This is a very nice paper. At first glance, some readers may be sceptical about the diagnosis of Dissociative Identity Disorder although it has been ratified in DSM-IV. For me however, the paper examines the distinction between psychosis and dissociation – which clinically is very important.
The authors identify an overlap between DID and schizophrenia in terms of experiencing auditory and visual hallucinations. There were a few points, that I was critical of when first reading the paper. For instance, conventionally it is thought useful to distinguish between hallucinations and the so-called pseudohallucinations in terms of the external nature of hallucinations as well as their non-volitional nature – a point which the authors discuss later in the article. However the authors reference work which challenges the distinction between hallucinations in DID and schizophrenia. Nevertheless with regards to the flashbacks that occur in PTSD, I would distinguish these from visual hallucinations in that they are recognised as occuring internally. This is necessary as otherwise it would mean that each time we recalled an event vividly we would be considered to be hallucinating. Perhaps there is some utility though in understanding the similarities and differences between these phenomenon.
The authors go on to identify methods for distinguishing between psychosis in schizophrenia and the experiences in DID including periods of amnesia. Towards the end of the paper the authors outline a number of interesting implications when considering overlaps or distinctions between the diagnoses of schizophrenia and dissociative disorders. The authors suggest a previously considered inclusion to the DSM-IV criteria of schizophrenia
‘auditory hallucinations and Schneiderian symptoms yield a diagnosis of schizophrenia unless better accounted for by DID’
There are lots of useful clinical insights in this paper and it provides a lot of material for deeper reflection on diagnostic issues and is well worth a look.
Potential Conflict of Interest
I have an interest in EMDR and using measurements of dissociation. Therefore I may have been biased in selecting this paper.
Brad Foote and Jane Park. Dissociative Identity Disorder and Schizophrenia: Differential Diagnosis and Theoretical Issues. Current Psychiatry Reports. 2008. 10. 217-222.
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