whereas patients with dissociation identity disorder hear voices originating from within the individual’s own head.

Patients with schizophrenia may experience visual hallucinations, although they are less well formed than those observed with certain other brain disorders. Patients with MPD occasionally experience hypnagogic phenomena.

Poor reality testing is observed with schizophrenia, whereas patients with MPD have essentially intact reality testing.

Tangential or loose associations accompanied by inappropriate affect are commonly observed with schizophrenia. Patients with dissociation identity disorder may have circumstantial association with appropriate affect.

Borderline personality disorder

Borderline personality disorder has been diagnosed in 70% of a sample of 33 patients with dissociative disorder and in 23% of 70 patients with dissociative disorder. Putnam acknowledged that a large number of his cases resembled Briquet syndrome or somatization disorder, but, like other investigators, he proposed that once the diagnostic criteria for MPD are satisfied, MPD should be considered the superordinate diagnosis because working with the alternates can provide a therapeutic device that cannot be used in the unified individual.


Malingering is said to be an important differential diagnosis in times when an obvious gain may result from mental health intervention. Malingering is the deliberate and fraudulent production of false and exaggerated symptoms to deceive observers for secondary gain that is recognizable with an understanding of the individual’s circumstances.

Dissociative amnesic disorder

MPD may prove difficult to distinguish from other dissociative amnesic disorders. With other dissociative amnesic disorders, behavior may be complex, but recovery is often complete, recurrences are less common, and the onset of amnesic spells may be intimately related to stressful events or to ingestion or intoxication.


DID is not schizophrenia

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I am so so so sick of people thinking that DID is schizophrenia… sick of explaining to people over and over that they are NOT the same and that one DOES NOT develop into the other.

So, I would like to compare the two disorders, Schizophrenia and Dissociative Identity Disorder. To shed light and more understanding about these two mental disorders.


Schizophrenia is probably one of the most stigmatized mental disorders. It seems that in so many cases, dealing with this disorder is just too much for some family members and the person suffering from the disorder loses family support and any help that they could provide. People suffering from this disorder tend not to stay in treatment and tend not to take the medications that have been prescribed for them. This can definitely cause a lot of upheaval within the family. Schizophrenics sometimes hear voices that seem to come from outside themselves. Not all schizophrenics hear these voices, but many do. If medication is administered on a regular basis, the schizophrenic can function normally within society; it is when they fail to maintain a regular schedule of medicating that problems arise. There are several types of schizophrenia as well, such as paranoid schizophrenia and schizoaffective disorder.

Symptoms of Schizophrenia:

I. Positive (or psychotic) symptoms, according to DSM-IV, “reflect an excess or distortion of normal functions” and include: delusions, hallucinations, disorganized speech, and disorganized or catatonic behaviour. These symptoms can be effectively treated with antipsychotic medication.

1. Delusions are defined as “erroneous beliefs that usually involve a misinterpretation of perceptions or experience” and cannot be accounted for by the persons cultural or religious background or level of intelligence. A person experiencing delusions strongly believe in their beliefs and will hold firmly to them regardless of the logical arguments and evidence presented. According to the delusion’s content theme, schizophrenics can experience several different types of delusions, such as:
• Persecutory delusions. They are the most common form of delusions experienced in schizophrenia, and their content revolves around the theme of being spied on, followed, ridiculed, tricked, cheated, conspired against, etc. These persecutory delusions usually involve bizarre ideas and plots.
• Referential delusions. According to these delusions certain events, objects, remarks, gestures, comments, passages from a book, newspapers, song’s lyrics, news, or environmental clues have a personal meaning or are directed to the individual.
• Somatic delusions. These delusions focus on the diseased, changed, or abnormal characteristic of a bodily functioning, bodily sensation, or physical appearance. For example, the patient can believe that their body is infested by parasites or that their organs were removed and replaced with someone else’s organs by a stranger that left no wounds or scars.
• Religious delusions. This type includes any delusion with a religious or spiritual content. Some of these delusions can have grandiose characteristics such as the belief that the person was chosen by God. However, religious delusions vary across cultures and in some cases, can lead to violent behaviours.
• Grandiose delusions. They express the individual’s beliefs that they posses special powers, talents, abilities, are famous people, or have accomplished great achievements for which they never received sufficient recognition.

