The Differences Between Bipolar Disorder, Schizophrenia and Multiple Personality Disorder: Sometimes people confuse three mental

disorders, only one of which could be refe rred to as “common” within the population — bipolar disorder (also known as manic-depr ession), schizophrenia, and multiple personality disorder (also known by its cli nical name, dissociative identity disorder). This confusion has largely resulted from the common use of some of these names in popular media, and as short-hand by people referring to someone who is grappling with a mental health issue. The disorders, however, have little in common other than the fact that many who have them are still stigmatized by society. Bipolar Disorder Bipolar disorder is a fairly common mental disorder compared with the other two disorders. Bipolar disorder is also well-understood and readily treated by a com bination of medications and psychotherapy. It is characterized by alternating mo ods of mania and depression, both of which usually last weeks or even months in most people who have the disorder. People who are manic have a high energy level and often irrational beliefs about the amount of work they can accomplish in a short amount of time. They sometimes take on a million different projects at onc e and finish none of them. Some people with mania talk at a faster rate and seem to the people around them to be constantly in motion. After a manic mood, a person with bipolar disorder will often “crash” into a depress ive mood, which is characterized by sadness, lethargy, and by a feeling that the re’s not much point in doing anything. Problems with sleep occur during both types of mood. Bipolar disorder affects both men and women equally and can be first d iagnosed throughout a person’s life. Bipolar disorder can be challenging to treat because, while a person will take a n antidepressant medication to help alleviate a depressed mood, they are less li kely to remain on the medications which help reign in the manic mood. Those medi cations tend to make a person feel “like a zombie” or “emotionless,” which are feelings most people wouldn’t want to experience. So many people with bipolar disorder find it difficult to maintain treatment while in their manic phase. However, most pe ople with bipolar disorder function relatively well in normal society and manage to cope with their mood swings, even if they don’t always keep on their prescribe d medications. For more information about bipolar disorder, please see our Bipolar Guide. Schizophrenia Schizophrenia is less common than bipolar disorder and is usually first diagnose d in a person’s late teens or early to late 20’s. More men than women receive a diag nosis of schizophrenia, which is characterized by having both hallucinations and delusions. Hallucinations are seeing or hearing things that aren’t there. Delusio ns are the belief in something that isn’t true. People who have delusions will con tinue with their delusions even when shown evidence that contradicts the delusio n. That’s because, like hallucinations, delusions are “irrational” — the opposite of log ic and reason. Since reason doesn’t apply to someone who has a schizophrenic delus ion, arguing with it logically gets a person nowhere. Schizophrenia is also challenging to treat mainly because people with this disor der don’t function as well in society and have difficulty maintaining the treatmen t regimen. Such treatment usually involves medications and psychotherapy, but ca n also involve a day program for people who have more severe or treatment-resist ant forms of the disorder. Because of the nature of the symptoms of schizophrenia, people with this disorde r often find it difficult to interact with others, and conduct normal life activ ities, such as holding down a job. Many people with schizophrenia go off of trea tment (sometimes, for instance, because a hallucination may tell them to do so), and end up homeless. For more information about Schizophrenia, please see our Schizophrenia Guide. Multiple Personality Disorder (Dissociative Identity Disorder) This disorder used to be known as multiple personality disorder (and is still co mmonly referred to as such in the media), but is now known by its newer clinical name, dissociative identity disorder (DID). DID is characterized by a set of on

