Can someone have schizophrenia and multiple personality disorder

"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 personality," 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," says 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, explains 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Split personality, more properly, is an old name for multiple personality disorder, which is itself an outdated name for dissociative identity disorder (DID), an officially recognized but still controversial diagnosis.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 notes that 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 says. 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. Explains 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 explains 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 schizophrenia," Welton says. "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 says "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.

Randon Welton, MD, is assistant professor of psychiatry at the Pennsylvania Psychiatric Institute, Penn State Hershey Medical Center. He can be reached at .

Last Updated October 26, 2010

Schizophrenia and dissociative disorders are both serious mental health conditions. While the two conditions do share some similarities, they are not the same and have distinct characteristics, symptoms, and treatments.

Schizophrenia is a condition marked by disturbances in thoughts, feelings, and behaviors. Dissociative disorders are characterized by problems with the continuity of memories, thoughts, identity, and actions that result in a disconnection from reality.

Learn more about the differences between dissociative disorders and schizophrenia. If you experience symptoms of these conditions, consult a healthcare provider for diagnosis and treatment.

Symptoms

People with schizophrenia and dissociative disorders may experience some similar symptoms. Shared symptoms may include hearing voices, memory loss, and feeling disconnected from the self and others.

However, people with dissociative disorders are more likely to experience depersonalization, derealization, and memory loss. Another notable difference is that people with schizophrenia are more likely to experience problems with cognitive functioning. 

Schizophrenia Symptoms

• Delusions

• Hallucinations

• Disorganized thinking

• Unusual motor behavior

• Social withdrawal

• Lack of emotional expression

• Cognitive deficits

Dissociative Disorder Symptoms

• Amnesia or memory gaps

• Feelings of detachment

• Feelings of unreality

• Inability to cope with stress

• Problems with identity

Causes

As with many mental health conditions, it can be difficult to determine the cause of schizophrenia and of dissociative disorder. Research is ongoing.

Causes of Schizophrenia

There isn’t one single cause of schizophrenia. Research has noted a strong genetic link, as a family history of psychosis significantly increases a person’s risk of the disease. Factors that may increase the risk for schizophrenia include:

• Brain differences: Schizophrenia has been linked to altered brain chemistry involving the neurotransmitters dopamine and glutamate.
• Environment: Schizophrenia has been linked to exposure to viruses or malnutrition during a parent's first or second trimester of pregnancy.
• Substance use: Substance use also can increase the risk of schizophrenia when mind-altering drugs are taken during teenage or young adult years. This includes smoking marijuana, as it increases the risk of psychotic incidents.

Causes of Dissociative Disorders

Dissociative disorders, on the other hand, typically develop in response to significant trauma. This might be military combat or physical or sexual abuse, experiences of which overwhelm the brain. The disorder may grow worse when an individual is under significant stress. 

Who Is Affected and When?

Both schizophrenia and dissociative disorders are relatively uncommon. According to some estimates:

• Schizophrenia affects around 1% of Americans. Those with schizophrenia—estimated at more than 21 million people across the globe—typically begin to experience symptoms in their late teens or early 20s for men and late 20s for women.
• Dissociative disorders affect 2.4% of Americans.

A person living with schizophrenia is more likely to experience other conditions, including posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and major depressive disorder. They are also at a higher risk for substance use.

Each type of dissociative disorder has different average onsets and frequencies. However, amnesic (memory loss) episodes can happen at any time, at any age, and last anywhere from minutes to years.

Studies indicate that dissociative symptoms do not differ between genders. Researchers speculate that the reason more women are diagnosed could be connected to the fact that men enter the legal system rather than the health system.

Diagnosis

In order to diagnose your condition, a healthcare provider will ask questions about your symptoms, take a medical history, and perform a physical exam. They may also use lab tests or other diagnostic tests to rule out any medical conditions that might be causing your symptoms.

Your specific diagnosis will depend on the type of symptoms you present with. Your healthcare provider will use the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DSM-5) to diagnose your condition. The DSM-5 describes disorders and lists the symptom and functioning criteria that a person must meet in order to be diagnosed with a specific condition. 

