Do schizophrenics have multiple personalities

Split personality. Violent behavior. Never being able to hold onto a job or have a career. Myths abound about schizophrenia, a serious and complex mental disorder currently affecting about 0.3% of American adults.1

Patients diagnosed with schizophrenia do not present with a split personality, nor is it common for someone with the disorder to be violent, says Simon Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City. And many individuals with schizophrenia are able to work.

Here, experts dispel some of the more common myths about schizophrenia.

#1 Myth: Schizophrenia means you have a split personality.

Reality: “This is a classic myth,” Dr. Rego says. A split personality, also called a Dissociative Identity Disorder or a Multiple Personality Disorder, is extraordinarily rare, he explains. It is quite distinct from schizophrenia, he says. “Schizophrenia is a thought disorder,” he explains, “The myth likely stems from the fact that in schizophrenia there is a breakdown, or split, between thoughts, emotions, and behavior.”

This split results in the person confusing reality and fantasy, Dr. Rego explains. “The person may experience delusions and hallucinations, and emotions may become blunted or inappropriate,” he explains. When most people think of schizophrenia, they think of someone who is seeing things and hearing voices, Dr. Rego points out. “These are what are called positive symptoms, but people with schizophrenia have negative symptoms, too,” he says. Among the common negative symptoms are low motivation, difficulty forming social connections, and a flat, blunted affect, Dr. Rego says. A lack of pleasure in everyday activities, rarely speaking, and difficulty paying attention are also symptoms, according to the American Psychological Association.

#2 Myth: Violence is common among individuals with schizophrenia.

Reality: It’s 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.

#3 Myth: People with schizophrenia can’t ever hold down a job.

Reality: Actually, some individuals, when stable, are able to function quite well, Dr. Rego says. “When they are being compliant with their medication and are engaged in some sort of psychosocial treatment, they are often quite functional,” he says. The National Alliance on Mental Illness estimates that as many as half of the two million Americans with schizophrenia can improve significantly or even recover completely if they get treatment. Dr. Rego refers to the “recovery model” of treatment for schizophrenia, and an article in the Current Opinion in Psychiatry.2

A substantial proportion of people with the illness will recover completely and many more will regain good social functioning, according to this article. “Working appears to help people recover from schizophrenia, and recent advances in vocational rehabilitation have been shown to be effective in countries with differing economies and labor markets. A growing body of research supports the concept that empowerment is an important component of the recovery process,” the authors write.3

About a quarter of young people with the disorder when treated within six months to two years, reports the American Psychological Association, and another 35 to 40% are improved enough after longer-term treatment to live fairly normal lives with only minor symptoms. What makes this possible is psychosocial support—psychotherapy, family education, and self-help groups that can help people with schizophrenia cope and regain their lives. Social skills counseling, job training, and vocational counseling also can be useful.4
Still, cautions Dr. Krakower, some patients have difficulty holding down a job. “And it’s okay for them to get additional treatment,” he says. “Sometimes they may need to be on disability, and that’s okay, too.”

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#4 Myth: A person with schizophrenia can seem perfectly normal one moment and change into a different person the next.

Reality: A sudden dramatic change of character in individuals with schizophrenia is not the usual scenario, Dr. Rego says. In fact, it’s common for the signs and symptoms of this mental disorder to surface over time. “There are often soft signs that the illness is going to take root,” Dr. Rego says. In the typical progression of the illness, a person may first become flat, isolate more frequently, and decrease their participation in activities. Then a psychotic break could occur—from a stressor such as starting college, Dr. Rego says. “So it is more of a slow progression, with a waxing and waning course that occurs over months and years,” he explains.

#5. Myth: People with schizophrenia usually require long-term hospitalization.

Reality: Appropriate treatment today may include a combination of out-patient care, acute hospitalization, and longer-term hospitalization when needed, Dr. Krakower says. And, even when family support and financial resources are available, many patients still need inpatient treatment, he adds.

“But the treatment model for schizophrenia is moving away from longer-term hospitalization and toward outpatient treatment,” he says. “At times, individuals may benefit from going to a day program or a partial day hospital, where they can receive daily treatment. Therapy may vary from individual to group therapy and the medication of choice is usually second-generation antipsychotic agents (i.e. aripiprazole, clozapine, and risperidone).”

In a longer-care setting, the time can vary from weeks to months and depends on how the patient is progressing, Dr. Krakower says.