2. Hallucinations are false or distorted sensory experiences generated by the mind and not by external stimuli which appear to the person as real perceptions. The most common hallucinations experienced by individual with schizophrenia are:
• Auditory hallucinations. This type is by far the most common hallucination described by schizophrenics. They are mostly experienced as familiar or unfamiliar voices or sounds. A typical auditory hallucination in schizophrenia is one where there is, “two or more voices conversing with one another or voices maintaining a running commentary on the person’s thoughts or behaviour.” In many cases, these voices are critical, vulgar, or abusive. Auditory hallucinations tend to get worse when the person is alone. When severe, these hallucinations intrude into the person’s life and activities, and the patient can even respond to them as if in conversation.
• Visual hallucinations. This type of hallucinations are also divided in simple (elementary or non-formed) hallucinations such as dots, colours, flashing light, or geometric patterns, and complex (formed) hallucinations such as objects, animals, or people.
• Olfactory hallucinations (smell).
• Tactile hallucinations (touch).

3. Disorganized speech. One of the characteristic features of schizophrenia is fragmented thinking. Fragmented thinking can be observed in the way the person talks (disorganized speech). This disorganization can vary in patients with schizophrenia. Some individuals can “slip out of track” from one subject to another, speak incoherently, or express illogical thinking. When answering questions, schizophrenics can “be obliquely related or completely unrelated.”
Some of the most common signs of disorganized speech include:
• Loose associations – The person rapidly shifts the conversation subject from one topic to another without connecting them.
• Neologisms – Neologisms, in schizophrenia, refer to those made-up words or phrases that make sense only for the patient.
• Perseveration – The patients repeats the same words or statements over and over.
• Clang -The patient uses different rhyming words in an order that doesn’t make sense.

4. Grossly disorganized or catatonic behaviour. Disorganized behaviour can manifest in various ways such as: childlike silliness, unpredictable agitation (shouting or swearing, muttering aloud in public), difficulties in performing activities of daily living (preparing meals or maintaining a proper hygiene), dressing in a bizarre manner (such as wearing multiples scarfs, multiple coats, or unsuitable cloth for the outside weather – gloves on a hot day), or display inappropriate sexual behaviours (masturbating in public). On the other hand, individuals suffering from schizophrenia also display what is called a catatonic behaviour. This behaviour is characterized by muscular tightness (rigidity) and lack of response to the environment. In severe cases, the catatonic behaviour can reach an extreme degree of complete unawareness (condition known in medical terms as catatonic stupor) when the body maintains a rigid posture and resists the efforts to be moved.

II. Negative symptoms are those symptoms that reflect the loss of normal functioning, and include: flat affection, avolition (withdrawal, loss of motivation, and ambivalence), anhedonia (loss of feeling or inability to express pleasure), and alogia (poverty of speech). Approximately 25 percent of the patients with schizophrenia display what is called the deficit syndrome “defined by severe and persistent negative symptoms”. Unfortunately, negative symptoms are the main reason why individuals with schizophrenia cannot live an independent life, hold jobs, and establish personal relationships.

1. Affective flattening is a common symptom in schizophrenia, and is characterized by unchanging facial expressions where the face appears immobile and unresponsive, poor or no eye contact, reduced body language, and decreased spontaneous movements. A person with affective flattening “may stare vacantly into the space and speak in a flat, toneless voice.” In certain occasions, an individual with affective flattening can smile or warm up, however their range of emotional expressiveness is diminished most of the time.

2. Avolition is a symptom characterized by the absence of initiative or motivation to begin or maintain a goal-directed activity. This symptom involves a lack of energy, increased apathy, and/or lack of interest in daily activities. A person with avolition may sit for hours doing nothing and show little interest in engaging in social or work activities. They can lack the desire to maintain proper personal hygiene or to groom, and have difficulties taking decisions. When these symptoms occur in the clinical picture, it significantly interferes with the individual’s ability to function normally in the work, social, or household settings.

