Once A Person Is Being Treated For A Dissociative Disorder How Can Family Members Best Support And Help Him/her
Be open and accepting in your responses. Do not take sides with one or another component of their identity. Rather view them as portions of the person as a whole. We are all different in different situations, but we see this as different sides of ourselves. Try to maintain that perspective with the person with dissociative disorder. Also, help them to protect themselves from any trauma, abuse, or self harm.
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Dissociative Model In Patients With Resistant Schizophrenia
- Psychiatric Clinic, University Hospital for Active Treatment Prof. D-R Stoian Kirkovic, Trakia University, Stara Zagora, Bulgaria
Background: Schizophrenia is a severe mental illness in which, despite the growing number of antipsychotics from 30 to 50% of patients remain resistant to treatment. Many resistance factors have been identified. Dissociation as a clinical phenomenon is associated with a loss of integrity between memories and perceptions of reality. Dissociative symptoms have also been found in patients with schizophrenia of varying severity. The established dispersion of the degree of dissociation in patients with schizophrenia gave us reason to look for the connection between the degree of dissociation and resistance to therapy.
Methods: The type of study is correlation analysis. 106 patients with schizophrenia were evaluated. Of these, 45 with resistant schizophrenia and 60 with clinical remission. The Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scales were used to assess clinical symptoms. The assessment of dissociative symptoms was made with the scale for dissociative experiences . Statistical methods were used to analyze the differences in results between the two groups of patients.
The level of dissociation measured in patients with resistant schizophrenia is as high as the points on the DES in dissociative personality disorder.
Multiple Personality Disorder And Other Dissociative Disorders
Multiple personality disorder is a psychiatric disorder characterized by the spontaneous generation of an alternate version of self. The personalities have distinctive styles of expressing themselves and they often posses separate names, genders, ages, family histories, and lifestyles. They may have different occupations, sets of friends, and social networks. Sometimes, the physiologic differences between the various MPD personalities can be really surprising: differences in IQ, handiness, handwriting style, visual acuity, and other features have been reported in the literature. Although personalities can be complementary to one other, very often one can distinguish an original personality from another personality that acts like a persecutor.
MPD is likely to occur as an attempt to integrate the consequences of traumatic experiences in individuals with high suggestibility. The exposure to a severe and emotionally overwhelming physical or mental trauma could somehow provoke dissociative disorders, as if the individual is unable to cope with the trauma of maintaining unit his own personality.
MPD is a controversial subject. Some scholars insist that it usually goes undetected others have criticized the conception of childhood trauma. Actually, an explicit trauma may or may not be present. Trauma may also occur only in the internal, emotional world of the subject, without any detectable recognizable events is. This debate directly concerns the foundation of psychoanalysis.
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Why Schizophrenics Have No Friends
Since people with schizophrenia tend to have trouble learning new things, and change very little as a result, we tend to have trouble making new friends. People with schizophrenia can come alive talking about things in the past before they became ill. It’s as if their life grinded to halt when they became sick.
Is It Bad To Be Very Dissociated
Dissociation may persist because it is a way of not having negative feelings at the moment, but it is never a cure. Too much dissociation can slow down or prevent recovery from the impact of trauma or PTSD. Dissociation can become a problem in itself. Exclusion interferes with good school performance.
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Dissociative Identity Disorder Is Not Schizophrenia
One of the most persistent myths about dissociative identity disorder is that people with it are schizophrenic. Schizophrenia and DID are generally considered synonymous with each other when, in fact, they’re two entirely different disorders. There’s no relationship between dissociative identity disorder and schizophrenia at all. People more educated than I could write entire books about the differences between these two chronically misunderstood disorders. I focus on what I see as the dead giveaway: the issue of identity.
People don’t talk about mental illness. Schizophrenia is the most hidden of all, and there’s lots of misinformation out there. Even some doctors, social workers, and therapists are ill-informed. A psychology professor once asked my sister how many personalities I had. – People Say I’m Crazy, John Cadigan
How Does The Change Of Identity Translate
In DID, people express different identities and move from one to the other without realizing it. They can alternately be a child or an adult, a man or a woman. Identity should not be confused with personality, which corresponds to a way of functioning, explains Prof. Llorca.
At each change of identity , the patients voice and behavior change: not to be confused with the auditory hallucinations present in some schizophrenic patients. These disorders are accompanied by disturbances of memory, the patient having more or less marked memories of what he says or does under another identity.
Unlike schizophrenia, DID is extremely rare. In thirty years of psychiatry, I have never seen one, testifies Professor Llorca. At present, this notion of dissociation of identity is still controversial, no doubt because it is insufficiently studied. Without a precise description, the diagnosis remains difficult to establish.
In Positive Minders published in 2021, Olivier Piedfort-Marin, a Swiss psychologist, looked at the available scientific literature. He estimates that Between a quarter and a half of DID subjects have previously been diagnosed with schizophrenia, which appears to be the most common misdiagnosis in patients with DID. » In fact, some symptoms are similar, but the origin of each of the two diseases is completely different.
