Comparative Analysis of Schizophrenia and Dissociative Disorder

Written By: Zain Hirji

What is Schizophrenia and Dissociative Disorder?

Schizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. It is typically diagnosed in the late teen years to early thirties and tends to emerge earlier in males in their late adolescence to early twenties compared to females, occurring in their early twenties and thirties. Nonetheless, more subtle changes in cognition and social relationships may precede the diagnosis, often over years (Schizophrenia, n.d.). The estimated prevalence of schizophrenia in the U.S. ranges between 0.25% and 0.64%, and individuals with this disorder have an increased risk of premature mortality. In addition, the estimated average potential life lost for individuals with schizophrenia in the U.S. is 28.5 years, and this is likely due to co-occurring medical conditions such as heart disease, liver disease, and diabetes. Furthermore, an estimated 4.9% of people with schizophrenia die by suicide, a rate far greater than the general population, with the highest risk in the early stages of illness (Schizophrenia, n.d.). Researchers believe that schizophrenia is caused by genetic and environmental factors. It occurs in 10% of people who have a first-degree relative with the disorder, and those who have second-degree relatives with the disease are also more likely to acquire it. Moreover, the risk is highest for an identical twin of a person with schizophrenia, as this individual has approximately a 50 percent chance of developing the disorder. The environmental factors include exposure to viruses or malnutrition before birth, problems during birth, and drug use during the early stages of life (Psychology Today Staff, 2021).

Dissociative disorders are experienced by two percent of Americans and involve problems with memory, identity, emotion, perception, behaviour, and sense of self. People with dissociative disorders escape reality in ways that are involuntary and unhealthy, which cause problems with functioning in everyday life. There is a disconnection with reality in the sense that one is daydreaming or under highway hypnosis for what can be hours or days and even months or years (Drescher, 2022). Dissociative disorders are associated with traumatic events mostly occurring during childhood, and there are three types: dissociative identity disorder, dissociative amnesia, and depersonalization-derealization disorder. Dissociative identity disorder, previously referred to as multiple personality disorder, is characterized by the involuntary shift in identities where an individual's attitude and personal preferences change. Although these alternate states may appear very different, they are all manifestations of a single person (Dissociative Disorders, 2022). Ninety percent of individuals with dissociative identity disorder in the United States, Canada, and Europe have been victims of childhood abuse, and over seventy percent of outpatients have attempted suicide (Drescher, 2022). Dissociative amnesia involves not being able to recall information about oneself which is more severe than normal forgetfulness. The forgetting may be limited to specific aspects of life or may include much of one's life history and identity. Lastly, depersonalization-derealization disorder occurs when a person is aware of reality and that their experiences are unusual. They feel detached from their life and disconnected from their environment (Dissociative Disorders, 2022). This disorder occurs in early childhood, with less than 20 percent of people first experiencing symptoms after age 20 (Drescher, 2022).

Symptoms

There are several symptoms of schizophrenia, and researchers believe that life stressors may play a role in the start of these symptoms and their course. When the disease is active, it can be characterized by episodes in which a person cannot distinguish between real and unreal experiences. Furthermore, the incidence of severe psychotic symptoms often decreases as a person becomes older. However, not taking prescribed medications, using alcohol or drugs, and stressful situations tend to increase symptoms (Mayo Clinic Staff, 2020). The symptoms of schizophrenia fall into three major categories: positive, negative, and cognitive. Positive symptoms refer to the presence of psychotic behaviours not seen in healthy people. These include hallucinations, such as hearing voices or seeing things that do not exist, illusions which are false beliefs that persist despite being proven illogical, and movement disorders where one repeats certain movements or displays unusual movements. Negative symptoms are associated with disruptions to normal emotions and behaviours, which include the flat effect where one's face does not move or they talk in a monotonous voice, lack of pleasure in everyday life, reduced emotional expression, and social withdrawal. Lastly, cognitive symptoms are problems with thinking, memory, and attention, including trouble with working memory, difficulty with attention, and problems with executive functioning (Torres, 2020).

The symptoms of an individual with dissociative disorder depend on which type they have. Symptoms of dissociative identity disorder include the existence of two or more identities which each have their own behaviours, memories, and thinking, and these signs may be observed by others or oneself. Additionally, one may experience ongoing gaps in memory about everyday events, personal information, and past traumatic events. People with dissociative identity disorder may also feel that they have suddenly become observers of their own speech and actions, or their bodies feel different in alternate personalities. Moreover, this disorder may cause significant distress or problems in social, occupational, or other areas of functioning (Drescher, 2022). For dissociative amnesia, symptoms can be localized, selective, or generalized. Localized dissociative amnesia is when one cannot remember an event or period of time, selective is the inability to remember a specific aspect of an event, and generalized is the complete loss of identity and life history (Dissociative Disorders, 2022). Finally, depersonalization-derealization disorder involves ongoing or recurring experiences of one or both conditions. Depersonalization is when an individual feels detachment from their mind, self, or body as if they are watching the events happening to them. Meanwhile, derealization is the experience of detachment from ones surrounding where individuals may feel as if things in the world around them are not real (Dissociative Disorders, 2022).

