DID Vs. Schizophrenia: What Is The Difference Between These Disorders?

Despite significant differences in their causes and presentations, dissociative identity disorder (DID) and schizophrenia may be confused with one another due to some overlapping symptoms involving changes in mood and behavior. It can be important to note that only licensed professionals can offer official diagnoses. However, recognizing the differences between DID and schizophrenia may help you advocate for yourself by arming you with the knowledge necessary to accurately discuss your symptoms and experiences with professionals. While treatment for these disorders often differs, it usually involves regular therapy sessions, which can take place online or in your local area.

Could you be living with schizophrenia or DID?

Discuss your symptoms with a therapist

What is dissociative identity disorder?

Individuals living with DID or dissociative identity disorder may have multiple identities or personality states (hence this disorder’s previous name, “multiple personality disorder”). These identities, often referred to as “alters,” can have distinct ways of thinking and acting, with memories that are often separate from other personality states. 

Specific identities may have different manners of speaking, attitudes, lifestyle preferences, and perceptions of their body or overall appearance. Some individuals may have as few as two alters, while others may have dozens or even hundreds. 

Aside from the presence of multiple personalities, an individual living with DID may experience symptoms like the following: 

• Feelings of anxiety or depression
• Delusions
• Memory loss
• Disorientation
• Mood swings
• Difficulty sleeping
• Co-occurring disorders, such as post-traumatic stress disorder (PTSD) or obsessive-compulsive disorder (OCD)

DID is generally considered a dissociative disorder. Other dissociative disorders can include dissociative amnesia, which typically involves an inability to recall information about oneself, and depersonalization/derealization disorder, which often manifests as feelings of detachment from oneself or one's surroundings. A doctor may need to rule out these disorders, as well as schizophrenia, before a diagnosis of DID can be provided. 

What is schizophrenia?

Individuals living with schizophrenia may experience changes in their thought patterns, perceptions, and behaviors. In many cases, schizophrenia may make it difficult for an individual to distinguish between reality and the symptoms of their disorder, which may include those discussed below.

Negative symptoms: The negative symptoms of schizophrenia may affect the level of motivation or interest an individual experiences in their daily life. These symptoms can make it difficult to participate in social functions or essential activities, such as buying groceries, completing projects at work, or attending school. Negative symptoms may also include low energy, difficulty showing emotion, and limited facial expressions, which may further complicate social interactions. 

Positive symptoms: Sometimes referred to as psychotic symptoms, positive symptoms usually have a direct impact on the thoughts, behaviors, and experiences of an individual living with schizophrenia. These symptoms typically include hallucinations, delusions, disordered thoughts, and changes in movement.

• Hallucinations can create false sensory experiences that may affect sight, hearing, taste, smell, or touch. A common manifestation of this symptom can involve hearing voices of individuals or entities that are not actually there. 
• Delusions may cause a person to believe in situations that may not be logical, rational, or true. For example, a person experiencing delusions may see someone walking behind them and believe they are a government agent tracking them.
• Disordered thoughts can make it difficult for an individual to stick to a specific topic or clearly communicate what they are thinking. This symptom may also cause a person to stop talking before finishing their sentence or use words that don’t exist or don’t make sense to others. 
• Changes in movement can include repetitive or involuntary motions, often in the limbs or facial muscles. 

Cognitive symptoms: Cognitive schizophrenia symptoms can affect a person’s attention span, memory, and ability to concentrate. These symptoms may negatively impact decision-making, create information processing difficulties, and make it difficult to function in certain settings, such as work or school. Cognitive symptoms may also interfere with treatment, as it could be difficult to remember appointments or use the information learned during treatment sessions.

What is the difference between DID and schizophrenia?

While DID and schizophrenia can be similar in some ways—and it may be possible to experience both simultaneously—they are usually seen as distinct and separate mental health disorders. Those who confuse the two may do so due to certain symptomatic similarities. These shared symptoms may include changes in behavior, thought patterns, and emotions.

However, schizophrenia does not typically involve the presentation of multiple personalities, which tends to be a hallmark symptom of DID, and those with DID usually don’t experience psychosis. In addition, individuals with DID may experience symptoms as early as five to 10 years of age, although updated evidence may be needed. 

In contrast, those with schizophrenia typically experience initial symptoms between their late teens and early 30s, with men typically displaying signs of the disorder during their late teens to early 20s and women usually showing signs between their 20s and early 30s. 

