Psychological Disorders

Schizophrenia Spectrum and Dissociative Disorders

Schizophrenia

Schizophrenia is a psychotic disorder characterized by delusions (false beliefs) and hallucinations (false sensory perceptions).

Psychotic disorders are serious mental disorders that involve distorted thinking or perceptions of the world. There are many psychotic disorders, differentiated by severity, their link to altered moods, and their connection to medical condition and substance use. Schizophrenia is one of the most serious forms of psychotic disorder, characterized by symptoms including delusions (false beliefs), hallucinations (perceptions of sights, sounds, or other events that others cannot see), and disorganized speech and behavior.

The substance of most delusions is a belief in malevolent persons or things out to harm the person who is mentally ill. Sometimes people with schizophrenia may have delusions of grandeur, or a belief they have special powers or abilities. Auditory and visual hallucinations are the most common forms of hallucinations. Often, auditory hallucinations involve one or more hostile voices speaking to the mentally ill person. These voices may be family members, celebrities, or supernatural beings. Visual hallucinations are often frightening. People with schizophrenia also show disorganized behavior such as incomprehensible speech, poor personal hygiene, unusual attire, and unexpected outbursts.

Clinicians sometimes refer to positive and negative symptoms of schizophrenia. In this context, positive does not mean "good." It means the presence of thoughts or behaviors that should not be there. Hallucinations, delusions, and disorganized behavior are positive symptoms. Negative symptoms, such as apathy, lack of emotion, and poor social functioning, refer to the absence of behavior that should be present. One of the worst symptoms of schizophrenia is anhedonia, or a lack of enjoyment in pleasurable activities. Sometimes people with schizophrenic psychosis have a flat affect, meaning they show no emotion. They may also speak very little or be physically rigid or immobile (catatonic).

Like other types of mental disorders, schizophrenia has a genetic component. Many genes are likely involved in the illness. Environmental factors are also predictors of schizophrenia. Problems during pregnancy such as stress, infection, malnutrition, and even diabetes may predispose an unborn child to this illness. Stressful events can jumpstart the illness in people who are genetically predisposed. According to the diathesis-stress theory, developing schizophrenia is the result of an interaction between a genetic or biological risk (the diathesis) and negative life events (stress). For example, two children could be born with a similar degree of genetic risk for developing schizophrenia. One may experience a family death or childhood trauma that creates enough stress to trigger the disease. The other child may avoid the disease by being lucky enough to have a peaceful and happy childhood.

Some people with schizophrenia have intellectual or emotional symptoms before the first onset of hallucinations or delusions. People who experience dulled emotions or catatonia experience intellectual impairment and have a poor chance of recovery. However, people with schizophrenia who experience hallucinations and delusions without catatonia have a better chance of recovery. Many people who have schizophrenic episodes recover with medication and therapy. However, for most people the disorder requires lifelong management and can impair occupational and social success.

Genetic Risk of Developing Schizophrenia

The more genes a person shares with someone who has schizophrenia, the greater their risk of also developing the illness. Environment also matters. Non-identical twins typically have more similar environments than ordinary siblings. This partly explains why having an identical twin with schizophrenia increases risk more than having a sibling with schizophrenia, despiste the same degree of genetic relationship in each case.

Dissociative Disorders

Dissociative disorders disrupt or scramble consciousness and are often a response to a traumatic event.

Dissociation is the disruption of consciousness or the scrambling of the continuity of consciousness. Some dissociation is typical. For example, people often dissociate on long drives, arriving at their destination without any conscious memory of driving there. When dissociation becomes a persistent trait, it is considered a psychological disorder.

Dissociative amnesia is a dissociative disorder in which a person blocks and cannot remember information related to a stressful or traumatic event. For example, people who have been subjected to torture and abuse as captives of a terrorist group may block out memories of events they experienced. Dissociative amnesia can span periods lasting minutes to years.

Short-lived, reversible amnesia is called dissociative fugue. In a fugue state a person may temporarily forget who they are or where they are. A fugue state involves physical wandering that was not planned. For example, a person may experience the trauma of a car accident and walk away, wandering the streets without knowing who they are. In more severe cases, a person may disappear from home for months without knowing who they are or where they belong.

Depersonalization/derealization disorder refers to a persistent and prolonged perception of being outside one's body and separate from one's thoughts. Sometimes people may describe this disorder as feeling like they are living in a dream. Depersonalization can be a symptom of other disorders or can be the result of substance abuse or a brain disease.

Dissociative identity disorder (DID), also called multiple personality disorder, is a controversial diagnosis in which a person presents with two or more distinct identities or personalities. Proponents believe DID is caused by severe childhood abuse. Others believe DID is caused by the inappropriate use of hypnosis and suggestive questioning. Repeated attempts to recover repressed memories may cause people to develop memories of traumas that never occurred.

The number of reported DID cases increased dramatically after the disorder was listed in the DSM-III in 1980, perhaps because of overeager clinicians with poor therapeutic skills. Some therapists may have colluded with patients, either consciously or unconsciously, to create stories of early childhood abuse, which led to the splitting of the patient's personality. In the 1970s a sensational account of a woman with 16 personalities became a best-selling book and later a movie called Sybil. The real Sybil, Shirley A. Mason, admitted to her therapist she'd been lying, but the therapist claimed she was in denial of her multiple personalities.