Dissociative Disorders vs. Schizophrenia: What Are the Differences?

Dissociative disorders and schizophrenia are both serious mental health conditions. While the two conditions share some similarities, they are not the same and have distinct characteristics, symptoms, and treatments.

Schizophrenia is a condition marked by disturbances in thoughts, feelings, and behaviors. Dissociative disorders are characterized by problems with the continuity of memories, thoughts, identity, and actions that result in a disconnection from reality.

Symptoms of Dissociative Disorders vs. Schizophrenia

People with schizophrenia and dissociative disorders may experience some similar symptoms. Shared symptoms may include hearing voices, memory loss, and feeling disconnected from the self and others.

However, people with dissociative disorders are more likely to experience depersonalization, derealization, and memory loss. Another notable difference is that people with schizophrenia are more likely to experience problems with cognitive functioning. 

Causes of Schizophrenia vs. Dissociative Disorders

As with many mental health conditions, it can be difficult to determine the cause of schizophrenia and of dissociative disorder. Research is ongoing, but a few different factors have been implicated in causing each of these conditions.

Causes of Schizophrenia

There isn’t one single cause of schizophrenia. Research has noted a strong genetic link, as a family history of psychosis significantly increases a person’s risk of the disease. Factors that may increase the risk for schizophrenia include:

• Brain differences: Schizophrenia has been linked to altered brain chemistry involving the neurotransmitters dopamine and glutamate.
• Environment: Schizophrenia has been linked to exposure to viruses or malnutrition during a parent's first or second trimester of pregnancy.
• Substance use: Substance use also can increase the risk of schizophrenia when mind-altering drugs are taken during teenage or young adult years. This includes smoking marijuana, as it increases the risk of psychotic incidents.

Causes of Dissociative Disorders

Dissociative disorders, on the other hand, typically develop in response to significant trauma. This might be military combat or physical or sexual abuse, experiences of which overwhelm the brain. The disorder may grow worse when an individual is under significant stress. 

Who Is Affected and When?

Both schizophrenia and dissociative disorders are relatively uncommon. According to some estimates:

• Schizophrenia affects around 0.25% and 0.64% of Americans. Those with schizophrenia—estimated at more than 24 million people across the globe—typically begin to experience symptoms in their late teens or early 20s for men and late 20s for women.
• Dissociative disorders affect 2.4% of Americans. Research has found that around 12% to 13.8% of psychiatric patients have dissociative disorders.

A person living with schizophrenia is more likely to experience other conditions, including posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and major depressive disorder. They are also at a higher risk for substance use.

Studies indicate that dissociative symptoms do not differ between genders. Researchers speculate that the reason more women are diagnosed could be connected to the fact that men enter the legal system rather than the health system.

Diagnosing Schizophrenia vs. Dissociative Disorders

In order to diagnose your condition, a healthcare provider will ask questions about your symptoms, take a medical history, and perform a physical exam. They may also use lab tests or other diagnostic tests to rule out any medical conditions that might be causing your symptoms.

Your specific diagnosis will depend on the type of symptoms you present with. Your healthcare provider will use the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition" (DSM-5) to diagnose your condition.

Diagnosing Schizophrenia

In order to meet the criteria for schizophrenia, an individual must experience two or more of the following symptoms (including at least one of the first three items on the list):

1. Delusions: Delusions include fixed false beliefs. For example, someone may believe aliens are talking to them through a certain radio program or that someone is spying on them even though there is no evidence of it.
2. Hallucinations: Someone may see things that others don’t see, hear things that no one else hears, or smell things that no one else smells.
3. Disorganized speech: This may include using made-up words or phrases that only have meaning to the individual, repeating the same words or statements, using meaningless rhyming words together, or jumping from topic to topic without being able to hold a conversation.
4. Grossly disorganized or catatonic behavior: Individuals may exhibit bizarre behavior that interferes with their ability to function. Individuals with catatonic behavior may appear unresponsive even though they are awake.
5. Negative symptoms: Individuals with schizophrenia may not exhibit certain types of emotional reactions that healthy people do. For example, an individual with schizophrenia might not interact socially or the individual might not show an emotional reaction to either good news or bad news.
   

Diagnosing Dissociative Disorders

There are three different types of dissociative disorders: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder (DID). Each has its own set of diagnostic criteria in the DSM-5.

• Depersonalization/derealization disorder: Diagnosis requires experiencing persistent or recurring episodes of depersonalization, derealization, or both.
• Dissociative amnesia: Those with dissociative amnesia have trouble remembering information about themselves, whether it’s a lack of memory of a particular traumatic event or, in rare cases, about their identity or past.
• Dissociative identity disorder (DID): A person with dissociative identity disorder will alternate between two or more distinct personality states or experiences. Gaps in memory are another common characteristic of this condition.

Individuals with dissociative disorders may function normally part of the time. Then, their symptoms may create difficulties for them, making it hard to work, maintain relationships, or continue with education.

Treatment for Dissociative Disorders vs. Schizophrenia

Because the treatments for schizophrenia and dissociative disorders are specific to the condition, it is essential to get an appropriate diagnosis. Neither schizophrenia nor dissociative disorders can be cured, but they can be managed in a variety of ways. Treatments often involve therapy, medication, and support.

Schizophrenia Treatments

Standard treatment for schizophrenia includes antipsychotic medications, along with psychotherapy and community support services. With proper medication, hallucinations and delusions can subside.

Hospitalization might be necessary for the safety of the person with schizophrenia as well as those around them.

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Dissociative Disorder Treatments

Dissociative disorders are commonly treated with talk therapy. Treatment options may include:

• Cognitive-behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Eye movement desensitization and reprocessing (EMDR)

Antidepressants or other medications may also be used. Such symptoms can help people manage symptoms of anxiety and depression that may occur alongside dissociative symptoms.

Complications

Individuals with schizophrenia are at a higher risk of suicide. Approximately 25% to 50% of people with schizophrenia attempt suicide during their lifetime, with around 5% dying by suicide.

Suicide can also be a serious issue for individuals with dissociative disorders, particularly dissociative identity disorder. More than 70% of individuals with dissociative identity disorder have attempted suicide. Multiple suicide attempts are common, and so is self-injury.

Prevention of Dissociative Disorders and Schizophrenia

There is no sure-fire way to prevent schizophrenia. The condition is strongly linked to genetic influences and brain differences. However, it may be possible to reduce the risk by avoiding environmental risk factors such as substance use. 

Summary

Schizophrenia and dissociative disorders share some overlapping symptoms, but it is important to recognize that they are distinct conditions. Schizophrenia is more likely to be marked by disorganized thoughts and behaviors, whereas dissociative disorders are more likely to cause feelings of detachment from the self and reality.

Getting a proper diagnosis is important because the treatments for schizophrenia and dissociative disorders can vary. Schizophrenia is generally treated with antipsychotic medication, while dissociative disorders are treated primarily with talk therapy.

Keep in Mind

Both schizophrenia and dissociative disorders are highly misunderstood conditions. Experiencing symptoms of either type of condition can be distressing and disruptive, so it is important to seek help if you have any symptoms that cause concern.

Your healthcare provider can determine whether the symptoms you are experiencing might be schizophrenia, a dissociative disorder, or something else. With proper treatment, people living with schizophrenia or dissociative disorder can lead productive, rewarding lives.