Dissociative Symptoms

Researchers have routinely identified several different dissociative symptoms; some of these symptoms are required criteria for diagnosis in the DSM psychiatric manual, but many are common in dissociative disorders but not described with the diagnostic criteria. Dissociative identity disorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). {{Rp|319-321}} {{See also| Dissociative Identity Disorder}}, being the most severe dissociative disorder, has a set of 13 common dissociative symptoms which are unique to dissociative identity disorder although separately may occur in other disorders.^[2]

Many of the symptoms of dissociative identity disorder and other dissociative disorders are hidden, they can still be revealed when directly investigating them. For example, a symptom like amnesia may appear normal, but only because the person does not know it is not normal to miss days in a week.

Straightforward Dissociative Symptoms

These symptoms are the most obvious signs of DIDDissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). {{Rp|319-321}} {{See also| Dissociative Identity Disorder}}, but are also often the most hidden ones. This is why the DSM has been criticized for requiring only two of the thirteen well-replicated dissociative symptoms found within dissociative identity disorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). {{Rp|319-321}} {{See also| Dissociative Identity Disorder}}. ^[2]:2

AmnesiaMemory loss. {{See also| amnesia}}

Although amnesiaMemory loss. {{See also| amnesia}} itself is often hidden, the symptoms may not be hidden. These include: time lossIt's memory loss for some bounded period of time, meaning amnesia. If time-loss occurs in dissociative identity disorder, it is when an alter takes completely over for another alter, so that the host alter has no memory of the time the other alter was in executive control. (see full dissociation and executive control) {{Rp|232-233}}, losing skills, finding evidence of doing something without memory"Memory is not a static thing, but an active set of processes." {{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." {{Rp|11}} and strangers claiming to know you. ^[2]

Conversion Symptoms, a form of somatoformSomatoform Dissociation - refers to dissociative symptoms that involve the body; these symptoms are characteristic of dissociative disorders. {{Rp| 9}}Somatoform or somatic symptoms are physical symptoms that resemble, but cannot be explained by, a medical symptom or the direct effects of a substance. {{Rp| 9}} These include bodily sensations such as numbness/loss of sensation, inability to feel pain and dizziness. They are strongly linked to past trauma. {{See also | Somatoform Disorders}} dissociative symptoms

Conversion symptoms are closely linked to dissociative disorders and childhood trauma.^[3] They are classified as a separate type of disorder in the DSM psychiatric manual, while the ICD-10 classifies them under the same category of dissociative (conversion"The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder." (Kaplan & Sadock, 2008). Functional Neurological Symptom Disorder is the new name for Conversion Disorder in the DSM-5 manual, and is part of the Somatic Symptom and Other Related Disorders category. Somatization Disorder was removed during the changes, but is represented in this category. {{Rp|11}}Conversion symptoms are most common in conversion disorder, but also seen in a variety of mental disorders." {{Rp|23}}"Conversion disorders" is the ICD-10 category includes somatoform dissociation within dissociative disorders of movement and sensation. {{Rp|9}}{{See also| Somatoform Disorders}}) disorders. ^[2] Conversion symptoms are a form of somatoform dissociationThis explanation refers to pathological dissociation only; which is dissociation which is a symptom of or causes a mental health disorder. For normative dissociation see Dissociation page. Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the Self. {{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. True or pathological dissociation requires an experiencing Self. {{Rp|233-234}}.^[1]:230 The most common form of Conversion Disorder"The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder." (Kaplan & Sadock, 2008). Functional Neurological Symptom Disorder is the new name for Conversion Disorder in the DSM-5 manual, and is part of the Somatic Symptom and Other Related Disorders category. Somatization Disorder was removed during the changes, but is represented in this category. {{Rp|11}}Conversion symptoms are most common in conversion disorder, but also seen in a variety of mental disorders." {{Rp|23}}"Conversion disorders" is the ICD-10 category includes somatoform dissociation within dissociative disorders of movement and sensation. {{Rp|9}}{{See also| Somatoform Disorders}} is pseduoseizures, also known as Psychogenicterm use to signify that illness and symptoms are of a mental origin. {{Rp|81}} Nonepileptic Seizures (PNESCommon in those with dissociative identity disorder. A non-epileptic seizure is psychogenic rather than epileptic. Symptoms of pseudoseizures include "side-to-side shaking of the head, bilateral asynchronous movements (eg, bicycling), weeping, stuttering, and arching of the back." These pseudoseizures can be "predicted by preserved awareness, eye flutter, and episodes affected by bystanders (intensified or alleviated). {{See also| Pseudoseizures}}).^[4]

