micky_ wrote:Differentiation between schizophrenia and DID is important, and as we know, sometimes very difficult.
In retrospect, it is understood that the original description of schizophrenia was based in part on patients with DID, not schizophrenia. As a result the two conditions were conflated for decades.
The researchers who describe “dissociative psychosis” appear to be using a concept of psychosis that is much broader than the concept used by many other researchers, a concept so broad that it includes most of the typical DID symptoms that other researchers call “pseudo-psychosis” or not psychosis at all.
Discontinuity in thought flow is one of the so-called Schneiderian first-rank symptoms. Although described as typical of schizophrenia, these symptoms are in fact far more typical of DID. They were included in the early research descriptions of schizophrenia based on patients who are now recognizable as having had DID not schizophrenia.
micky_ wrote:Yet, incidentally there are cases that remain a mystery from diagnostic point of view, see e.g. this article Long-Term Atypical Psychoses
I don't see any mystery there. That article reports on 7 patients who were not diagnosable using criteria for diagnosing psychosis. The authors of the article state these patients appear to have DID, only the authors reject the validity of DID. Therefore, the authors reason, their 7 patients cannot have DID and must have a very unusual psychosis. They say this is unusual (long term and atypical) and yet they have not just one case, but 7 cases. So in fact it is not unusual. Do you see the logical error here? The authors reject their own direct observation and the published literature reporting observations of many other patients with the same symptoms, based on their personal disbelief. Standard practice, as documented in both DSM and ICD, is that those symptoms indicate a diagnosis of DID. The entire premise of this article is based on a cognitive error by the authors. On the other hand, had they written an article reporting they have 7 patients with DID, it would not have been accepted for publication because that's not new or interesting.
I read the article and the patients sound very typical for DID with high somatic symptoms. I can relate, totally. I “hear voices” and have strange sensations in various parts of my body. But what makes my symptoms dissociative and not psychotic is that I know these sensations are just that: sensations. When I feel “as if” some creature were moving around in the back of my brain, inside my skull, I know there isn't any creature there. I know I am “hallucinating” this bizarre sensation and because I know it, this symptom is not psychotic.
micky_ wrote:The background of my contribution to this thread is that (a long time ago) I myself had a (waxing and waning) dissociative psychosis for years and couldn’t get a better diagnosis than something like “an atypical chronic psychosis resistant to any treatment”. The medical team treating me was on the verge of giving up.
Interesting. Do tell more!
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