Diagnosis

The diagnosis of schizophrenia involves ruling out other mental health disorders and determining that symptoms are not due to other causes. This illness often follows a progression, starting with a prodromal stage where an individual exhibits a decline in functioning and may display very mild forms of psychosis, such as odd beliefs or unusual perceptional experiences (Diagnosing Schizophrenia, n.d.). Firstly, a psychiatrist performs a physical exam to rule out problems that could be causing symptoms and then they conduct a thorough review of a person's medical, psychiatric, and family history. Following this, the doctor will perform a psychiatric evaluation observing appearance and demeanour by asking questions about thoughts, moods, delusions, hallucinations, substance use, and potential for violence or suicide. To receive a diagnosis of schizophrenia, a person must have experienced at least two symptoms most of the time for one month, with some level of disturbance being present for six months (Mayo Clinic Staff, 2020). Finally, the doctor will order additional tests, including MRI scans or blood tests. An MRI scan provides a good view of the brain's structure and can rule out schizophrenia by detecting abnormalities that may cause certain symptoms. Additionally, the blood test can help rule out conditions with schizophrenia-like symptoms like alcohol, drug abuse, and mixings of certain medications (Diagnosing Schizophrenia, n.d.).

Diagnosing dissociative disorders involves ruling out any medical conditions that could be causing similar symptoms. Initially, a doctor will perform a physical exam, ask in-depth questions about specific symptoms, and review personal and family history. The doctor will also administer different tests to eliminate the possibility of certain physical conditions. For example, head injuries, brain diseases, sleep deprivation, and intoxication can cause symptoms such as memory loss and a sense of unreality (Mayo Clinic Staff, 2022). Next, a psychiatrist will perform a psychiatric exam which involves asking questions about one’s thoughts, feelings, and behaviour as well as discussing symptoms. Furthermore, doctors will examine the use of substances or alcohol, which can also cause similar symptoms to dissociative disorders (Dissociative Disorders, 2022). To determine which type of dissociative disorder an individual has, mental health professionals will compare symptoms to criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 states that those with dissociative identity disorder display distinct identities, which may be described in some cultures as possession, and the symptoms cause significant stress or problems in relationships, work or other important areas of life. Moreover, the DSM-5 recognizes that those with dissociative amnesia may experience dissociative fugue, which is when someone purposefully travels or experiences confused wandering due to amnesia. Finally, according to the DSM-5, those with depersonalization-derealization disorder have symptoms which do not occur simultaneously with schizophrenia, panic disorder, or another dissociative disorder and are not explained by medical conditions such as temporal lobe epilepsy (Mayo Clinic Staff, 2022).

Treatments

Treatment for schizophrenia focuses on eliminating the symptoms of the disease, and with the right tools, most symptoms can be greatly improved, diminishing the likelihood of a recurrence. The first method is hospitalization, which may be necessary during the acute phase of the illness if an individual presents a danger to themselves or others and is unable to care for themselves. Another treatment method is using medications such as antipsychotics which are currently the best and most used treatment available as they affect the neurotransmitter dopamine, usually blocking some of the receptors in the brain (Psychology Today Staff, 2021). People with schizophrenia may be treated with either first or second-generation antipsychotics, but clinicians and patients generally prefer second-generation medications because they have a lower risk of serious side effects. First-generation antipsychotics such as haloperidol or chlorpromazine may have side effects such as dullness and movement disorders, whereas second-generation medications like olanzapine, quetiapine, risperidone, ziprasidone, and paliperidone are less likely to have this problem (Mayo Clinic Staff, 2020). In addition, cognitive behavioural therapy is effective as it helps people test the reality of individuals' thoughts and perceptions, including how to "not listen" to their voices and how to manage their symptoms overall. Last but certainly not least, individual psychotherapy involves regularly scheduled talks between the patient and a mental health professional. These sessions give the patient reliable information about what they are going through, sympathy, encouragement, and hope, all of which are essential for living with schizophrenia (Psychology Today Staff, 2021).

