[schizotypal-culture-is]

Unpleasant and Pleasant Referential Thinking: Relations with Self- Processing, Paranoia, and Other Schizotypal Traits

"One issue in examining the relation between referential thinking with both self-processing variables and paranoia is that, as suggested by a number of psychopathologists, referential thinking could be multidimensional (Startup & Startup, 2005; Wing, Cooper, & Sartorious, 1974). In particular, referential thoughts might vary in terms of their experienced emotional valence. For example, the most comprehensive measure of referential thinking, The Referential Thinking Scale, was designed to include both positively and negatively valenced referential thoughts (Lenzenweger et al., 1997, Study 1). In contrast, paranoia might involve exclusively negatively valenced thoughts. This is because paranoia involves a threat to self. Hence, paranoid thoughts always involve some unpleasant emotional content. On the other hand, referential thoughts do not necessarily involve a threat to the self and could be either unpleasant or pleasant (Lenzenweger et al., 1997). For example, referential thinking may include unpleasant thoughts, such as “when I see something broken, I often wonder if people blame me for it.” However, it may also include pleasant thoughts, such as “when I hear a favorite song, I often wonder if it was written with me in mind.” Thus, although paranoia seems to always involve negatively valenced thoughts, referential thinking can refer to negatively or positively valenced thoughts. The current research builds on the work of Lenzenweger and colleagues (1997) by empirically testing whether referential thoughts can be experienced as positively valenced, as opposed to exclusively unpleasant."

[hiiragi7]

Y'all really need to learn about DID more outside the context of alters. DID is not just "disordered plurality" - It is a developmental disorder, an attachment disorder, a posttraumatic stress disorder. It is comorbid with many other issues, such as somatic pain syndromes, physical health issues, and a variety of mental illnesses. It is a complex organization of symptoms related to the disrupted healthy development of a child, both in terms of their body and their mind. It is not just about the alters.

[traumameds]

lol it’s not an attachment disorder or developmental disorder….it’s a trauma based disorder due to coping mechanisms they are two separate things please read the DSM.

[hiiragi7]

I have read the DSM. This post is not referring to DSM diagnostic categories. The DSM categorizes diagnoses the way it does due to its usage as a manual, not because its categories have no overlap. This same argument is used to claim that dissociative disorders and personality disorders are not also trauma disorders because they are not in the trauma disorder category in the DSM. It's a silly argument with no basis even within the DSM itself; Here is a quote directly from the preface of the DSM:

Although DSM-5 remains a categorical classification of separate disorders, we recognize that mental disorders do not always fit completely within the boundaries of a single disorder. Some symptom domains, such as depression and anxiety, involve multiple diagnostic categories and may reflect common underlying vulnerabilities for a larger group of disorders.

Additionally, in the introduction of the DSM, they talk not only about how disorder "categories" are fluid and how "a too-rigid categorical system does not capture clinical experience or important scientific observations," but also that the boundaries between disorders themselves are "porous".

Although some mental disorders may have well-defined boundaries around symptom clusters, scientific evidence now places many, if not most, disorders on a spectrum with closely related disorders that have shared symptoms, shared genetic and environmental risk factors, and possibly shared neural substrates (perhaps most strongly established for a subset of anxiety disorders by neuroimaging and animal models). In short, we have come to recognize that the boundaries between disorders are more porous than originally perceived.

Pinging @sysmedsaresexist in case they can add on more than I can here.

To understand DID, it is necessary to look at many more sources than the DSM. Surely this is something we both agree on, as what you are saying - That DID is a trauma-based disorder due to coping mechanisms - is not in the DSM. This is information you must have gotten elsewhere, because the DSM does not say this. At best, the DSM says that DID is "associated with overwhelming experiences, traumatic events, and/or abuse occurring in childhood." Nowhere does it say that DID is either trauma-based or due to coping mechanisms.

Of course, I agree that DID is, in fact, trauma-based and that dissociation is not only a coping mechanism but even more accurately a survival mechanism, but the DSM is not the source to use for this. If you're going to reference a source, make sure what you're saying is actually backed up by that source. Otherwise, use a different source or don't bother at all.

DID being both a developmental and an attachment disorder in addition to a posttraumatic/trauma-based disorder is not at all new. This is an idea which has been explored before and which has rather strong arguments for it.

