Piecing the Puzzle Together: Addressing the Overlaps Between DID and Psychosis

The similarities between DID and psychotic disorder are many. There’s considerable overlap in the symptoms of both:

• disruptions in memory
• hallucinations (or what can appear to be hallucinations)
• delusions (or what can appear to be delusions)
• confused ideas about the self
• fluctuating moods
• intense anxiety

Underlying the similarities between these disorders, however, are vastly differing causes. Let’s take memory as an example. Someone suffering from a psychotic episode might experience memory loss because of how the disorder affects the brain, while someone living with DID may move into one identity without having any recollection of what they’ve experienced in another.

As one woman with DID explains:

I convinced myself that the things that happened to me, that were completely baffling and unexplainable, happened to everyone. Didn’t everyone lose track of time, belongings, people? Didn’t everyone find things in their possession they couldn’t recall buying, or money spent they couldn’t recall spending? Didn’t everyone have such drastic extremes in desire and goals? Didn’t everyone regularly run into people whose names and faces couldn’t be placed?

In both experiences, there’s a kind of memory loss, but they’re caused by very different things. The symptoms merely present themselves similarly, and that’s where the difficulty in diagnosing lies. The problem, of course, is that misdiagnosis of DID as a Psychotic Disorder not only hides what they’re really struggling with—multiple personas—it prevents those who struggle with DID from exploring why they formed.

One of the main commonalities among those with DID is childhood trauma. As a child, experiencing trauma with no physical escape can cause some people to retreat further and further into their minds. It’s a defense mechanism that allows them to dissociate from all of the memories and emotions attached to their trauma, essentially creating another sense of self that has not endured that pain. Over time, they come to rely on this defense mechanism for any situation that’s too emotionally or physically painful, and that catalyzes the development of several senses of self, each with its own unique consciousness separate from the others in terms of thought, emotion, and memory.

When those who live with DID are misdiagnosed with Psychotic Disorder, the trauma that underlies that dissociation often goes unaddressed. For psychoanalyst and writer Valerie Sinason, the differences are there, though subtle: the voices her clients with DID heard came “from inside and not outside,” manifested from their most repressed traumatic memories. Disordered thoughts were not consistent, surfacing only at certain times, and time and place distortions only manifested when her patients dissociated into other identities. Crucially, it was trauma that defined her clients, and distinguished them from those with Psychotic Disorder.