Conversion disorder is a disorder that appears initially to have a neurological cause, but which has actually a psychiatric cause (thought to be extreme stress). The stress would then be 'converted' into what looks like a neurological disease.^[5]

The four key symptoms of conversion disorder: ^[5]

• Symptoms of a neurological disease
• No evidence of a neurological disease that can explain the symptoms
• Associated psychological stress (which caused the symptoms)
• FeigningA flashback is a reactivated traumatic memory experienced as intrusive thoughts, feelings, or images associated with past trauma, but lacking a sense of being from the past. {{Rp|30}} {{See also | Grounding techniques}} is excluded (faking symptoms)

These diagnostic criteria have been criticized for being too difficult to use. For example, it is not really possible to exclude all neurological diseases. ^[5]

Voices (Hearing Voices)

Hearing voices is very common in dissociative disorders, especially DID. Normally, these are actually altersAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. {{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. {{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) {{Rp|301}} talking, but the voices may also be due to psychoticA person experiencing psychosis, or a characteristic of psychosis. {{Rp|24}}-like hallucinationsThe DSM-IV-TR psychiatric manual defined hallucinations as a "sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Auditory hallucinations are common both in schizophrenia and dissociative identity disorder. {{Rp|525}}Hallucinations can be auditory (voices, noises or other sounds), voices commenting on the person's behavior or thoughts, voices conversing, somatic or tactile (peculiar physical sensations), olfactory (unusual smells), visual (shapes or people that are not present). {{Rp|45}}Visual hallucinations are the most common type of hallucination and are often in geometric forms and figures {{Rp|127}} Illusions are similar to visual hallucinations but are based on real images or sensations... It does not always occur, though, and some people have reframed or rationalized them as being themselves or being their conscience. ^[2]:3

DepersonalisationA sense of detachment from the Self. Depersonalization disorder includes derealization, since the two often co-occur. {{See also| Depersonalization disorder}}

Depersonalisation is a feeling of detachmentCharacterized by distant interpersonal relationships and lack of emotional involvement {{Rp|24}} from the body and a feeling the body is not real (while actually knowing it is). Reality testing is intact. The same symptoms may be caused by drugs, but depersonalisation disorder as defined by the DSM is not caused by drugs or substance abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" . There have been reports depersonalisation may also be caused by substance useHarmful Use is a pattern of psychoactive substance use that results in damage to physical or mental health, e.g. hepatitis following injecting drugs or depression which is secondary to heavy alcohol intake. Adverse social consequences normally also occur. Previously known as "non-dependent use" in the ICD manual, referred to as "substance use" in the DSM manual. {{Rp|41}} (for example alcohol and illicit drug use including cannabis), but this does not seem to a clear cause.^[6][7]

Trance"periods of absence-like staring and unresponsiveness; well documented in severely dissociative people for over 100 years"{{Rp|229}}

Trance states are "periods of nonresponsiveness during which the person manifests a blank stare". ^[2]:4

SelfThe DSM-IV uses the term identity in its definition of dissociation. (see identity) {{Rp|127}}-alteration

This is not the same as with switchingFull dissociation is when an alter switches with the alter currently in executive control, resulting in amnesia for that alter. (see executive control) {{Rp|4-6}} In full dissociation, there is complete amnesia between alters, which is a {{Rp|228}} criteria for a diagnosis of Dissociative Identity Disorder in the DSM. {{See also| Dissociation}} between alter identitiesAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. {{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. {{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) {{Rp|301}}. It is the experience of "undergoing sudden, inexplicable, and often ego-alien changes in one’s sense of selfNormal sense of self is experienced as alterations in consciousness, but the sense of self remains stable and consistent. In individuals with a Dissociative disorder the sense of self alternates and is inconsistent across time and experience. {{Rp|160}} There is no unified sense of self."; feeling that "one’s body, thoughts, or urges belong to someone else."^[2] Identity alterationDefined as "objective behaviors that are manifestations of the assumption of different identities or ego states"{{Rp|14}} within DID, also known as "switching". The structured clinical interview for the dissociative disorders and other diagnostic tools assess identity alteration. {{See also| Identity alteration}} {{See also| Diagnosis}} is one of the five diagnostic symptoms of dissociation that the SCID-D diagnostic interview assesses. It is not mentioned in the DSM. ^[2]:4

DerealizationDepersonalization disorder includes derealization, since the two often co-occur.

