Differential diagnosis

by **Una+** » Thu Jul 14, 2011 8:25 pm

Differential diagnosis is the step beyond a diagnosis that is merely "in the ballpark", to one that is a "home run". Here is a recent article about using inkblots to obtain a differential diagnosis that separates out DID from borderline personality disorder and from psychotic disorders including schizophrenia.

Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients.
Brand, Bethany L.; Armstrong, Judith G.; Loewenstein, Richard J.; McNary, Scot W.
Psychological Trauma: Theory, Research, Practice, and Policy, Vol 1(3), Sep 2009, 188-205.

Abstract: Patients with dissociative identity disorder (DID) are often diagnosed with borderline personality disorder (BPD) and misdiagnosed with psychotic illnesses. This study is designed to determine whether the Rorschach protocols of 67 patients with DID differ from those of 40 patients with BPD and 43 patients with psychotic disorder (PSD) in variables reflecting capacity for working alliance, complexity of experience, and ability to reason despite traumatic flooding. As theoretically and clinically predicted, the DID group could be distinguished from the PSD sample by the DID group’s significantly higher level of traumatic associations alongside their more logical reasoning (e.g., Trauma Content Index [TCI], WSUM6). In comparison to the BPD group who, by definition, were also likely to dissociate and struggle with other trauma based symptoms, the DID sample showed greater social interest (Sum H), self-reflective capacity (FD; Form Dimension), ability to perceive more accurately and think more logically (X-, WSUM6). The authors discuss the treatment applications of these findings and make suggestions for further research.

Is it possible to see the whole article, not just the abstract?

It sounds like they are not using the Rorschach tests as a way of determining whether someone has DID or not (thus creating a differential diagnosis). The diagnoses were already determined, and the patients were already diagnosed before they did the testing. The tests, it sounds, were used as a means of finding verifiable and provable differences in cognition, reaction, brain function, etc between the groups of DID patients and non-DID patients (BPD and PSD). The tests show that differences between DID and non-DID (BPD, etc) can be veritably proven. It's still quite an interesting test. I would like to read more about it.

by **Kerry H** » Thu Jul 14, 2011 9:18 pm

That's an interesting article Una I didn't realise BPD & PSD was similar to DID. It makes me think I've got DID because in the middle of a nightmare I'll be trying to work out from logic and other people's reactions if it's real or not. And even at my worst I'm capable of being nice to people. x

by **Una+** » Thu Jul 14, 2011 9:19 pm

brandic wrote:Is it possible to see the whole article, not just the abstract?

The article can be purchased for download from the publisher website, or obtained through a research library or public library document delivery program.

brandic wrote:the patients were already diagnosed before they did the testing.

This is the kind of work that goes into establishing a reliable method of differential diagnosis. To show that a method works, researchers first apply it to people who have established (long term) diagnoses. Only then is the method used to make new diagnoses.

by **brandic** » Thu Jul 14, 2011 9:22 pm

I see. Thanks for the clarification. Very cool stuff

.

by **Una+** » Thu Jul 14, 2011 9:23 pm

Kerry H wrote:I didn't realise BPD & PSD was similar to DID

They have some symptoms in common. It is common for people who have DID to be misdiagnosed as having bipolar disorder or borderline personality disorder or schizophrenia, or any of several other disorders. However, rarely is someone who has one of these other disorders misdiagnosed as having DID.

-- Thu Jul 14, 2011 9:53 pm --

In the differential diagnosis of schizophrenia apart from other psychotic disorders, the presence of Schneiderian first-rank symptoms is important. Unfortunately, Schneiderian first-rank symptoms occur more frequently in patients with DID than in patients with schizophrenia (Ross et al 1990). In DID patients these symptoms often are reported during initial assessment (Kluft 1987). Thus, failure to identify DID rests with therapists, not with patients. This suggests that people who suspect they have DID, who are being seen by a therapist who does not have experience with DID, may find it helpful to give a copy of Kluft's 1987 article to the therapist during initial assessment.

Ross CA, Miller SD, Reagor P, Bjornson L, Fraser GA, Anderson G.
Schneiderian symptoms in multiple personality disorder and schizophrenia.
Compr Psychiatry. 1990 Mar-Apr;31(2):111-8.

Abstract: We report structured interview data from a series of 102 cases of multiple personality disorder (MPD) diagnosed in four centers. Schneiderian first-rank symptoms of schizophrenia were equally common in all four centers. The average MPD patient had experienced 6.4 Schneiderian symptoms. When these 102 cases are combined with two previously reported series of MPD cases, an average of 4.9 Schneiderian symptoms in 368 cases of MPD is noted. This compares with an average of 1.3 symptoms acknowledged by 1,739 schizophrenics in 10 published series. Schneiderian symptoms are more characteristic of MPD than of schizophrenia.

Kluft RP.
First-rank symptoms as a diagnostic clue to multiple personality disorder.
Am J Psychiatry. 1987 Mar;144(3):293-8.

Abstract: Thirty patients with multiple personality disorder had one or more of Schneider's 11 first-rank symptoms at initial assessment (mean = 3.6; range = 1-8). The author describes these symptom categories, eight of which were noted in the patients he interviewed, and illustrates them from the patients' case material. He suggests that inquiry about first-rank symptom phenomena may be a valuable diagnostic clue to the presence of multiple personality disorder.

by **sev0n** » Fri Jul 15, 2011 3:39 pm

surveys-studies/topic46925.html

If you have never taken the Rorschach test, here is a link to it on this group.

I took it and then looked at some of the other answers. I just don't get it.

How can that help anyone tell anything? What are they looking for?

I saw anything from people tied up with bleeding parts to animal crackers. lol

by **Una+** » Sat Jul 23, 2011 7:54 pm

A useful tool for differential diagnosis, separating DID from borderline personality disorder and from schizophrenia, is the Dissociative Disorders Interview Schedule (DDIS). Of special note is the section of the DDIS that deals with Schneiderian first-rank symptoms. People with DID often have difficulty deciding how to score items in that section.

DID Forum: Dissociative Disorders Interview Schedule
DID Forum: Schneiderian First Rank Symptoms

by **brandic** » Sat Jul 23, 2011 10:25 pm

Hmm. Interesting. Here are (some of) my results:

Somatization Disorder - No. (Although I was "positive" for many of these)
Substance Abuse - Yes
Major Depressive Episode - Yes
Features Associated with DID - 10
Supernatural Experiences - 5
Borderline Personality Disorder - Yes
Dissociative Amnesia - Yes
Dissociative Fugue - No
Depersonalization Disorder - Yes
DID - Yes

The only thing is, I've had dissociative amnesia in the past (before I was 18 and my life was much more chaotic), that's why I scored positive for dissociative amnesia. But if I don't have dissociative amnesia now doesn't that mean I don't qualify for the DID diagnosis? I'm quite confused...
caroline

by **ZeldaZonk** » Sun Jul 24, 2011 3:44 am

brandic wrote:
The only thing is, I've had dissociative amnesia in the past (before I was 18 and my life was much more chaotic), that's why I scored positive for dissociative amnesia. But if I don't have dissociative amnesia now doesn't that mean I don't qualify for the DID diagnosis? I'm quite confused...
caroline

That's my understanding of it, Brandic. I'm in the same boat - no 'contemporary amnesia'.

Best, Zel.

Differential diagnosis

Differential diagnosis

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