e or more distinct identities that a person believes to exist within themselves. These identities can talk to the person, and the person can answer back. The id entities often are formed to help a person cope with different parts of their li fe, and seem to have distinct personalities that are unique and different than t he person’s core personality. Sometimes, people with DID will lose track of time or will be unable to account for blocks of time during their day. This occurs when one of the identities with in the person takes control of the individual and engages in behaviors that the core personality would otherwise not engage in. For instance, the person with DI D may be unable to be assertive in a situation with her boss, so the assertive i dentity takes over for the important meeting to ensure the individual is asserti ve. Dissociative identity disorder is not commonly diagnosed within the population, and is not well understood by mental health professionals and researchers. Treat ment typically involves psychotherapy to help integrate all of the identities in to the core personality and can take years when successful. For more information about Multiple Personality Disorders, please see our Multip le Personality Disorder Guide. Contrasting the Three Very Different Disorders People with bipolar disorder usually can lead fairly “normal” lives, hold down a reg ular job, have a happy relationship and family, even be very successful in a car eer. People with bipolar disorder do not hear voices that aren’t there, and they d o not have multiple personalities in their bodies. People with bipolar disorder do best when they stick to some treatment regimen. Many people with schizophrenia often have a more difficult time functioning in n ormal society. Because of the nature of the disorder, people with schizophrenia often have a hard time staying in treatment, and an even harder time with social relationships, family, friends, and work. Still one of the most stigmatized dis orders in mental health, help in many communities can be hard to come by and man y people with schizophrenia end up homeless and forgotten by their family and so ciety. People with schizophrenia who have strong community and family support and resou rces do well, and can lead happy, healthy, fulfilling lives, with rewarding fami ly and social relationships. People with schizophrenia can be depressed or manic , but it is usually as a result of the schizophrenia itself (e.g. they are depre ssed because they have schizophrenia). If a person hears voices (not all people with schizophrenia do), they do not recognize the voices as being a part of them selves. People with multiple personality disorder, or dissociative identity disorder (DI D), can often lead successful, “normal” lives with healthy, happy relationships with others. While, like people with schizophrenia, they can “hear voices” in their head , the voices are recognized by the person as different identities within themsel ves (not as external voices from outside themselves). Such identities may help t he person function in life, and may allow the person to live their lives with on ly disruption. Others with DID have a more difficult time, because the identitie s take over parts of their life, making accounting for time throughout the day c hallenging and frustrating. While a person may become depressed with DID, it is secondary to the DID symptoms themselves (e.g., the person is depressed because they are trying to cope with their DID). People seem to most often confuse someone who is suffering from schizophrenia wi th someone who has dissociative identity disorder. While both are chronic, serio us mental health concerns, the differences between these two disorders are stark . People with schizophrenia hear or see things that aren’t there and believe thing s that aren’t true, often tied into a complex, irrational belief system. They do n ot have multiple identities or personalities. People with DID do not have delusi on beliefs, outside of their multiple personalities or identities. The only voic es they hear or talk to are these identities. Multiple Personality Disorder (Dissociative Identity Disorder) This disorder used to be known as multiple personality disorder (and is still co mmonly referred to as such in the media), but is now known by its newer clinical

name, dissociative identity disorder (DID). DID is characterized by a set of on e or more distinct identities that a person believes to exist within themselves. These identities can talk to the person, and the person can answer back. The id entities often are formed to help a person cope with different parts of their li fe, and seem to have distinct personalities that are unique and different than t he person’s core personality. Sometimes, people with DID will lose track of time or will be unable to account for blocks of time during their day. This occurs when one of the identities with in the person takes control of the individual and engages in behaviors that the core personality would otherwise not engage in. For instance, the person with DI D may be unable to be assertive in a situation with her boss, so the assertive i dentity takes over for the important meeting to ensure the individual is asserti ve. Dissociative identity disorder is not commonly diagnosed within the population, and is not well understood by mental health professionals and researchers. Treat ment typically involves psychotherapy to help integrate all of the identities in to the core personality and can take years when successful. For more information about Multiple Personality Disorders, please see our Multip le Personality Disorder Guide. Contrasting the Three Very Different Disorders People with bipolar disorder usually can lead fairly “normal” lives, hold down a reg ular job, have a happy relationship and family, even be very successful in a car eer. People with bipolar disorder do not hear voices that aren’t there, and they d o not have multiple personalities in their bodies. People with bipolar disorder do best when they stick to some treatment regimen. Many people with schizophrenia often have a more difficult time functioning in n ormal society. Because of the nature of the disorder, people with schizophrenia often have a hard time staying in treatment, and an even harder time with social relationships, family, friends, and work. Still one of the most stigmatized dis orders in mental health, help in many communities can be hard to come by and man y people with schizophrenia end up homeless and forgotten by their family and so ciety. People with schizophrenia who have strong community and family support and resou rces do well, and can lead happy, healthy, fulfilling lives, with rewarding fami ly and social relationships. People with schizophrenia can be depressed or manic , but it is usually as a result of the schizophrenia itself (e.g. they are depre ssed because they have schizophrenia). If a person hears voices (not all people with schizophrenia do), they do not recognize the voices as being a part of them selves. People with multiple personality disorder, or dissociative identity disorder (DI D), can often lead successful, “normal” lives with healthy, happy relationships with others. While, like people with schizophrenia, they can “hear voices” in their head , the voices are recognized by the person as different identities within themsel ves (not as external voices from outside themselves). Such identities may help t he person function in life, and may allow the person to live their lives with on ly disruption. Others with DID have a more difficult time, because the identitie s take over parts of their life, making accounting for time throughout the day c hallenging and frustrating. While a person may become depressed with DID, it is secondary to the DID symptoms themselves (e.g., the person is depressed because they are trying to cope with their DID). People seem to most often confuse someone who is suffering from schizophrenia wi th someone who has dissociative identity disorder. While both are chronic, serio us mental health concerns, the differences between these two disorders are stark . People with schizophrenia hear or see things that aren’t there and believe thing s that aren’t true, often tied into a complex, irrational belief system. They do n ot have multiple identities or personalities. People with DID do not have delusi on beliefs, outside of their multiple personalities or identities. The only voic es they hear or talk to are these identities. Borderline Personality Disorder Background

