Dissociative Disorders: Between Neurosis And Psychosis
1Department of Mental Health and Psychiatry, General Psychiatry Department, University Hospital of Geneva, CAPPI Jonction, Rue des Bains 35, 1205 Geneva, Switzerland
Dissociative disorders are a set of disorders defined by a disturbance affecting functions that are normally integrated with a prevalence of 2.4 percent in industrialised countries. These disorders are often poorly diagnosed or misdiagnosed because of sharing common clinical features with psychotic disorders, but requiring a very different trajectory of care. Repeated clinical situations in a crisis centre in Geneva provided us with a critical overview of current evidence of knowledge in clinical and etiopathological field about dissociative disorders. Because of their multiple expressions and the overlap with psychotic disorders, we focused on the clinical aspects using three different situations to better understand their specificity and to extend our thinking to the relevance of terms neurosis and psychosis. Finally, we hope that this work might help physicians and psychiatrists to become more aware of this complex set of disorders while making a diagnosis.
According to ICD-10, there are more subtypes of diagnostic categories and depersonalization/derealization disorder is classified in neurotic disorders .
2.1. Clinical Vignette Number 1
2.2. Clinical Vignette Number 2
2.3. Clinical Vignette Number 3
Other Family Environmental Factors
In the British 1946 Birth Cohort, schizophrenia in offspring has been linked with problems in mothers general understanding and management of their children . Goldstein concluded that communication deviance in the family increased the risk for schizophrenia. Having a positive relationship with both the mother and father might be protective against schizophrenia among high-risk children. These findings may be explained by geneenvironment interaction.
In Finnish studies some possible stress factors have not generally been linked to schizophrenia. Very early temporal separation from parents and transfer to adequate nursing homes immediately after birth because of tuberculosis in the family did not predict schizophrenia, and neither did living in a single-parent family in childhood, low socio-economic status, or the size of the family of origin and multiparity. The connection between childhood socio-economic status and schizophrenia is not yet entirely resolved. Low or high socio-economic status in the family of origin has been found to be at least a modest risk factor for schizophrenia in some studies, while other studies report no increased risk.
If A Friend Or Family Member Has Did How Can I Help
Having a loved one with DID can be confusing and overwhelming. You may not know how to respond to their different alters or behaviors. You can help by:
- Learning about DID and its symptoms.
- Offering to attend family counseling or support groups with your loved one.
- Staying calm and supportive when sudden behavior changes occur.
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Will I Get It Too
The risk for schizophrenia is about one in every hundred people. It is thought to be caused by genetics and environment working together. This means that it runs in families, but just because someone in your family has schizophrenia does not mean you will get it too. It just means that your risk of getting it is a bit higher, so you need to take good care of your brain. If you have a sister or brother with schizophrenia, you have about a 10% chance of having it too. If your identical twin has schizophrenia, you have about a 50% risk.
Adjusted Odds Ratios For Schizophrenia
Table 3 presents the adjusted odds ratios for those complications which were demonstrated to have an odds ratio for schizophrenia > 1.5 or < 0.7 from Tables 1 and 2. Adjusting either separately or simultaneously for maternal history of psychotic illness, maternal age, parity, socio-economic classification, civil status and attendance at antenatal care did not substantially alter the odds ratios for most of the obstetric complications listed. However, after adjusting for these possible confounding variables, the odds ratio for schizophrenia in relation to signs of asphyxia at birth was increased to 4.5 .
Since several of the complications are associated with each other, the odds ratio for schizophrenia in relation to any one obstetric complication was also further adjusted separately for every other complication. The adjustments reported in Table 3 simultaneously take into account each of the remaining six complications listed. The odds ratio for schizophrenia in relation to any signs of asphyxia was 4.4 after adjusting for other complications. If the relationship with asphyxia was causal, the population-attributable fraction would be 7.7% . The strengths of associations between schizophrenia and all other complications were reduced and no longer statistically significant after these adjustments.
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The Onset Of Schizophrenia
Schizophrenia can be different for each individual. You might have a different mix of symptoms than another sufferer. And the way schizophrenia starts for you can differ.
For some people, it can start with a sudden, acute episode of psychosis.
But more frequently there is what is known as a ‘prodromal period’ before your first episode of acute psychosis.This means that for anywhere for a few days to about 18 months you exhibit negative changes to the way you function.
Prodromal symptoms can look like troubles concentrating and remembering things, struggling to communicate, losing interest in your hobbies and social life, and acting and thinking in ways that are unusual for you.
Looking After Your Own Brain
You can do your part by taking good care of your body and brain. This includes things like getting exercise, eating well, and avoiding things that are bad for the brain. Cannabis, crystal meth and other street drugs are particularly hard on the brain. For example, using cannabis on a regular basis can increase your risk of getting schizophrenia by 40%.
If you like, you can talk to a genetic counsellor, who can help figure out what illnesses you might be at more risk for, and what you can do to stay well.