Derealization is assessed in the SCID-D diagnostic interview and the DES self-report screening tool.^[2]:4

Awareness of Alters

Awareness of alters is obviously a symptom of DID. Previously, therapists incorrectly assumed awareness was not possible. This is not the case. While awareness is often limited or non-existent before awareness of Dissociative Identity Disorder, awareness of alters is very common in DID (but not universal). It may involve being able to say or hear what another alter does when they are physically in control.^[2]:4

Identity Confusion

Identity confusionDefined as "a feeling of uncertainty, puzzlement, or conflict about one's own identity. "{{Rp|13}}. The structured clinical interview for the dissociative disorders and other diagnostic tools assess identity confusion. {{See also| Identity confusion}} {{See also| Diagnosis}} is defined by the SCID-D as a feeling of uncertainty, puzzlement, or conflict about one's own identity. ^[8] It is not mentioned in the DSM. ^[2]

FlashbacksA flashback is a reactivated traumatic memory experienced as intrusive thoughts, feelings, or images associated with past trauma, but lacking a sense of being from the past. {{Rp|30}} {{See also | Grounding techniques}}

"The flashbacks and intrusionsThis is not limited to those with dissociative identity disorder. Parts of the [[personality]] influence each other, whether they are aware of others or not. Any part may intrude on, and influence the experience of the part that is functioning in daily life, without taking full control of functioning. {{Rp|27}} In dissociative identity disorder dissociative symptoms are felt when one alter intrudes into the experience of another. Intrusions occur in perceptions, ideas, wishes, needs, movements and behaviors. {{Rp|18}} In partial dissociation, amnesia is not present. {{Rp|228}} [[Dissociated|Switching]] is not equivalent to amnesia. {{Rp|228-229}} so characteristic of posttraumatic stress disorder (PTSD) are examples of partial dissociationThis is not limited to those with dissociative identity disorder. Parts of the [[personality]] influence each other, whether they are aware of others or not. Any part may intrude on, and influence the experience of the part that is functioning in daily life, without taking full control of functioning. {{Rp|27}} In dissociative identity disorder dissociative symptoms are felt when one alter intrudes into the experience of another. Intrusions occur in perceptions, ideas, wishes, needs, movements and behaviors. {{Rp|18}} In partial dissociation, amnesia is not present. {{Rp|228}} [[Dissociated|Switching]] is not equivalent to amnesia. {{Rp|228-229}}."^[9]:7 Flashbacks are usually attributed to PTSD, but also occur in Dissociative Identity Disorder because it has a strong comorbidity with PTSD, and is caused by trauma. ^[10]

PsychoticA person experiencing psychosis, or a characteristic of psychosis. {{Rp|24}}-like symptoms (which could like to a misdiagnosis of schizophrenia)^[2]:5

While they are not the primary symptoms, psychotic-like symptoms are common in dissociative disorders. This is one of the reasons why dissociative disorders are sometimes misdiagnosed as periods of psychosis"Mental disorder in which thoughts, affective response, ability to recognize reality, and the ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality." Impaired reality testing, hallucinations, delusions, and illusions are classic characteristics. {{Rp|24}}"Mental disorder in which thoughts, affective response, ability to recognize reality, and the ability to communicate and relate to others are sufficiently impaired to interfere grossly with the capacity to deal with reality." Impaired reality testing, hallucinations, delusions, and illusions are classic characteristics. {{Rp|24}}.

Auditory hallucinations

Hearing voices is common in DID, usually due to alters. But other psychotic-like auditory hallucinations also often occur. These voices may be 'in the head' (this is common), but may also be outside.