Long-term hospitalization may also be an indication that the person isn’t getting enough support. “In some cases, society has failed them,” says Stephen Ferrando, MD, Director of Psychiatry at Westchester Medical Center Health Network (WMCHealth). “We are not providing enough services for them to succeed.”

#6. Myth: Bad parenting is what causes schizophrenia.

Years ago, it was believed that the mother or both parents were responsible if the child developed schizophrenia, Dr. Rego explains. While there is a genetic susceptibility—the disorder tends to run in families—there is absolutely no evidence that it is caused by how a person is parented, he says.

“Plus, even if your parent has schizophrenia your chances of getting it are less than 25%,” Dr. Ferrando explains.

So what does cause it? Rather than a single gene for schizophrenia, it’s likely that various genes, as well as environmental factors, are responsible, according to the American Psychological Association. 5

Environmental factors that may trigger the onset of schizophrenia can range from extreme academic stress to substance abuse. Dr. Ferrando says. “We know that extreme environmental stress like these situations can trigger the onset of schizophrenia,” he says.

If you or a loved one has been diagnosed with schizophrenia, it may feel scary. However, understanding the reality of the disorder not only helps to erase the stigma surrounding the condition but also frees you up to focus on an effective treatment plan.

Article Sources Last Updated: Mar 19, 2018

Debunking 4 Myths About Schizophrenia

Schizophrenia is perhaps the most misunderstood of all mental illnesses, mostly due to the sheer amount of misinformation out there. Some of this is due to movies and TV, while some can be attributed to stereotypes about mental illness. There are several cultural and demographic myths regarding schizophrenia — these are the four most common.

Myth #1: People with Schizophrenia All Have the Same Symptoms

There are many different types of schizophrenia, and they can all affect a person in different ways. Symptoms of paranoid schizophrenia, such as delusions that someone is out to get the sufferer, are different from catatonic schizophrenia symptoms, which include a lack of emotion and decreased motivation.

Mental illnesses affect people differently. It is possible to encounter two sufferers with the same type of schizophrenia who behave differently. Schizophrenia isn’t all about being paranoid and hearing voices.

Myth #2: Women are More Likely to Have Schizophrenia than Men

Although some people believe women are more likely to be diagnosed with schizophrenia and other mental illnesses than men, studies show that the rate of schizophrenia is two to three times higher in men than women. This could be because women are more likely to seek out treatment for their mental health than men, but also because there are genetic components of the disorder as well.

This myth has some unfortunate implications and side effects. Schizophrenia is a serious illness that requires treatment and medication. Men and women who do not receive this treatment are more likely to become a danger to themselves and others. There is still a serious stigma in our culture against men who seek help for their mental health issues. This barrier can lead to severe consequences when men do not receive the treatment and therapy they need.

Myth #3: 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 (previously multiple personality 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 doesn’t mean the mind itself is split.

Myth #4: People with Schizophrenia are Dangerous

Thanks in part to movies, TV, and other forms of pop culture that portray all people with mental illness as unpredictable criminals and killers, this is one of the most common myths about schizophrenia. The vast majority of those who live with the illness aren’t violent at all. According to studies of people with schizophrenia who have committed violent crimes, only 23% of those offenses were directly related to their symptoms.

The Reality

With proper treatment and medication, it is possible to live a full life with schizophrenia. Many famous people such as football star and sports analyst Lionel Aldridge, former Fleetwood Mac guitarist Peter Green, and mathematician John Nash have all lived with schizophrenia. Life was often difficult for them, yet they learned to thrive.

There is hope for those who live with this frightening yet misunderstood condition. By combatting the stigma of the illness, we can help them be at peace and free of judgment.

Bio: Mike Jones is a health and fitness writer. He hopes people will stop stigmatizing others dealing with a mental illness and start fighting against common schizophrenia misconceptions. More of his work can be found on Twitter.

Schizophrenia | Symptoms & Causes

Schizophrenia is a major psychiatric illness that—while it is more common in adults—also affects children and adolescents. The disease is called “early-onset” schizophrenia when it occurs before the age of 18.