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What Is Dissociative Identity Disorder
Dissociative identity disorder is a mental health condition. People with DID have two or more separate identities. These personalities control their behavior at different times. Each identity has its own personal history, traits, likes and dislikes. DID can lead to gaps in memory and hallucinations .
Dissociative identity disorder used to be called multiple personality disorder or split personality disorder.
DID is one of several dissociative disorders. These disorders affect a persons ability to connect with reality. Other dissociative disorders include:
- Depersonalized or derealization disorder, which causes a feeling of detachment from your actions.
- Dissociative amnesia, or problems remembering information about yourself.
Schizophrenia And Autism: Differential Diagnosis
Even now, experts sometimes have difficulty differentiating between these two disorders. Schizophrenia shouldnt be diagnosed separately from autism, unless delusions and hallucinations are prominent.The main problem with the differential diagnosis of these two disorders is that the negative symptoms of schizophrenia and the symptoms of autism mimic one another. So when someone with autism is being considered for a schizophrenia diagnosis, the psychotic features and some negative symptoms are the the most important ones to be considered. People can avoid speaking for various reasons including language difficulties, speech difficulties, anxiety, etc. If a person does not speak, it doesnt mean they are autistic nor that they even have autistic traits. In the last several decades, considerable evidence has suggested that autism and schizophrenia are unrelated. However, recent reports have suggested that individuals with autism may be at greater risk for schizophrenia and that the conditions may be more closely related than generally believed.
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Can One Be Born With Schizophrenia
I read about a new study that says the beginnings of schizophrenia and alzheimers might be present at birth.
I believe thats the only way to have it.
People can be influenced to insanity through brain injury ,environment, or introduction of some chemicals like drugs but schizophrenia is a chemical imbalance in the brain
Thats just my belief. I also believe that those that have it due to drugs or environment were naturally predisposed to it to begin with.I mean think of how many people that have done drugs that DONT have it.
There have been people that have had brain injury that have psychotic symptoms but I think that is because the injury disrupted the normal chemical pathways in the brain redirecting the flow.
This is just my opinion mind you I could be waaay off.But think about it if the introduction of chemicals through medicating effects the brain differently be it positive or negative then its the chemicals present befor medicating that were the cause of the disorder.
They say that if you have a difficult birth, you increase your risks of schizophrenia. I had a difficult labour, but in my opinion I think sz is just karma.
yeah Karma is too what I believe is the cause.
Scientists have said that SZ is due to Birth issues + Environmental issues
I personally feel both the factors are very important and if any one of them is missing then SZ dosent materialize.
In my case, Both my parents , nor my elder brother nor my entire extended family have SZ But I do have SZ.
Final Thoughts: Getting Past The Stigma
Stories abound of individuals who have schizophrenia attempting to hide their condition from others. Despite research and mental health outreach efforts, the ignorance surrounding mental health issues is prevalent. This has led to a shameful social stigma attached to conditions like schizophrenia, bipolar disorder, and others.
As global citizens, we must do better. When people who are suffering feel support and encouragement, they are far more likely to seek potentially life-changing treatment.
If you or someone you love is suffering from a serious mental health disorder, please reach out for support. The Substance Abuse and Mental Health Services Administration National Hotline can be reached at 1-800-662-HELP.
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Myth #: People With Schizophrenia Have Multiple Personalities
This is another myth that refuses to die. In fact, according to a 2008 study by the National Alliance on Mental Illness, 64% of people still believe schizophrenia means having multiple personalities. While people with multiple personalities do exist, most do not live with schizophrenia. The condition people are actually thinking about is called dissociative identity disorder .
Part of the reason why people believe schizophrenia is the same as dissociative identity disorder is because schizophrenia derives from a Greek word meaning split mind. The split mind aspect refers to how people with schizophrenia have minds that tend to isolate them from the rest of the world, as if they were split off. The phrase doesnt mean the mind itself is split.
Why Is My Brother Or Sister Acting This Way
Just like it is hard to see the back of your own head, it is hard for a person whose brain is not working to tell what is wrong. Your brother or sisters brain may make up incorrect explanations for why they feel so weird, and they may act strangely. It will be really hard for them to tell the difference between what is real and not real.
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Odds Ratios For Schizophrenia In Relation To Indicators Of Foetal Growth Impairment And Short Gestational Age
Those who were SGA , showed delay in gaining weight after birth or whose mothers had had pre-eclampsia all showed trends towards greater risk of schizophrenia, although this was not statistically significant . The odds ratio for schizophrenia in subjects whose birth weight was less than 2500 g was 1.8 . Adjusting for length of gestation barely affected the odds ratios in relation to birth weight, birth length, ponderal index and head circumference. The odds ratio for schizophrenia in those who had extremely short gestational age was 2.7 .
Table 1Odds ratios for schizophrenia in relation to indicators of foetal growth impairment and short gestational age
Other Causes Of Schizophrenia
Along with genetics, other potential causes of schizophrenia include:
- The environment. Being exposed to viruses or toxins, or experiencing malnutrition before birth, can increase the risk of schizophrenia.