Personality traits are enduring patterns of perceiving, relating to, and thinkin g about the environment and oneself. They are exhibited in a wide range of impor tant social and personal contexts. When these traits are significantly maladapti ve and cause serious functional impairment or subjective distress, they constitu te a personality disorder. The manifestations of personality disorders are often recognized by adolescence and continue throughout most of adult life. Personality disorders are not formally diagnosed in patients younger than 18 yea rs because of the ongoing developmental changes. However, if the disturbance is pervasive and if the criteria are fully and persistently met and are not limited to a developmental stage, diagnosing borderline personality disorder (BPD) in c hildren and adolescents is appropriate. Historically, borderline personality disorder has been seen as lying on the bord er between psychosis and neurosis. It is characterized by marked instability in functioning, affect, mood, interpersonal relationships, and, at times, reality t esting. In 1942, Deutsch described a group of patients who lacked a consistent s ense of identity and source of inner direction.[1] She created the term "as-if p ersonalities" because the patients completely identified with those upon whom th ey were dependent. In 1975, Kernberg conceptualized borderline personality disor der to describe a group of patients with particular primitive defense mechanisms and pathologic internalized object relations (eg, splitting, projective identif ication).[2] Borderline pathology in children refers to a syndrome characterized by a combina tion of externalizing symptoms (disruptive behavioral problems), internalizing s ymptoms (mood and anxiety symptoms), and cognitive symptoms. Follow-up studies o f these children show that they have a tendency to develop a wide range of perso nality disorders, not specifically borderline personality disorder. Further rese arch in this area is imperative, not only to elucidate etiology, but also to all ow for the earliest possible intervention. Case study Susan was 28 years old. She experienced a troubled childhood, including her fath er dying when she was 4 and her mother marrying a man who brought great tension into the house and eventually sexually abused her. Since she was a child, her re actions to events had always been very strong. As a child, people found her diff icult. Her mother eventually got rid of the abusive stepfather and provided stru cture. Susan was able to do well in school and even get through college by going to a small very supportive school with lots of structure. Once out in the work environment, however, she ran into problems. Colleagues and employers did not li ke her moodiness and the ease with which she could fly off the handle. She also was inappropriately seductive at times. Her greatest difficulties occurred in her relationships. Fairly attractive, she did not have trouble attracting men. However, relationships rapidly became storm y and self destructive. She would rapidly become clingy. She could go into a rag e if her boyfriend was not fully available to her. When her most recent boyfrien d went to visit his parents without her she became so distraught that she found a man at a bar and spent the weekend with him. The first night she met a man, sh e would be sure he was the life of her life and perfect. She would throw herself into the relationship, idealize him, share every bit of her history and self, o nly to become rapidly disillusioned by him. At times this woman would feel she did not exist and would cut her arms in disso ciative episodes. She could never tolerate being alone with herself. Without str ucture and activities she would feel bored, empty, and almost desperately throw herself into some risky activity. Since finishing college she had considered various career paths. She started law school and dropped out, worked for a magazine for awhile and quit, and joined t he Peace Corps. Stationed in a far off land with little contact with her mother or friends she developed paranoid thoughts and had to be brought back home. Susa n s thoughts about herself and others vacillated markedly. Sometimes she would f eel rage at her mother for not protecting her. Other times she would idealize he r for standing by her and helping her. Her image of herself also vacillated from seeing herself as a loser who would never survive in the world to seeing hersel