Schizophrenia can cause:

  • visual hallucinations of people and objects that are not actually there
  • auditory hallucinations of voices, music or other sounds that are not real
  • delusions of threats that have no basis in reality
  • severe difficulty making friends and maintaining relationships
  • impaired speech and other communication skills
  • inappropriate and damaging behavior

Though we are still learning the specifics of how schizophrenia affects the brain, it is believed that the disease may be linked to:

  • a below-normal amount of gray matter—cell material that transmits sensory and movement messages throughout the central nervous system–in the brain’s temporal lobe (the part of the brain’s cerebral cortex that is responsible for hearing) and frontal lobe (the front portion of the brain’s cerebral hemisphere, responsible for processing emotions, retaining memories, making decisions and measuring social responses)

  • related loss of gray matter in the parietal lobe (part of the brain that processes information from the senses, makes mathematical calculations and controls how we handle objects)

In summary, schizophrenia:

  • has no known, exact cause

  • often appears to be inherited, passing down from generation to generation

  • affects boys slightly more often than girls when it develops in childhood

  • affects men and women equally when it develops in adolescence and adulthood

  • has no known cure, but can be managed well when caught early and treated with effective therapy, medications and support

Causes

What causes schizophrenia?

There is no known, exact cause for schizophrenia, but the disease is believed to be linked to the following factors:

Genetics

While there is no single known cause for schizophrenia, experts believe that the disease has a strong genetic component—specifically, an inherited chemical imbalance in the brain.
A combination of genes passed down by both parents can lead to schizophrenia: If a parent has the disorder, a child has an estimated 10 to 15 percent chance of developing it; if a sibling is schizophrenic, a child has an estimated 7 to 8 percent chance of developing the disease. The risk significantly increases if more than one family member has the disease.

Environmental stresses during pregnancy

Though data is not conclusive, some experts believe a child’s schizophrenia may be linked to certain environmental factors that affect the mother during pregnancy, such as:

  • drug or alcohol use
  • exposure to particular hormonal or chemical agents
  • exposure to certain viruses or infections
  • extreme stress
  • poor nutritional health

Signs and symptoms

What are the early warning signs of schizophrenia?

The behavioral changes caused by schizophrenia can be difficult to identify in the earliest stages of the disease. Symptoms may emerge slowly, develop over time or occur suddenly, as though “out of the blue.”

The following list of possible warning signs for schizophrenia is not definitive. Many of these symptoms may be caused by a condition other than schizophrenia; some will occur in children who do not have any disorder. However, it’s important to take note of any of these behaviors in your child as soon as they arise—especially if you have a family history of schizophrenia—and, if the behaviors persist, to contact a mental health professional as soon as possible.

Possible early warning signs in infants

  • abnormal listlessness or extensive periods of inactivity
  • overly relaxed or “floppy” arms or legs
  • unnaturally still, flat posture when lying down
  • unusual sensitivity to bright lights or rapid movements

Possible early warning signs in toddlers

  • chronic high fevers

  • fixation on repeating behaviors, even play, according to a specific regimen

  • persistent state of distraction, anxiety or distress

  • pronounced and sustained fear of certain events, situations or objects (note: while nearly all children experience specific fears as a normal developmental stage, children with early-onset schizophrenia tend to experience an extreme degree of fear that does not subside)

  • weak and slumping posture

Possible early warning signs in school-aged children

  • auditory hallucinations (the perception of sounds that others do not hear); most often, these hallucinations manifest as loud noises, whispers or collective murmuring

  • claims that someone or something is “in my head” or “telling me to do things”

  • extreme sensitivity to sounds and lights

  • frequent self-talk (note: while many children will go through phases of having an “imaginary friend” or occasionally talking to themselves, children with possible early-onset schizophrenia spend the majority of their time conversing and laughing with themselves while shutting out real people and surroundings)

  • tendency to be very “closed off” from others

  • visual hallucinations (seeing things that are not actually there); common examples include streaks or swirls of light or flashing patches of darkness

Possible early warning signs in adolescents and teens

  • a persistently vacant facial expression (known as “blank affect”)

  • awkward, contorted or unusual movements of the face, limbs or body

  • complaints and suspicions of threats, plots or conspiracies (for example, “someone has been sent to spy on me”)

  • dwelling excessively on perceived slights, failures or past disappointments

  • extreme irritability or angry outbursts that are unprovoked or disproportionate to the situation

  • extreme or unwarranted resentment and accusations against others (“I know my parents have been stealing from me”)

  • inability to follow a single train of thought

  • inability to read nonverbal “cues” (failing to understand and respond appropriately to other people’s tone of voice, facial expressions or body language)

  • inappropriate behavior and responses to social situations (for example, laughing out loud during a sad moment)

  • incoherent speech

  • irrational thinking, including:

    • assignment of “special meaning” to events and objects with no personal significance (for example, watching a famous person on television and believing they are conveying a secret message with their words or gestures)

    • assumption of extravagant religious, political or other authority (“I am God”)

    • belief that another person or entity is controlling one’s body, thoughts or movements