Visual hallucinations

Visual hallucinations are also common. They can be either seeing or visualizing alters, a flashbackA flashback is a reactivated traumatic memory experienced as intrusive thoughts, feelings, or images associated with past trauma, but lacking a sense of being from the past. {{Rp|30}} {{See also | Grounding techniques}}, or genuine psychotic-like hallucinations.

Schneiderian first-rank symptoms

These symptoms have been historically used to help describe and diagnosis schizophrenia, but they are not the sole diagnostic criteria for schizophrenia. Schizophrenia and DID may be comorbidComorbid means the the presence of more than one psychiatric diagnosis at once, with substance use this is often referred to as "dual diagnosis" Also see [[Cormobid]]., but this is rare.^[11] These are experienced as "autonomous intrusions into a person’s executive functioning and sense of self."^[2]:8 The presence of these symptoms alone should not be used to diagnose a dissociative disorder, since they do not form the diagnostic criteria, and some may present due to other diagnoses.

Only 8 of the 11 Schneiderian first-rank symptoms occur in dissociative identity disorder. Those that do occur in dissociative identity disorder are listed below.

'Made' actions'Made' or intrusive actions are also called 'made volitional acts'; a person's actions are "from and are controlled by an external agent; the person is a passive participant in the action". {{Rp|1434}} A Schnieder first-rank symptom often present in schizophrenia, but common in DID.In DID the behavior does not feel like it belongs to the person, they make be unaware of the actions (due to amnesia) or may "see" another part take control of the body (if co-conscious with an alter). In DID there are three types of experience of made actions:
1. Depersonalized stance - inside or outside of the body just passively watching or observing your actions
2. feeling as if you are being suddenly being "overpowered, taken over, controlled, or even possessed"
3. observing a part of your body which suddenly seems to have a mind of its own, and performs an unintended action.{{Rp|230}}

Common in DID. The person may be unaware of the actions or may "see" another part take control of the body (co-consciousness).

1. depersonalized stance - inside or outside of the body just passively watching or observing your actions
2. feeling as if you are being suddenly being "overpowered, taken over, controlled, or even possessed"
3. observing a part of your body which suddenly seems to have a mind of its own, and performs an unintended action.

Voices arguingTwo or more voices conversing, they may be arguing. Common in both schizophrenia and dissociative identity disorder. This is a type of auditory hallucination. {{Rp|45}} In dissociative identity disorder the voices belong to alter identities and this may extend to alters who are contending for physical control, for example involving the person feeling a force or an "other" that ties to control or change the person's actions, or feeling or hearing an angry other that tries to control the person.{{Rp|230}} (or conversing)

Also known as an internal dialogue or internal struggle. Referring to Dissociative Identity Disorder, Dell et al. ^(2009):230 writes that "these form the person's awareness that different parts of the mind are autonomously conversing or competing for control: hearing two or more voices that discuss or ague about what should be done, feelings a force or an other that tries to take control or change what the person does; feeling or hearing an angry other that tries to control one, etc.".

Voices commentingRefers to voices commenting (in the form of a running commentary) on the person's behavior or thoughts. Common in both schizophrenia and dissociative identity disorder. This is a type of auditory hallucination. {{Rp|45}}{{Rp|230}}

Dell ⁽²⁰⁰⁹⁾ states "Dissociative individuals almost always hear the voice of a child", and often have a visual image of the child that they are hearing, this can be a frank visual hallucinationThe DSM-IV-TR psychiatric manual defined hallucinations as a "sensory perception that has the compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. Auditory hallucinations are common both in schizophrenia and dissociative identity disorder. {{Rp|525}}Hallucinations can be auditory (voices, noises or other sounds), voices commenting on the person's behavior or thoughts, voices conversing, somatic or tactile (peculiar physical sensations), olfactory (unusual smells), visual (shapes or people that are not present). {{Rp|45}}Visual hallucinations are the most common type of hallucination and are often in geometric forms and figures {{Rp|127}} Illusions are similar to visual hallucinations but are based on real images or sensations. or an imaginative picture. Child voices may be happy, sad, crying or angry and can be commenting, arguing or simply crying.