3. Anhedonia represents the inability to feel joy. This symptom manifests when the individual lacks the interest in social or recreational activities and fails in developing close relationships.

4. Alogia or “poverty of speech” is characterized by “brief, laconic, empty replies.” Individuals with alogia appear “to have a diminution of thoughts that is reflected in decreased fluency and productivity of speech”; they tend to be vague and repetitious. However, this symptom should not be confused with the lack of desire to speak.

III. Cognitive symptoms (or impairments) also called cognitive dysfunctions or disorganized symptoms are often present in people with schizophrenia. However, this type of symptom is subtle and is usually detected when the patient undergoes neuropsychological tests. Some of the common cognitive impairments associated with schizophrenia are:
• Difficulties prioritizing tasks and organizing their thoughts.
• Trouble with logical thinking.
• Confused and disordered speech.
• Inability to sustain attention.
• Difficulties making decisions.
• Problems with memory.
• Lack of insight into their condition.

Treating Schizophrenia is also time consuming. Various medications are given and what works well for one person may not work well for another. Once an effective medication has been applied, most schizophrenics are able to live a normal life and function well in society. Medical Science is currently developing new medications for this disorder and soon there will be more and better treatment options.


Just as schizophrenics hear voices that seem to come from outside themselves, most people with Dissociative Identity Disorder hear voices that seem to come from inside themselves. People with DID also do not suffer from hallucinations, delusions, or have problems with speech and understanding. The problems arise when there is a switch from one alternate personality to another, which could cause someone to think the person has a very poor memory, when in fact, they do not; they just were not fully “present” for a short time
Dissociative Identity Disorder results, for the most part, from situations where the person is unable to tolerate a situation, so they “flee” by fragmenting the mind, or splitting off. One alternate personality will remain to endure the event and store that information away from the conscious mind. Memories of these events become compartmentalized. Memories that are similar are often telescoped together and not always stored as separate incidents, but rather, as similar incidents in the same compartment of the mind. The more intense, repetitive and lengthy the situation, the more fragmented the personality becomes.

Symptoms of DID:

1. Amnesia. A very common manifestation of the disorder is amnesia or loss of time usually observed by those around the person. Patients with DID experience frequent memory gaps in personal history (as extreme as an overall loss of biographical memory for extended periods of time during childhood, adolescence, or adulthood years), past events (they can forget what had happened during a certain period of time such as 3 years in a row) or recent events (they find items in their house that they do not remember purchasing, written notes with a different handwriting than their own, or evidence of activities they don’t remember engaging in). Some expert’s hypothesis that amnesia might be possible due to the fact that passive identities tend to have more constricted memories, while the more hostile, controlling, or protective identities have more complete memories.

2. Depersonalization is a dissociation symptom characterized by an alteration in the perception or experience of self, in which the patient either feels that their body is unreal, changing or dissolving, or detached from it, similar with an outside observer of their own mental processes or body while having no control over the situation.

3. Derealisation is also a dissociation symptom in which the external world is perceive as strange or unreal.

4. Identity disturbances are one of the most distinct symptoms of dissociative identity disorder. Individuals with DID usually have a main personality and several alters that take charge in different situations. The alternate identities “are intrapsychic entities that have a sense of self, have an emotional repertoire, and can process information”. Some of the alters handle and act out emotions the patient cannot deal with such as rage or terror, others (called internal self helpers) watch what is going on and give advice, or act as friends. Some alters can know, observe, and interact with one another in an extremely elaborated inner world, while others may not be aware of the existence of some alters. When they interact with one another, the patient can report hearing inner conversations which are usually diagnosed as auditory hallucinations. However, DID auditory hallucinations differ from schizophrenia auditory hallucinations due to their distinct qualities. In DID, the voices are perceived to be heard internally in the brain, while in schizophrenia the voices are perceived to come from outside the brain.

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