    • belief that an evil force, spirit or entity has “possessed” the body or mind

  • lapses in personal hygiene practices

  • long periods of staring without blinking or difficulty focusing on objects

  • rapidly fluctuating moods

  • seeing or hearing things that others do not

  • sudden, painful sensitivity to light and noise

  • sudden, significant changes in sleep patterns—either inability to fall or stay asleep (insomnia), or excessive sleepiness and listlessness (called catatonia)

  • talking aloud to oneself, often repeating or rehearsing conversations with others (real or imaginary)

  • tendency to rapidly shift topics during a single conversation

  • use of “nonsense” or made-up words

  • withdrawal from friendships and activities

It is important to note that, in the case of all of the above warning signs, a child or adolescent with schizophrenia is not aware that these behaviors pose a problem. A schizophrenic child does not have a sense of becoming ill or that something is wrong. The gravity of the situation is only apparent to outside observers.
What symptoms do people with schizophrenia develop as the disease progresses?

As the disease progresses, people with schizophrenia display symptoms that are grouped into four categories: positive symptoms, negative symptoms, disorganized speech and disorganized or catatonic behavior.

Positive symptoms

Positive symptoms of schizophrenia involve the onset and acquisition of certain feelings, traits, and behaviors. These can include:

  • beliefs that someone, or something, poses a threat or is causing some type of harm (for example, a sense of being followed by a person or group)

  • confused thinking (for example, confusing what is happening on television with what is occurring in reality)

  • hallucinations (seeing, hearing or feeling things that are not real; for example, hearing voices giving commands or seeing people, animals or objects that are not really there)

  • delusions (ideas, situations or threats that seem real but are not actually based in reality; for example, believing a surveillance device has been installed in the body, home or car). Children with schizophrenia tend to experience hallucinations, but not delusions, until they reach early adulthood.

  • problems distinguishing dreams from reality

  • regressive behavior (for example, an older child suddenly acting like a much younger child and clinging to parents)

  • severe anxiety

  • severe changes in behavior (for example, becoming noticeably withdrawn)

  • suddenly struggling with schoolwork; inability to comprehend material that was previously familiar

  • vivid, detailed and bizarre thoughts and ideas

Negative symptoms

Negative symptoms of schizophrenia involve the lack or loss of certain capabilities and traits, such as:

  • failure to demonstrate appropriate emotional responses (for example, laughing during a somber event or an upsetting conversation)

  • inability to sustain existing friendships and relationships

  • lack of emotional expression when speaking or interacting with others (having what is known as a “blank affect” on the face or failing to make eye contact)

  • severe difficulty making friends

Disorganized speech

Schizophrenia often causes spoken and written communication that is garbled, nonsensical or otherwise impossible for others to follow. Examples of this disorganized speech may include:

  • using words and sentences that do not fit together
  • inventing words or terms that make no sense to others
  • inability to stay “on track” in a conversation

Disorganized or catatonic behavior

Schizophrenia may lead to impaired behaviors that have a drastic impact on daily functions and activities. These disorganized or catatonic behaviors include:

  • engaging in inappropriate activities or speech (for example, making obscene gestures or comments in public)

  • extreme moodiness and irritability

  • failure to dress in accordance with the weather (for example, wearing layers of heavy clothing on a sweltering summer day)

  • failure to practice personal hygiene (for example, not bathing or brushing teeth)

  • suddenly becoming confused or agitated, followed by sitting and staring in place as though “frozen” (this is called a catatonic state)

Your child may be diagnosed with schizophrenia if these symptoms are present for a period of at least one month.

FAQ

Q: Is schizophrenia common in adults? In children?
A: According to the Society for Neuroscience, about one in 100 adults has schizophrenia. The disease is considerably rarer in children; roughly one in 40,000 people under the age of 18 are diagnosed with the disease.

Q: What are the major similarities and differences between schizophrenia in adults and childhood-onset schizophrenia?
A: As is the case for adults with schizophrenia, children who are schizophrenic are also likely to:

  • display limited or impaired emotional responses
  • fail to practice adequate personal hygiene or other aspects of self-care (such as dressing weather-appropriately)
  • have great difficulty in day-to-day functioning
  • “live in their heads,” closing themselves off from other people and their surroundings
  • suffer from hallucinations (both visual and auditory) or delusions (impressions or perceptions of situations that are not real)
  • struggle to make and maintain friendships

Unlike adults with schizophrenia, children with the disease tend to:

  • experience a gradual appearance and progression of symptoms, as opposed to a sudden and severe onset
  • display difficulty meeting age-appropriate developmental milestones in motor skills, memory and reasoning and speech and language before developing symptoms of schizophrenia

Q: Can I prevent my child from developing schizophrenia?
A: While there is no way to prevent schizophrenia, a close look at your family history and careful observation of your child’s behavior can help predict the likelihood of him developing the disease. The earlier you seek treatment, the better chance you have to improve your child’s quality of life.
If you suspect your child is displaying symptoms of schizophrenia, the most important step you can take is scheduling an immediate professional evaluation. Request an appointment at Children’s today.