'Made' feelings'Made' or intrusive feelings and emotions are unexpected surges of feeling-pain, hurt, anger, fear, shame, and so on. Often these surges of feeling are inexplicable and frankly puzzling". A Schnieder first-rank symptom often present in schizophrenia. These tend to be partially dissociated intrusions from another self-state, fairly common in "PTSD, borderline personality disorder, bipolar disorder, panic disorder and ADHD."{{Rp|231}}

These feelings are often puzzling and not understood by the person; they tend to be partially-dissociated intrusions from another self-state (alter personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) The DSM-IV uses the term identity in its definition of dissociation. (see identity) {{Rp|127}}). Angry intrusions are particularly common in DID, and are a sign of pathological (non-normative) dissociation; angry intrusions involve either sudden, unexpected surges of anger and/or partially dissociated seizures of executive controlThe alter that has control of an individual at that moment has executive control, and the alter most often in executive control is commonly called the host alter. {{Rp|27}} where a person is consciously aware of "being invaded and/or taken over by an autonomous other"

Influences on the bodySomatic passivity is also referred to as "influences on the body". These are tactile or visceral hallucinations that are imposed by some external agent (can be combinations of different somatic hallucinations). Common in Schizophrenia in Dissociative Identity Disorder. {{Rp|1434}} {{Rp|6}}

Also known as 'External influencesSomatic passivity is also referred to as "influences on the body". These are tactile or visceral hallucinations that are imposed by some external agent (can be combinations of different somatic hallucinations). Common in Schizophrenia in Dissociative Identity Disorder. {{Rp|1434}} {{Rp|6}}' or 'Somatic passivitySomatic passivity is also referred to as "influences on the body". These are tactile or visceral hallucinations that are imposed by some external agent (can be combinations of different somatic hallucinations). Common in Schizophrenia in Dissociative Identity Disorder. {{Rp|1434}} {{Rp|6}}'.

Thought withdrawalThe person believes thoughts have been taken away from his/her mind. This is a symptom of schizophrenia,{{Rp|45}} but either thought withdrawal and thought insertion are also very common in people with Dissociative Identity Disorder. {{Rp|527}}

Thought withdrawal can take different forms, including your mind suddenly going 'blank'; as a thought seems to disappear. In Dissociative Identity DisorderPrior to the DSM-IV, dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}} this would be puzzling and unexplained, rather than given a delusionA delusion is a "false belief, based on incorrect inference about external reality, that is firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief." {{Rp|24}}Delusional perception is a "perception that has a unique and idiosyncratic meaning for a person, which leads to an immediate delusional interpretation". A Schniederian first-rank symptom often associated with schizophrenia {{Rp|1434}} but not associated with dissociative identity disorder. {{Rp|391}} explanation.

Thought insertionThe person believes that thoughts that are not his/her own thoughts have been inserted into his/her mind. {{Rp|45}}This is a symptom of schizophrenia, but either thought withdrawal and thought insertion are also very common in people with Dissociative Identity Disorder. {{Rp|527}}

This is also known as 'Thoughts ascribed to others'. These can be strong thoughts which seem to come out of nowhere, e.g., the instrusive thoughts common in PTSD (these are partially dissociated), the thoughts are often distressing.^[1]

'Made' impulsesThese impulses for action are imposed on the person and do not feel like they belong to the person, who feels like the impulses are "coming from somewhere else or someone else". In dissociative disorders this can some other part is trying to overrule the host/apparently normal part of the personality. A Schnieder first-rank symptom often present in schizophrenia but common in DID.{{Rp|231}}In schizophrenia or psychosis the impulses may be given a delusional explanation, for example naming a person or object who the impulses appear the be coming from.

The impulses are a strong desire to act in a particular way, which appear to not "belong" to the person experiencing them and may not make sense to them. In dissociative disorders this can some other alter identityAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. {{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. {{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) {{Rp|301}}/part which is trying to overrule the host/apparently normal part of the personality.