To quote just one example, this is from Treating Trauma-Related Dissociation by Kathy Steele et. al., to illustrate that this concept is both recognized and accepted even by "big names" in the field of dissociative disorders and DID treatment:

Dissociation is not only an intrapsychic phenomenon but an interpersonal one, being highly reactive to what is happening in relationships in the present (Allen, 2001; Liotti, 2009; Nijenhuis, 2015; Steele & Van der Hart, 2013; Steele et al., 2001). In fact, DID has been aptly described as a developmental attachment disorder (Barach, 1991).

There is so much more out there than the DSM. I highly recommend looking into other books and sources. There's so much to learn from them.

[sysmedsaresexist]

First, OMG,

🤩

But yeah, no, it's a posttraumatic, developmental disorder, and if you called it an attachment disorder to any doctor worth even half their weight, they'd agree, especially with the research coming out about disorganized attachment being the leading predictor of CDDs. This is such an important move in the clinical community!! The very acknowledgment of attachment in the disorder is amazing.

This is the first time I'm seeing someone say "it's not developmental, it's trauma!" Usually, it's, "it's not trauma, it's dissociative!" This should give an indication of how long this argument has been going on and how useless it is in these kinds of discussions.

It's all of them. Literally, it's all of the things, all at once.

Like hiiragi7 said, the categories in the DSM are basically chapter headings, and very nearly every disorder listed in the DSM can be referred to in multiple ways. For example, you'll very often see PTSD referred to as an anxiety disorder and now a dissociative disorder, on top of being posttraumatic.

Also see this section from the DSM:

Some personality disorders can also be posttraumatic, attachment based, and/or developmental [x] [x].

None of these are wrong, it just depends on how and why you're talking about them. Depending on the conversation, it can be more appropriate and easy to refer to it in one way over another. If we're talking about DID as a trauma-based disorder, referring to it as a dissociative disorder might create more confusion, as not all DDs are trauma based. If we're talking about disorganized attachment as a basis, referring to it as an attachment disorder is perfectly appropriate. If we're talking about symptoms, dissociative disorder is best.

But all are correct.

Finish it off with a bunch more doctors calling it different things, developmental, posttraumatic, and attachment.

And some more about attachment! The first link is from 1991-- we've known this for a long time.

Multiple personality disorder as an attachment disorder.

A Model of Dissociation Based on Attachment Theory and Research

From Infant Attachment Disorganization to Adult Dissociation: Relational Adaptations or Traumatic Experiences?

[schizospecinfo]

Hold on, we*re going to try and actually make [ this post ] shorter and easier to read by providing instead of quoting the links.

Anonymous asked: So, do you just make shit up to justify pretending you have multiple personalities? Because it's really weird how psychiatrists don't back up the shit you talk about. But yeah, I'm sure you're smarter than people with real doctorates because you have a Google account. Totally not just a delusional idiot.

A.) PTSD, C-PTSD, PDs, OSDD and DID are disorders of the narrative self. (This will be called Structural Dissociation Disorders)

“Narrative identity is the internalized and evolving story of the self that a person constructs to make sense and meaning out of his or her life. The story is a selective reconstruction of the autobiographical past and a narrative anticipation of the imagined future that serves to explain, for the self and others, how the person came to be and where his or her life may be going.”

Narrative Identity by Dan P. McAdams hosted on APA PsycNet (2011)

To put this into layman's terms, the Narrative Self is the part of the Self that “knows the story” of the self. People have their own autobiographical knowledge and memories of themself, and there is a sort of narration to each individual. The problem with the Structural Dissociation Disorders is that it prevents this “narration” from being a single, cohesive unit. In SDDs, this narration is interrupted by trauma, where the traumatic memory and the emotions stored in it are separated. A pwSDD may be able to recall a traumatic memory and do so in a very detached way (ANP), while flashbacks hold the emotions of the memory (EP). The two aspects of the memory have been fragmented or separated. They are not integrated.

SOURCE: Is Trauma Memory Special? Trauma Narrative Fragmentation in PTSD: Effects of Treatment and Response by Michele Bedard-Gilligan, Lori A. Zoellner, and Norah C. Feeny hosted on PMC (2017)

SOURCE: Understanding and Treating Unwanted Trauma Memories in Posttraumatic Stress Disorder by Anke Ehlers hosted on PMC (2010)

As a side note, this is why “meaning making” is the final step in trauma therapy for pwPTSD. A pwPTSD can reintegrate the traumatic memory and assign personal meaning to it that goes beyond meaningless abuse/violence/trauma.