Diagnosing Schizophrenia

In order to meet the criteria for schizophrenia, an individual must experience two or more of the following symptoms (including at least one of the first three items on the list):

1. Delusions: Delusions include fixed false beliefs. For example, someone may believe aliens are talking to them through a certain radio program or that someone is spying on them even though there is no evidence of it.
2. Hallucinations: Someone may see things that others don’t see, hear things that no one else hears, or smell things that no one else smells.
3. Disorganized speech: This may include using made-up words or phrases that only have meaning to the individual, repeating the same words or statements, using meaningless rhyming words together, or jumping from topic to topic without being able to hold a conversation.
4. Grossly disorganized or catatonic behavior: Individuals may exhibit bizarre behavior that interferes with their ability to function. Individuals with catatonic behavior may appear unresponsive even though they are awake.
5. Negative symptoms:Individuals with schizophrenia may not exhibit certain types of emotional reactions that healthy people do. For example, an individual with schizophrenia might not interact socially or the individual might not show an emotional reaction to either good news or bad news.

People with schizophrenia may lack insight into their disorder. Individuals who do not think they have a problem are less likely to be compliant with their treatment. That may mean higher relapse rates, increased involuntary admissions to psychiatric hospitals, and poorer psychosocial functioning.

Diagnosing Dissociative Disorders

There are three different types of dissociative disorders: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder (DID). Each has its own set of diagnostic criteria in the DSM-5.

• Depersonalization/derealization disorder: Diagnosis requires experiencing persistent or recurring episodes of depersonalization, derealization, or both.
• Dissociative amnesia: Those with dissociative amnesia have trouble remembering information about themselves, whether it’s a lack of memory of a particular traumatic event or, in rare cases, about their identity or past.
• Dissociative identity disorder (DID): A person with dissociative identity disorder will alternate between two or more distinct personality states or experiences. Gaps in memory are another common characteristic of this condition.

Individuals with dissociative disorders may function normally part of the time. Then, their symptoms may create difficulties for them, making it hard to work, maintain relationships, or continue with education.

Recap

Schizophrenia and dissociative disorders are distinct diagnoses, each with their own set of symptoms and specific diagnostic criteria.

Treatment

Because the treatments for schizophrenia and dissociative disorders are specific to the condition, it is essential to get an appropriate diagnosis. Neither schizophrenia nor dissociative disorders can be cured, but they can be managed in a variety of ways. Treatments often involve therapy, medication, and support.

Schizophrenia Treatments

Standard treatment for schizophrenia includes antipsychotic medications, along with psychotherapy and community support services. With proper medication, hallucinations and delusions can subside.

Hospitalization might be necessary for the safety of the person with schizophrenia as well as those around them.

Schizophrenia Discussion Guide

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Dissociative Disorder Treatments

Dissociative disorders are commonly treated with talk therapy. Treatment options may include cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR). Antidepressants or other medications may also be used.

Complications

Individuals with schizophrenia are at a higher risk of suicide. The risk of suicide is 20 times higher in people with schizophrenia, while 5% to 13% die from suicide.

Suicide can also be a serious issue for individuals with dissociative disorders, particularly dissociative identity disorder. More than 70% of individuals with dissociative identity disorder have attempted suicide. Multiple suicide attempts are common and so is self-injury.

Prevention

There is no sure-fire way to prevent schizophrenia. The condition is strongly linked to genetic influences and brain differences. However, it may be possible to reduce the risk by avoiding environmental risk factors such as substance use. 

Because dissociative disorders are strongly linked to traumatic experiences, finding ways to reduce distress and treat the aftereffects of trauma may be helpful.

Summary

Schizophrenia and dissociative disorders share some overlapping symptoms, but it is important to recognize that they are distinct conditions. Schizophrenia is more likely to be marked by disorganized thoughts and behaviors, whereas dissociative disorders are more likely to cause feelings of detachment from the self and reality.

Getting a proper diagnosis is important because the treatments for schizophrenia and dissociative disorders can vary. Schizophrenia is generally treated with antipsychotic medication, while dissociative disorders are treated primarily with talk therapy.

A Word From Verywell

Both schizophrenia and dissociative disorders are highly misunderstood conditions. Experiencing symptoms of either type of condition can be distressing and disruptive, so it is important to seek help if you have any symptoms that cause concern.

Your healthcare provider can determine whether the symptoms you are experiencing might be schizophrenia, a dissociative disorder, or something else. With proper treatment, people living with schizophrenia or dissociative disorder can lead productive, rewarding lives.

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