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Symptoms Of Schizophrenia In Dds
There has been relatively little research on symptoms of schizophrenia in DDs compared to the research done on dissociation in SSDs. Furthermore, interpreting the results can be complicated as some authors argue there is a difference between, eg, true hallucinations and pseudo-hallucinations,103 while others argue there is no clear distinction between these 2 concepts.104 No studies were found that explicitly compared symptoms of patients with healthy controls. A substantial number of studies focused on Schneiders first-rank symptoms of schizophrenia in DDs. Schneider105 described the following 11 symptoms as characteristic of schizophrenia: auditory hallucinations somatic passivity thought withdrawal, insertion, and broadcasting delusional perception and delusions of control . In the past Schneiders first-rank symptoms were considered pathognomonic for schizophrenia.2,12,106 Some of these symptoms were still considered to be pathognomonic in the DSM-IV. However, this has been changed in the DSM-5.
DID patients have on average more positive symptoms than schizophrenia patients, as assessed with the PANSS.114 Between 16% and 20% of the patients with a DD experience visual hallucinations and more than 70% experience auditory hallucinations.115,116 In addition, DD patients showed elevated scores on the schizophrenia scale of the Minnesota Multiphasic Personality Inventory.117
Whats The Treatment Plan For Dissociative Identity Disorder
There are currently no formal, evidence-based guildelines to treat DID. Many treatments are based on case reports or are even controversial.
While theres also no cure for dissociative identity disorder, long-term treatment can be helpful, if the patient stays committed. Effective treatment includes:
- Psychotherapy: Also called talk therapy, the therapy is designed to work through whatever triggered and triggers the DID. The goal is to help fuse? the separate personality traits into one consolidated personality that can control the triggers. This therapy often includes involving family members in the therapy.
- Hypnotherapy. Used in conjunction with psychotherapy, clinical hypnosis can be used to help access repressed memories, control some of the problematic behaviors which accompany DID as well as help integrate the personalities into one.
- Adjunctive therapy. Therapies such as art or movement therapy have been shown to help people connect with parts of their mind that they have shut off to cope with trauma.
There are no established treatments for dissociative identity disorder, making psychologically-based approaches the mainstay of therapy. Treatment of co-occurring disorders, such as or substance use disorders, is fundamental to overall improvement. Because the symptoms of dissociative disorders often occur with other disorders, such as anxiety and , medicines to treat those co-occurring problems, if present, are sometimes used in addition to psychotherapy.
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Differences Between Schizophrenia Vs Multiple Personality Disorder
Now that we know a little more about each of these mental illnesses, lets explore the main differences between the two.
MPD often comes about as a result of trauma, an external and environmental cause. For example, severe childhood trauma or other traumas, like sexual assault or combat. It can be developed at a young age.
Schizophrenia, however, is a highly genetic condition that develops later in life with a more biological component, such as altered brain chemistry that can lead an inability to function normally. Symptoms generally dont present until later in a persons life, around 20s and 30s.
MPD presents with multiple personalities or alters, meaning a person may feel that theyre switching into different kinds of people.
Schizophrenia presents with hallucinations, and while a person who has schizophrenia may struggle to determine what is real and what is not, their core personality remains intact and they do not switch into different personalities.
Benign Schizotypy And Happy Schizotypes
Thus, in contrast to the disorder-based view of schizotypy, the temperament-based models allow for the existence of benign aspects inherent to unidimensional schizotypy that, only in excess, may become pathological. This is especially true for positive schizotypy, expressing, e.g., as spiritual experiences, feelings of interconnectedness with others and/or the environment, and personal enlightenment.
The supposition that positive schizotypy and disease proneness constitute different dimensions has been argued for by Claridge and colleagues who regard the difference between mentally healthyor even happy schizotypes and schizophrenia-spectrum patients not as one of quantity or severity of psychosis proneness but as one of quality of phenomena . These qualitative differences are due to influences of other dimensions that are linked to negative and disorganized schizotypy . Being distinct from continuously distributed schizotypy, schizophrenia is, thus, regarded as a breakdown process and endpoint on a second graded continuum that starts from SPD, making it taxon-like clusters of several dimensions .
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How Does Obsessive Compulsive Personality Disorder Develop
OCPD may be caused by a combination of genetics and childhood experiences. In some case studies, adults can recall experiencing OCPD from a very early age. They may have felt that they needed to be a perfect or perfectly obedient child. This need to follow the rules then carries over into adulthood.
What Are The Signs And Symptoms Of Did
A person with DID has two or more distinct identities. The core identity is the persons usual personality. Alters are the persons alternate personalities. Some people with DID have up to 100 alters.
Alters tend to be very different from one another. The identities might have different genders, ethnicities, interests and ways of interacting with their environments.
Other common signs and symptoms of DID can include:
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Myth: Violence Is Common Among Individuals With Schizophrenia
Reality: Its actually rare for someone with schizophrenia to be violent, says Dr. Rego. An individual with schizophrenia is much more likely to be the victim of violence rather than the perpetrator, he says. They tend to struggle more to have the social benefits that most of us have, Dr. Rego explains. They may be homeless or staying in a shelter, where they may be singled out and assaulted.