The treatment of dissociative disorders aims to gain control over symptoms, and with the appropriate methods, many people successfully improve their ability to function and live productive, fulfilling lives. The primary treatment for dissociative disorders is psychotherapy, which involves discussing your disorder and related issues with a mental health professional (Mayo Clinic Staff, 2022). The two common types of psychotherapy used are cognitive behavioural therapy and dialectical behaviour therapy. Cognitive behavioural therapy is a structured, goal-oriented approach that takes a closer look at one’s thoughts and emotions. This method can help individuals unlearn negative thoughts and behaviours and adopt healthier thinking patterns and habits. Meanwhile, dialectical behaviour therapy is specially adapted for people who experience emotions intensely and focuses on improving emotion regulation. The main goal is to achieve acceptance of who one is, the challenges one may experience, and the benefits of change (Dissociative Disorders, 2022). Furthermore, hypnosis is also used to treat dissociative disorders as it is a state of deep relaxation and focused concentration. When one is under hypnosis, the intense level of concentration and focus allows them to ignore ordinary distractions and be more open to suggestions about self-improvement (Drescher, 2022). Eye movement desensitization and reprocessing therapy is also an effective treatment method as it involves moving one’s eyes a specific way while processing traumatic memories. This process helps individuals heal from trauma or distressing life experiences. The last treatment method is medication, and although there are no medications which specifically treat dissociative disorders, antidepressants, anti-anxiety medications, or antipsychotic drugs can help control associated symptoms (Dissociative Disorders, 2022).

Comparison

Schizophrenia and dissociative disorders are serious mental health conditions and share several similarities and differences. Schizophrenia is a condition marked by disturbances in thoughts, feelings, and behaviours (Schizophrenia, n.d.). In contrast, dissociative disorders are characterized by problems with the continuity of memories, thoughts, identity, and actions that result in a disconnection from reality (Drescher, 2022). Furthermore, schizophrenia is genetically linked and is impacted by brain differences, environmental factors, and substance use. On the other hand, dissociative disorders develop in response to trauma and life stresses. Both clinical disorders are rare as schizophrenia affects only one percent of Americans, and dissociative disorders affect two percent. However, those with schizophrenia typically begin to experience symptoms in their late teens and 20s, depending on gender. Meanwhile, dissociative disorders have no relation to gender, and the different types have different average onsets, some of which can occur at any age (Morin, 2022). Suicide rates are also significant in both disorders, as schizophrenic individuals are 20 times more likely than the average person to commit suicide, and more than 70% of individuals with dissociative identity disorder have attempted suicide. In terms of symptoms, people with schizophrenia and dissociative disorders share similar experiences, including hearing voices, memory loss, and feeling disconnected from themselves and others. However, people with dissociative disorders are more likely to experience a detachment from reality, whereas those with schizophrenia are more likely to experience problems with cognitive functioning. Additionally, people with schizophrenia are more likely to experience other conditions, including post-traumatic stress disorder, obsessive-compulsive disorder, and major depressive disorder (Morin, 2022). Both conditions have no specific test to diagnose the disorder, and their diagnoses involves ruling out other conditions and explanations for symptoms. They both involve completing a physical exam, family history check, psychiatric evaluation, diagnostic testing, and identifying criteria on the DSM-5. Finally, neither schizophrenia nor dissociative disorders can be cured, but they can be managed in a variety of ways. They can both be treated using medication, cognitive behavioural therapy, and support from external entities. Nonetheless, schizophrenia is primarily treated with antipsychotic medication, while dissociative disorders are treated primarily with psychotherapy.  

Works Cited

Schizophrenia. (n.d.). National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/schizophrenia

Torres, F. (2020, August). What is Schizophrenia? American Psychiatric Association. https://www.psychiatry.org/patients-families/schizophrenia/what-is-schizophrenia#section_1

Psychology Today Staff. (2021, September 21). Schizophrenia. Psychology Today. https://www.psychologytoday.com/ca/conditions/schizophrenia

Diagnosing Schizophrenia. (n.d.). NYU Langone Health. https://nyulangone.org/conditions/schizophrenia/diagnosis

Mayo Clinic Staff. (2020, January 7). Schizophrenia. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/schizophrenia/diagnosis-treatment/drc-20354449

Drescher, J. (2022, October). What Are Dissociative Disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders

Mayo Clinic Staff. (2022, December 13). Dissociative disorders. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/diagnosis-treatment/drc-20355221

Dissociative Disorders. (2022, October 24). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/17749-dissociative-disorders

Morin, A. (2022, April 8). Dissociative Disorders vs. Schizophrenia: What Are the Differences? Very well mind. https://www.verywellmind.com/dissociative-disorder-vs-schizophrenia-4160180