- Brain chemistry. Issues with brain chemicals, such as the neurotransmitters dopamine and glutamate, may contribute to schizophrenia.
- Substance use. Teen and young adult use of mind-altering drugs may increase the risk of schizophrenia.
- Immune system activation. Schizophrenia can also be connected to autoimmune diseases or inflammation.
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When To See A Healthcare Provider
As schizophrenia usually develops gradually, it can be difficult to pinpoint when changes in behavior start or know whether they are something to worry about. Identifying that you are experiencing a pattern of concerning behaviors can be a sign you should consult with a professional.
Symptoms may intensify in the run-up to an acute episode of psychosis in schizophrenia. The warning signs include:
- A worrying drop in grades or job performance
- New difficulty thinking clearly or concentrating
- Suspiciousness of or uneasiness with others
- Withdrawing socially, spending a lot more time alone than usual
- Unusual, overly intense new ideas, strange feelings, or having no feelings at all
- Difficulty telling reality from fantasy
- Confused speech or trouble communicating
While these changes might not be concerning by themselves, if you or a loved one are experiencing a number of these symptoms, you should contact a mental health professional. It can be difficult for those with schizophrenia to want to get help, especially if they are experiencing symptoms such as paranoia.
If you or your loved one is thinking of or talking about harming themselves, contact someone who can help right away. You can call the toll-free, 24-hour National Suicide Prevention Lifeline at 800-237-8255.
If you require immediate emergency care, call 911 for emergency services or go to the nearest hospital emergency room.
What Are Complications Of Dissociative Identity Disorder
As with other mental health conditions, the prognosis for people with DID becomes much less optimistic if not appropriately treated. Individuals with a history of being sexually abused, including those who go on to develop dissociative identity disorder, are vulnerable to abusing alcohol or other substances as a negative way of coping with their victimization. People with DID are also at risk for attempting more than once. Violent behavior has a high level of association with dissociation as well. Other debilitating outcomes of DID, like that of other severe chronic mental illnesses, include inability to obtain and maintain employment, poor relationships with others, and therefore overall lower productivity and quality of life.
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Early Detection Of Psychotic Disorders
In clinical samples, the early detection of psychoses mainly follows an indicated preventive approach. Currently, a CHR state is alternatively defined by two complementary approaches : The ultra-high risk approach, developed to identify persons with high likelihood of transition to psychosis within the next 12 months, and the basic symptom approach, developed to detect beginning psychosis as early as possible.
The basic symptom criteria include cognitive disturbances and the cognitive-perceptive basic symptoms . Of these, the latter lacked sufficient meta-analytical evidence to be already recommended for clinical practice . Contrary to the trait character of schizotypy and SPD, basic symptoms decidedly have state character, as, by definition, they differ from what patients consider to be their normal mental self . Basic symptoms are conceptualized as the earliest primary psychopathological correlates of the neurophysiological disturbances of information processing underlying the development of attenuated and frank psychotic symptoms, which develop based on and partly in reaction to basic symptoms . Thus, independently of any thought content or perception, basic symptoms are disturbances in mental processes themselves, thereby clearly differing from more content-related positive features of schizotypy and SPD, and attenuated and brief limited psychotic symptoms .
Studies of personality dimensions, schizotypy, PDs, and SPD, in CHR samples indicate the following:
Can Substance Abuse Cause Schizophrenia
Yes, substances can trigger schizophrenia if you have a predisposition to having it. This seems particularly true with cannabis use, but it can be other mind-altering substances, too, like amphetamines and cocaine.
An overview of data from studies on psychosis and schizophrenia confirmed that cannabis use itself didn’t cause schizophrenia. But heavy use at a young age did indeed increase your chance of developing it, if you had a genetic liability and were exposed to the right set of stressors like childhood trauma.
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Strengths Of The Study
The study was large, and identified people with schizophrenia from a population-based register, hence it was relatively free from selection bias. The obstetric information was collected at birth and measured without recall bias in relation to casecontrol status. We were able to ensure that controls were resident in Stockholm at the time that the cases were identified, thus further reducing any possibility of selection bias. Finally, we were able to adjust for a number of confounding factors. By matching for hospital of birth, we could take account of any hospital variation in coding the complications. There is also a geographical variation in rates of birth complications and schizophrenia , so we also matched for parish of birth. Finally, we also adjusted for attendance at antenatal care, social class at birth and maternal psychotic illness, which are potential confounders.
Symptoms Of Dissociation In Ssds
Several studies examined symptoms of dissociation in schizophrenia spectrum patients through the Dissociative Experiences Scale , which is the most commonly used instrument for measuring dissociation. The questionnaire contains 28 items describing dissociative experiences. The respondent is asked to state how often they had each experience ranging from 0% to 100% of the time, resulting in mean scores ranging from 0 to 100. Mean scores for healthy controls ranged between 4.38 and 14.86, whereas mean scores of patients with a DD ranged between 24.9 for depersonalization disorder and 57.06 for multiple personality disorder .
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