Another differentiating factor between these disorders may be their cause. While the precise causes of schizophrenia aren’t yet known, research suggests that certain factors may increase the likelihood that an individual will develop schizophrenia:

• Substance misuse: Certain substances, such as LSD, amphetamines, cocaine, and cannabis, may increase the risk of developing schizophrenia or experiencing a relapse after a period without an episode. However, research hasn’t concluded whether the use of these substances causes symptoms, or if individuals with schizophrenia are simply more likely to engage in substance use. 
• Genetics: Individuals with a family history of schizophrenia may be more likely to develop the disorder, though a single gene may not be responsible. However, having a close relative with schizophrenia does not necessarily guarantee that an individual will develop the disorder. In addition, changes in the genetic material of chromosomes (specifically duplications or deletions) may be linked to an increased risk of schizophrenia. 
• Complications during pregnancy or birth: Individuals who experienced complications before or during their birth may be more likely to develop schizophrenia. These complications can vary but may include premature labor, a lack of oxygen during birth, or a low birth weight. 

On the other hand, DID may be primarily caused by trauma during key developmental stages of childhood, which is frequently referred to as “developmental traumatization.” 

One article reviewed scientific research on the etiology of DID, linking it to traumatic experiences in childhood, certain family dynamics, and specific attachment styles. Research suggests that a child may develop DID when exposed to a chaotic or coercive environment that may include physical and/or sexual abuse. These children are often neglected or have a disorganized attachment to their caregivers. The development of multiple self-states may be a way for a child to compartmentalize the thoughts and feelings related to the trauma they’ve experienced. 

In addition, researchers believe secondary sources of DID may be related to cognitive functioning and neurobiological anomalies that may emerge in tandem with the primary factor of developmental traumatization. 

If you or a loved one is witnessing or experiencing any form of abuse, please know that help is available. You can call the National Domestic Violence Hotline anytime at 1-800-799-SAFE (7233).

How are DID and schizophrenia treated? 

While some treatments may be effective for both DID and schizophrenia, each disorder typically requires a unique treatment plan. One form of treatment can involve the use of medications prescribed by a doctor or psychiatrist. Depending on the disorder being treated, these medications may include antipsychotics, antidepressants, or anti-anxiety medicines. However, while antipsychotic medication may be recommended for those with schizophrenia, there may be no medications specifically designed to treat DID. 

Please note that the information in this article does not constitute medical advice. Always talk to your doctor before starting, stopping, or changing the way you take any form of medication.

Psychosocial interventions, such as therapy, may be used as a treatment for both schizophrenia and DID. According to the National Institute of Health (NIH), recent approaches to the treatment of DID include dialectical behavioral therapy (DBT) and trauma-focused cognitive behavioral therapy (CBT). 

The NIH states that DBT, which was originally developed to treat borderline personality disorder (BPD), can be used due to the overlapping symptoms that may present in both BPD and DID. Other therapeutic approaches, such as eye movement desensitization and reprocessing therapy (EMDR), may also be effective. 

Schizophrenia, on the other hand, may respond to psychosocial interventions that include cognitive behavioral therapy, cognitive remediation therapy, family intervention, psychoeducation, social skills training, and assertive community treatment. While newer research may be necessary, according to one study, these approaches resulted in short- to medium-term control or reduction of symptoms, improved levels of functioning, and satisfactory relapse rate levels.  

Could you be living with schizophrenia or DID?

Discuss your symptoms with a therapist

While therapeutic approaches may be helpful for individuals experiencing these disorders, in-person therapy may not be available to everyone. For example, some areas may lack a sufficient number of mental healthcare providers. These regions are often called Health Professional Shortage Areas (HSPAs). For those who live in an HSPA, it may be necessary to travel a significant distance to find a provider or specialist. In these situations, or for individuals who want a more convenient option, it may be beneficial to try alternatives like online therapy.

Research suggests that video-delivered psychotherapy (VDP) and in-person psychotherapy (IPP) may be equally effective. One meta-analysis found that significant and substantial improvement usually occurred between the pre- and post-phases of video-delivered psychotherapy, concluding that videoconferencing therapy seemed to be no less effective than its in-person counterpart. While many individuals with DID and schizophrenia may benefit from online therapy, please note that individuals experiencing acute psychosis may need to seek care in person.

Takeaway

While DID and schizophrenia may share several symptoms, such as emotional and behavioral changes, they are normally seen as distinct and separate mental health disorders. DID typically presents with multiple personalities, each of which may have its own thought patterns, behaviors, and preferences, while schizophrenia usually involves hallucinations and delusions, along with negative symptoms like lack of motivation and social withdrawal. The causes and ages of symptom manifestation tend to differ between schizophrenia and DID as well. The treatments for these disorders can vary but may include the use of certain medications and psychotherapeutic approaches. Cognitive behavioral therapy may be helpful for both disorders and can usually be completed in person or online.