 

f as a heroic survivor. MULTIPLE PERSONALITY DISORDER THE CONCEPT OF "PERSONALITY" Behavioral expressions of humans and other complex social animals are defined by three psychological components: temperament, culture, and personality. Temperam ent is inborn and characterizes a specific animal species. A fox constantly runs about looking for food or mischief, but a lion sleeps twenty hours a day. Cows mainly rest or feed slowly, but dolphins are highly active, spending brief momen ts to feed and long hours to play. Humans devote long hours to work, rest, sex, learning, exploration, and entertainment. These biologically predetermined chara cteristics are resistant to change within the lifetime of an individual and defi ne us as a species. Culture is a set of acquired traits and is learned in a social environment. Cult ure can dampen or enhance personal expression. Hispanics are generally vivacious , but Scandinavians are more reserved. Germans are private people, but Italians seem to expose their private lives in the streets. New Zealanders dress conserva tively and the same way, but Americans dress to express their different tastes. Asian cultures suppress individualism, but Americans embrace it. Personality is a psychological concept that reflects acquired behavioral trends of individuals. We spontaneously evaluate other people within the same culture a nd categorize them based on the overall impression they make on us. Although per sonality is difficult to define exactly, we intuitively know what personality is and do not hesitate to form our opinions about the mental, social, and behavior al traits of others. The above characterization of the psychological makeup of humans is largely corr ect, but neither an individual s impression nor psychology as a science are able to fully and correctly recognize the relationships between temperament, culture , and personality. Each of the three psychological components is produced by a c omplex system of neural structures, connections, and neurochemicals. Damage to e ven one attribute of the biological, neural, or psychological makeup of a person can produce subtle or major changes in behavioral expression. These issues are especially important in the multiple personality disorder, when all three psycho logical components of the human being interact and project the images of unique personalities (personas or alters) within a personality (persona or alter) syste m. The alternative labels persona and alter are used intentionally to indicate t hat the neuropsychological construct of a "personality" in the multiple personal ity disorder is not the same thing as the purely psychological set of traits kno wn as personality. To understand the personas/personalities of people with multiple personalities, we need to learn about the overall neurocognitive makeup of the human brain. On ly with this blueprint in our hands, can we reliably recognize what individual p ersonalities consist of and what properties they have. Knowing and correctly app lying the neurocognitive organization of the mind is not merely an academic exer cise, but is critically important for our ability to identify personalities, eva luate their neurocognitive completeness or disintegration, recognize the underly ing brain disorders, and devise appropriate treatment strategies. These issues a re especially significant when personalities exhibit diverse ages, diverse cogni tive abilities, or diverse physiology, handedness, blood pressure, sexual orient ation, allergies, illnesses, or responses to drugs and medications. Having Both PTSD and Borderline Personality Disorder(The Consequences of Living with Both): PTSD and Borderline personality disorder (BPD) have been found to commonly co-oc cur. In fact, it has been found that anywhere between 25 and approximately 60% o f people with BPD also have PTSD -- a rate much higher than what is seen in the

