Psychotic Symptoms in Complex Dissociative Disorders

Abstract

Psychotic symptoms occur in some, but not all dissociative disorders. They are usually seen in dissociative identity disorder (DID) and dissociative disorder not otherwise specifiedtype I (DDNOS-1, according to the DSM-IV), traditionally subsumed under the rubric of ‘complex’ dissociative disorders (Loewenstein, 1991). There are also patients who experience dissociative-based hallucinations, sometimes combined with depersonalization or dissociative amnesia, but in the absence of distinct personality states (Sar, Akyuz and Dogan, 2007). Further, some patients have transient (acute) dissociative disorders with auditory and visual hallucinations which may be combined with dissociative somatic (conversion) symptoms (Sar, Koyuncu et al., 2007), which would also likely be classed in the NOS category of dissociative disorders. Dissociative disorders may mimic psychotic disorders in many ways. While some have suggested ways of distinguishing dissociative from schizophrenic disorders (Ross et al., 1989a; Steinberg et al., 1994; Yargic et al., 1998), empirical studies of overlapping symptoms in psychotic and dissociative disorders are rare. One of the few was conducted by Steinberg et al. (1994) utilizing the SCID-D (Structured Clinical Interview for DSM-IV Dissociative Disorders, Revised; Steinberg et al., 1994). They demonstrated that patients Q1 with DID had significantly higher scores on five specific dissociative symptom clusters than patients with schizophrenia or schizoaffective disorder (Steinberg et al., 1994). These clusters are: dissociative amnesia, depersonalization, derealization, identity confusion and identity alteration. In accordance with the DSM-IV (American Psychiatric Association, 1994), the SCID-D does not assess dissociative somatic (conversion) phenomena, yet these symptoms are placed in the dissociative disorder section of the ICD-10 (World Health