Q: Do people with schizophrenia really have multiple personalities?
A: Although this is a common misconception about schizophrenia, it’s not true. What many peoplerefer to as “multiple personality disorder” is altogether different and is now known as dissociative identity disorder.
A schizophrenic person does not experience memory “blackouts” and alternate identities. Instead, an individual with schizophrenia experiences a separation from reality that is characterized by:

  • visual and auditory hallucinations
  • false and irrational ideas and perceptions
  • impaired or incoherent thinking and speech
  • problems initiating and maintaining relationships
  • difficulty processing social cues and non-verbal communication
  • inability to recognize and adhere to appropriate social behaviors or personal hygiene practices
  • oversensitivity to external stimulation, such as sounds and lights
  • withdrawal from the outside world

Q: Is it possible my child has bipolar disorder, not schizophrenia?
A: There are certain similarities between early-onset schizophrenia and pediatric bipolar disorder, particularly in the shared tendency to erupt in sudden and often unpredictable emotional outbursts.
The differentiating factor is what triggers these episodes: A child with bipolar disorder will become angry or inconsolable in response to a specific event or action). A child with early schizophrenia, by contrast, will have outbursts seemingly “out of nowhere,” with no obvious cause. In these cases, schizophrenic children are usually reacting to an overwhelming onslaught of sensation, such as sudden, unbearable sensitivity to noise in a room. They may also be frustrated by a sudden inability to communicate, think clearly or even stand or walk properly.

Q: What is the “black label warning” I keep hearing about when it comes to certain psychiatric medications?
A: Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications. The warning label states, in part:
“Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”
Your clinician will carefully go over the specifics of any medication prescribed for your child’s schizophrenia, as well as any potential side effects you should watch for. Our team has years of experience in managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. We will closely monitor your child for any sign of a negative response to the medication, and are always here to answer your questions and address any concerns you may have.

Q: What is the long-term outlook for my child?
A: If schizophrenia is detected and treated early, and if medications and therapies are successful, the disease has an excellent treatment rate. Lifelong monitoring by a qualified health professional is a must for anyone diagnosed with schizophrenia.
While there is no cure, children and adolescents with the disease can achieve normal—and even extraordinary—milestones at school, at work and in their personal lives. With proper treatment, many children with schizophrenia are able to go to college, hold jobs and have families as adults.

The following factors are critical in successfully treating schizophrenia:

  • building a foundation of family and school awareness and support
  • remaining under a clinician’s care for therapeutic treatment and regular monitoring
  • seeking professional treatment as soon as symptoms emerge
  • taking prescribed medications exactly as directed and for as long as directed (often long-term or throughout the lifetime)

Your treating clinician can give you specific information about your child’s condition, symptoms and recommended treatment plan.

The Differences Between Bipolar Disorder, Schizophrenia and Multiple Personality Disorder

Sometimes people confuse three mental disorders, only one of which could be referred to as “common” within the population — bipolar disorder (also known as manic-depression), schizophrenia, and multiple personality disorder (also known by its clinical name, dissociative identity disorder). This confusion has largely resulted from the common use of some of these names in popular media, and as short-hand by people referring to someone who is grappling with a mental health issue. The disorders, however, have little in common other than the fact that many who have them are still stigmatized by society.

Bipolar Disorder

Bipolar disorder is a fairly common mental disorder compared with the other two disorders. Bipolar disorder is also well-understood and readily treated by a combination of medications and psychotherapy. It is characterized by alternating moods of mania and depression, both of which usually last weeks or even months in most people who have the disorder. People who are manic have a high energy level and often irrational beliefs about the amount of work they can accomplish in a short amount of time. They sometimes take on a million different projects at once and finish none of them. Some people with mania talk at a faster rate and seem to the people around them to be constantly in motion.