 

general population. Likewise, one study of veterans with combat-related PTSD see king treatment found that 76% of them also had a diagnosis of BPD. The Diagnosis of BPD BPD is part of a group of mental disorders that are referred to as personality d isorders by the 4th edition of the Diagnostic and Statistical Manual of Mental D isorders (DSM-IV). According to the DSM-IV, personality disorders represent a lo ng-standing pattern of problematic behaviors, thoughts, and feelings that often start in adolescence or early adulthood. BPD is made up of the following symptom s: • Persistent and extreme efforts to avoid real or imagined abandonment by others • A pattern of unstable, intense, and stormy relationships where the person may fr equently shift between idealizing and devaluing their partner • Problems with identity, self-image or a sense of who one really is • Being impulsive in ways that are problematic or damaging (for example, engaging in substance use, sexual promiscuity, reckless driving, binge eating, etc.) • Recurring suicidal acts or threats, or deliberate self-harm. • Frequent and intense mood swings • Constant feelings of emptiness • The intense experience of anger and/or difficulties controlling anger • Paranoia or dissociation that comes and goes as a result of experiencing stress To receive a diagnosis of BPD, you need to exhibit at least 5 of these symptoms. Of course, as with all mental disorders, only a mental health professional can provide a diagnosis of BPD. The Consequences of Having Both PTSD and BPD A number of studies have looked at the physical and psychological consequences o f having both PTSD and BPD. It has generally been found that people with both di agnoses experience more psychological and physical difficulties, including, for example: • Overall general distress • Other psychiatric disorders • Depression • Anxiety • Obsessive-compulsive symptoms • Worse perceived health • Impulsivity • Suicidal thoughts • More hospitalizations • Anger problems • Dissociation • Interpersonal problems The findings of these studies suggest the importance of seeking out help if you have both PTSD and BPD. Getting Treatment for PTSD and BPD:There are a number of effective treatments av ailable for PTSD. Seeking out treatment for BPD, such as dialectical behavior th erapy (DBT), may also help reduce PTSD symptoms and address BPD symptoms. Many o f the skills taught in DBT (for example, emotion regulation, being effective in interpersonal relationships) may address some of the problems seen among people with PTSD. Finally, there are some good self-help resources available for BPD as well. PTSD and Anxiety Disorders:It is not surprising that there is a strong connectio n between PTSD and anxiety disorders. The symptoms of PTSD can have a tremendous effect on a person s life. Not only are the symptoms of PTSD distressing, but a person with PTSD may also be more likely to develop other mental disorders, esp ecially anxiety disorders. In addition to the stress-related anxiety disorders of PTSD and Acute Stress Dis order, the anxiety disorders include Generalized Anxiety Disorder, Panic Disorde r, Social Anxiety Disorder, Obsessive-Compulsive Disorder, and Specific Phobia. Each of these disorders will be briefly reviewed below, as well as the rate with which they occur among people who have had PTSD at some point in their lifetime .

 