Some individuals with psychiatric disorders like schizophrenia do become aggressive, says Scott Ira Krakower, DO, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, New York. However, it is a myth that this is always the case, he says. A person can be aggressive and have an anger problem and not have schizophrenia, he explains. Both medication and counseling can help with any signs of violent behavior, he says.
What Are The Symptoms Of Schizophrenia
Schizophrenia involves a wide range of behavioral, emotional, and cognitive problems. The signs and symptoms of the condition vary from person to person. However, the most commonly observed symptoms include
Delusions are false beliefs that are way different from reality. For example, if youre a schizophrenic you may feel that youre harassed or harmed. There are certain comments and gestures that are directed to you. You have worldwide fame or somebody is in love with you, etc. And there would be nothing like this in the reality. Moving forward hallucinations involve hearing or seeing stuff that doesnt exist at all. However, for the schizophrenics, these false talks and sights have a full force or impact on their mind. Hallucinations might occur in other senses as well but hearing voices is the most common one.
Disorganization of thoughts and speech impairs your effective communication. You may not be able to answer questions properly and utter meaningless words. The disease also impairs your functioning and motor behavior. Your behavior may include
- Resistance to instructions
Other negative symptoms of the disease are
The person may give up on personal hygiene as well. Lack of motivation may alleviate their will to take care of themselves. In addition, they may also be involved in substance abuse like alcohol and drugs, etc.
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Etiology And Risk Factors
Dissociative identity disorder is usually caused by excessive stress or trauma during childhood. In normal development, the sense of a unified identity develops from a variety of experiences and sources. In a child who is overwhelmed, many factors that should have blended together or become integrated over time instead remain separate. Chronic, severe emotional, physical, or sexual abuse and neglect often lead to the development of dissociative identity disorder. In fact, about 90% of patients with the disorder have experienced some type of early trauma. Other contributing factors include important early losses, including death of a parent, as well as serious medical illnesses or other overwhelming stressors. Children who are severely mistreated may develop in distinct phases that include different emotions, memories, and perceptions, which develop separately and therefore are especially vulnerable to not being naturally integrated into a singular developing self or personality. Over years, they may develop a way to escape mistreatment by detaching themselves or disappearing into their own minds. Each phase of development or traumatic event may cause a different identity to be created. Standardized testing of patients with dissociative identity disorder reveals high scores for being susceptible to hypnosis, and for dissociation.
J.R. Maldonado, in, 2007
Multiple Identities Delusions Or Hallucinations
Some people confuse the multiple identities of DID for the delusions or hallucinations of schizophrenia, but they arent the same.
To break down the difference between these symptoms, lets define them:
- Delusions. False beliefs that are not based in reality. If you have delusions, you believe them despite evidence to the contrary, even if everyone else believes otherwise. There are many types of delusions, including grandiose, bizarre, persecutory, and somatic .
- Hallucinations. False perceptions when someone sees, hears, or feels something thats not actually happening. These sensory experiences feel real, but theyre not.
- Multiple identities. Also called alternate identities or alters, these occur when someone has more than one personality state. This alternate personality may appear to function separately from another. Alternate identities may have distinct behaviors, memories, expressions, languages, ages, and more. For instance, an alter of a 30-year-old female could be a 12-year-old male.
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How Is Did Different From Schizophrenia
There are a lot of misconceptions surrounding both DID and schizophrenia. Many people inaccurately believe that people with schizophrenia have split personalities. This isnt the case.
This isnt even technically true of DID. The Sidran Institute says that, although these personalities may feel or appear different, Theyre all manifestations of a single, whole person.
While some symptoms do overlap between DID and schizophrenia, they are different in important ways, including their causes, treatments, and age of onset.
Types Of Dissociative Disorders Associated With Sleep
There are five diagnostic categories of DDs in DSM-IV47 including dissociative identity disorder , dissociative fugue, dissociative amnesia, depersonalization disorder, and dissociative disorder not otherwise specified . Of these, three are considered SRDD: dissociative identity disorder, dissociative fugue, and DD NOS. Most but not all patients with SRDD have both daytime DD episodes as well as previous episodes of SRDD.1,48
Dissociative Identity Disorder
In dissociative identity disorder, a person displays multiple identities and personalities each with its own pattern of perceiving and integrating with the environment. A minimum of two personalities is required.
Dissociative Fugue State
The dissociative fugue state is characterized by reversible amnesia for personal identity and memories usually lasting hours to days. A dissociative fugue state usually involves unplanned travel or wandering and is sometimes associated with establishment of a new identity. After the episode, prior memories return but there is amnesia for the fugue episode.
Dissociative Disorder Not Otherwise Specified
The classification DD NOS is used for a DD that does not fit the criteria for a specific DD.
Epidemiology
Diagnosis of SRDD
The ICSD-2 diagnostic criteria are listed in Box 2817 and important facts are displayed in Box 2818.
Treatment of SRDDs
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