After a manic mood, a person with bipolar disorder will often “crash” into a depressive mood, which is characterized by sadness, lethargy, and by a feeling that there’s not much point in doing anything. Problems with sleep occur during both types of mood. Bipolar disorder affects both men and women equally and can be first diagnosed throughout a person’s life.

Bipolar disorder can be challenging to treat because, while a person will take an antidepressant medication to help alleviate a depressed mood, they are less likely to remain on the medications which help rein in the manic mood. Those medications tend to make a person feel “like a zombie” or “emotionless,” which are feelings most people wouldn’t want to experience. So many people with bipolar disorder find it difficult to maintain treatment while in their manic phase. However, most people with bipolar disorder function relatively well in normal society and manage to cope with their mood swings, even if they don’t always keep on their prescribed medications.

For more information about bipolar disorder, please see our Bipolar Guide.

Schizophrenia

Schizophrenia is less common than bipolar disorder and is usually first diagnosed in a person’s late teens or early to late 20’s. More men than women receive a diagnosis of schizophrenia, which is characterized by having both hallucinations and delusions. Hallucinations are seeing or hearing things that aren’t there. Delusions are the belief in something that isn’t true. People who have delusions will continue with their delusions even when shown evidence that contradicts the delusion. That’s because, like hallucinations, delusions are “irrational” — the opposite of logic and reason. Since reason doesn’t apply to someone who has a schizophrenic delusion, arguing with it logically gets a person nowhere.

Schizophrenia is also challenging to treat mainly because people with this disorder don’t function as well in society and have difficulty maintaining the treatment regimen. Such treatment usually involves medications and psychotherapy, but can also involve a day program for people who have more severe or treatment-resistant forms of the disorder.

Because of the nature of the symptoms of schizophrenia, people with this disorder often find it difficult to interact with others, and conduct normal life activities, such as holding down a job. Many people with schizophrenia go off of treatment (sometimes, for instance, because a hallucination may tell them to do so), and end up homeless.

For more information about Schizophrenia, please see our Schizophrenia Guide.

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Dissociative identity disorder (DID), known as multiple personality disorder until renamed in the DSM-IV (American Psychiatric Association, 1994), is a controversial diagnosis. Many highly regarded clinicians (Putnam, 1989; Ross, 1989) have built careers working with patients they believe to have DID. Other distinguished practitioners consider DID to be a bogus diagnostic tag.

McHugh (1992) argues vigorously that hysteria-what he sees as the DID patient’s “more or less unconscious effort to appear more significant to others and to be more entitled to their interest and support”-along with the current social canonization of the victim, accounts for the fanciful behavior of those who claim to have multiple identities and personalities.

Merskey (1992) believes that the rise in DID diagnosis can be traced to the influence of the 1957 book The Three Faces of Eve and other books and films about DID, as well as the uncritical embracing of the DID diagnosis by a large number of mental health care professionals. He claims he could not identify a single uncontaminated DID case originating in a defensive response to trauma, the mechanism classically thought to underlie DID.

McHugh, Merskey and other critics of DID all essentially agree that the behavior named by this diagnosis is socially learned behavior. Highlighting the interaction of patient and culture, Merskey sees DID behavior as the “manufacture of madness.” Focusing on the role of the mental health care profession in this mislearning, McHugh calls the diagnosis a “psychiatric misadventure” (McHugh, 1992, 1995; McHugh and Putnam, 1995).

Perhaps some patients-but probably not most given this diagnosis-experience a trauma-induced, psychodynamically based dissociation and fragmentation of feeling, thinking and behavior sufficient to allow coalescence around two or more distinct identities. (DSM-IV bases diagnosis on behavior; the meaning of this behavior often remains unclear and unspecified.) Whatever the origin of their dissociated behavior, those who meet criteria for DID have frequent exacerbations of their symptoms, and they often come to the emergency room in crisis.

Nadine, age 23, acted in a way consistent with the supposition of dissociated identities to a greater degree than any other patient with whom I have worked. (How Nadine came to act this way and what her actions meant is ultimately unknown.) This was the third time I had been asked to see her in the ER. She was sitting on a royal blue mattress in the seclusion room, watched and comforted by a female technician who had a particularly gentle way with patients.

Nadine seemed to be holding court, alternately speaking English and Russian, a language she later told me she had studied seriously. Her speech was rapid and pressured, loud and emphatic. Much of what she said was intelligible, some was not. She wrote in a notebook as she spoke, making bold strokes that produced lines and, occasionally, a few words. Nadine was childlike in appearance and manner-short, slightly built, with short brown hair and thick glasses that seemed too big for her sharp-featured, feral face.

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