Generalized Anxiety Disorder Generalized Anxiety Disorder (or GAD) is an anxiety disorder that is characteriz ed by excessive and uncontrollable worry about a number of things. Approximately 17% of people who have had PTSD at some point in their life have b een found to also have GAD at some point in their lifetime. People with a histor y of PTSD are almost 6 times as likely to have a current or past diagnosis of GA D as compared to people without PTSD. Panic Disorder People with Panic Disorder experience frequent and unexpected or "out of the blu e" panic attacks (intense and sudden feelings of fear, impending doom, and/or te rror), as well as worry and concern about having future attacks. Around 7% of people who have had PTSD at some point in their life also have had a diagnosis of Panic Disorder. People who have or have had a diagnosis of PTSD a re 4 times as likely to also have a current or past diagnosis of Panic Disorder as compared to people without PTSD. Social Anxiety Disorder Social Anxiety Disorder or Social Phobia is an anxiety disorder characterized by the experience of intense fear in and avoidance of social situations (for examp le, public speaking, eating in front of others, meeting new people). This fear s tems from strong concerns about being negatively evaluated or judged by other pe ople. People with PTSD may feel "different" from other people or as if they "don t fit in." A person with PTSD may also feel as though social situations are dangerous and therefore can be suspicious of other people. Given this, it is not surprisi ng that Social Anxiety Disorder co-occurs with PTSD at a high rate. Approximately 28% of people with a current or past diagnosis of PTSD also have o r have had a diagnosis of Social Anxiety Disorder. People who have had PTSD at s ome point in their life are 3 times as likely as someone without PTSD to have al so had Social Anxiety Disorder. Obsessive-Compulsive Disorder The main features of Obsessive-Compulsive Disorder (or OCD) are re-occurring and excessive obsessive and/or intrusive thoughts, as well as repetitive behaviors or thoughts (also called compulsions), such as hand washing, counting, or checki ng. Fewer studies have looked at the co-occurrence of PTSD and OCD. It has been foun d that anywhere between 4% to 22% of people with PTSD also have a diagnosis of O CD. Specific Phobia Specific Phobia (sometimes referred to as Simple Phobia) is an anxiety disorder where a person has a fear of specific objects (for example, spiders, blood, snak es, dogs) and/or situations (for example, elevators, bridges, heights). Approximately 31% of people who have had PTSD at some point in their life also h ad or have had a specific phobia. People with a history of PTSD are 7 times as l ikely as people without a history of PTSD to have also had a specific phobia. What Does This All Mean? In a nutshell, these rates mean that having a diagnosis of PTSD puts you at risk to have more problems in the form of additional anxiety disorders. If you have a diagnosis of PTSD, it is very important to seek treatment as soon as possible. Early attention to symptoms of PTSD can reduce the likelihood that they lead to the development of other problems with anxiety that could become another anxiet y disorder. The Relationship of Borderline Personality Disorder to Posttraumatic Stress Diso rder and Traumatic Events: Among the personality disorders, borderline personali ty disorder has been the most frequently studied in terms of the prevalence of e arly adverse events. Multiple studies have reported that a history of physical a nd sexual abuse in childhood has a high prevalence among patients with borderlin e personality disorder, with some studies finding that abuse is a nearly ubiquit ous experience in the early lives of these patients (1–3). The high rate of early trauma in subjects with borderline personality disorder and the phenomenological overlap with posttraumatic stress disorder (PTSD) have led to the hypothesis th

 

at borderline personality disorder may be a trauma-related disorder or variant o f PTSD stemming from early childhood trauma (1, 4). However, early trauma has no t been systematically examined in subjects with other personality disorders, so it is unclear whether the association with early trauma is unique to borderline personality disorder. High rates of comorbid PTSD, ranging from 26% to 57%, have been found in subject s with borderline personality disorder (5, 6). These findings further suggest th at this particular personality disorder may be a variant of PTSD; however, it is not known how prevalent PTSD is in the other personality disorders. Several exp lanations have been proposed for the co-occurrence of borderline personality dis order and PTSD. The comorbidity could be the result of greater trauma exposure i n patients with borderline personality disorder, either in childhood or later in life. Childhood trauma may be a focal precipitant to PTSD or may contribute to a cycle of revictimization that leads to trauma in adulthood (7, 8) and the subs equent development of PTSD. Subjects with borderline personality disorder may al so be at greater risk for victimization or other forms of trauma later in life, perhaps as a result of their impulsivity or chaotic relationships, which could i ndirectly increase their risk of PTSD. Higher rates of PTSD in subjects with bor derline personality disorder may also reflect a greater vulnerability to the psy chological effects of traumatic stress (9) and a diminished ability to adapt to or recover from such events. The co-occurrence could also reflect an intrinsic l ink between the two disorders that is unrelated to trauma exposure, or the co-oc currence may simply be an artifact of overlapping diagnostic criteria, such as a nger and dissociative symptoms. However, since the associations of borderline pe rsonality disorder with both childhood trauma and PTSD have not been studied con currently, the relationship of these variables to one another and to traumatic e vents in adulthood is not known. The objective of this study was to examine the relationship between borderline p ersonality disorder and PTSD with respect to the role and timing of trauma expos ure. These relationships were then examined among other types of personality dis orders to determine whether associations with trauma and PTSD are unique to bord erline personality disorder.

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