^[2]:1[1]:231

First-rank symptoms not associated with Dissociative Disorders

Some Schneiderian first-rank symptoms are not associated with dissociative disorders. The three that do not occur in dissociative identity disorder are thought broadcastingThe belief that "a person's thoughts are experienced as real phenomena by others - the thoughts are made audible or heard through telepathy". A Schnieder first-rank symptom often associated with schizophrenia {{Rp|1434}} but not associated with DID.{{Rp|391}} {{See also| Schizophrenia}}, audible thoughtsA person's thoughts being spoken aloud. A Schniederian first-rank symptom often associated with schizophrenia.{{Rp|1434}} but not associated with DID.{{Rp|391}}, and delusionalA delusion is a "false belief, based on incorrect inference about external reality, that is firmly held despite objective and obvious contradictory proof or evidence and despite the fact that other members of the culture do not share the belief." {{Rp|24}}Delusional perception is a "perception that has a unique and idiosyncratic meaning for a person, which leads to an immediate delusional interpretation". A Schniederian first-rank symptom often associated with schizophrenia {{Rp|1434}} but not associated with dissociative identity disorder. {{Rp|391}} perception.^[2] In schizophrenia, the intrusions take a psychotic form such as the person explaining them using a delusional explanation. Dell ⁽²⁰⁰⁶⁾ gives the example of "Marilyn Monroe is controlling my thoughts".

In DID, these intrusions take a nonpsychotic form; they are noticed and described by the person, but without a delusional explanation. The person may describe, eg, "I know this sounds crazy, but sudden strong thoughts come into my mind and they feel like they are not mine".^[2]:8See also: Differences between schizophrenia and DID

References

1. ^ ^{a b c d e f g h i j k l m n o p q} Dell, Paul F.. A New Model of Dissociative Identity Disorder. The Psychiatric Clinics of North America, volume 29, issue 1, page 1-26. (doi:10.1016/j.psc.)
2. ^ ^{a b c d e} Dell, Paul F., O'Neil, John A. (Eds) (2009). Dissociation and the dissociative disorders: DSM-V and beyond. .
3. ^ Sar, Verdat; Akyüz,Gamze, Kundakçı, Turgut, Kızıltan, Emre, Doğan, Orhan (2004). Childhood Trauma, Dissociation, and Psychiatric Comorbidity in Patients With Conversion Disorder. Am J Psychiatry, volume 161, issue 12, 01, page 2271-2276. (doi:10.1176/appi.ajp.)
4. ^ LaFrance, W. Curt Jr; Baird, Grayson L., Barry, John J., Blum, Andrew S., Frank Webb, Anne, Keitner, Gabor I., Machan, Jason T., Miller, Ivan, Szaflarski, Jerzy P. (2014). Multicenter Pilot Treatment Trial for Psychogenic Nonepileptic Seizures. A Randomized Clinical Trial. JAMA Psychiatry, July 2, 2014. (doi:10.1001/jamapsychiatry.2014.817)
5. ^ ^{a b c} Nicholson, Timothy R.J.; Stone, Jon, Kanaan, Richard A A (2010). Conversion disorder: a problematic diagnosis. J Neurol Neurosurg Psychiatry 2011;82:1267-1273 .1136/jnnp.2008.171306, volume 82, page ;82:1267-1273. (doi:10.1136/jnnp.2008.171306)
6. ^ Medford, Nick; Sierra, Mauricio, Baker, Dawn, Hunter, Elaine, Lawrence, Emma, Phillips, Mary L., Anthony S., David (2003). Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases. Addiction, volume 98, page 1731–1736.
7. ^ Medford, Nick; Sierra, Mauricio, Baker, Dawn, Anthony S., David (2005). Understanding and treating depersonalisation disorder. Advances in Psychiatric Treatment, volume 11, page 92-100. (doi:10.1192/apt.11.2.92)
8. ^ Steinberg, Marlene. Handbook of the Assessment of Dissociation: A Clinical Guide. American Psychiatric Pub, 1995.
9. ^ Howell, Elizabeth F.. The treatment of dissociative identity disorder : a relational approach. 972. London: Routledge
10. ^ Beck, J. Gayle, and Denise M. Sloan. The Oxford handbook of traumatic stress disorders. OUP USA, 2012.
11. ^ Moskowitz, Andrew, Ingo Schafer, and Martin Justin Dorahy. Psychosis, trauma and dissociation: Emerging perspectives on severe psychopathology. Wiley, 2011.