SOURCE: Narrative Exposure Therapy (NET) by N/A hosted on apa.org (2017)

SOURCE: Meaning Making Following Trauma by Crystal L. Park hosted on PMC (2022)

So we understand now, right? Structural Dissociation Disorders (PTSD, C-PTSD, PDs*, OSDD and DID) are disorders of the narrative self because traumatic memories are stored in the brain in a different way than normal memories, which results in an ANP(s) and EP(s). This disrupts the autobiographical nature of the Narrative Self because the narration has been split into parts: the actual memory and the emotions attached to the memory. PTSD can actually recover through memory making, which works to reintegrate the traumatic memory bak into the overall narrative of one’s self.

*PDs are a disorder of the narrative self due to splitting, and info on that can be found here: Key Concept - Splitting by Dr. Craig Childress (2014) you can also research attachment theory and disordered attachment to understand what the splitting process/basis of PDs is and why it forms.

B.) Ipseity disturbance is the disorder of the minimal self

Ipseity disturbance is a theory for schizo-spec disorders to explain what the root cause of schizo-spec disorders are. For those who don’t know, schizophrenia isn’t really a singular disorder, but rather the grouping of several disorders that can actually all exist on their own (delusional disorder, hallucinations, PPD, catania, and disorganized symptoms which are an umbrella of various cognitive and intellectual disabilities). Ipseity is the theory that pwSzSD (Schizo-Spec Disorders) lack or have a weak minimal self, and that’s why these grouping of other disorders A.) manifest and B.) have the profound effect that they do on pwSzSD.

The minimal self is basically the foundation for a person’s sense of self, it is what (on a very subconscious level) allows your brain to determine what is “you” and what isn’t “you”, it draws a line between the Outside and the Inside. The minimal self is what allows you to know that you take up space, that your consciousness inhabits a body, that you are in a specific, fixed point. You are separate from the chair, from the walls, from the people in the crowd. It is this very innermost, basic, fundamental, subconscious sense of self. People on the schizo spectrum lack this barrier between “me” and “not me”.

SOURCE: Self-disturbance and schizophrenia: structure, specificity, pathogenesis (Current issues, New directions) by Louis A Sass hosted on PMC (2013)

SOURCE: Disturbance of Minimal Self (Ipseity) in Schizophrenia: Clarification and Current Status by Barnaby Nelson, Josef Parnas, and Louis A. Sass hosted on PMC (2014)

SOURCE: Varieties of Self Disorder: A Bio-Pheno-Social Model of Schizophrenia by Louis Sass, Juan P Borda, Luis Madeira, Elizabeth Pienkos, and Barnaby Nelson hosted on PMC (2018)

SOURCE: Towards a Neurophenomenological Understanding of Self-Disorder in Schizophrenia Spectrum Disorders: A Systematic Review and Synthesis of Anatomical, Physiological, and Neurocognitive Findings by: James C. Martin, Scott R. Clark, and K. Oliver Schubert hosted on PMC (2023)

C.) Because minimal self is a deeper layer of self than the narrative self, there’s no way to have a self disorder, but have a cohesive, healthy, non-fragmented narrative self

SOURCE: The fragmented self: imbalance between intrinsic and extrinsic self-networks in psychotic disorders by Dr Sjoerd J H Ebisch, PhD and André Aleman, PhD hosted on The Lancet Psychiatry (2016)

SOURCE: Between Minimal Self and Narrative Self: A Husserlian Analysis of Person by Jaakko Belt hosted on ResearchGate (2019)

SOURCE: Reflections on Inner and Outer Silence and Consciousness Without Contents According to the Sphere Model of Consciousness by Patrizio Paoletti and Tal Dotan Ben-Soussan hosted on ResearchGate (2020)

As you can see in the diagram, the narrative self is built off the minimal self. Think of the minimal self as the foundation to a house, and the narrative self as the frame. Structural Dissociation Disorders have a solid minimal self/foundation, but the frame of their house is fragmented, broken and unstable. With ipseity in schizo-spectrum disorders, the minimal self is disordered, so the foundation is fragmented and broken. You can’t really build a solid, sturdy and reliable framework for a house on a broken and fragmented foundation. In a similar sense, Structural Dissociation Disorders have a disorder in the narrative self because their autobiographical narration is fragmented (traumatic memory + ANP and EP); in ipseity, or minimal self disorder, you can’t have an autobiographical narrative when you don’t feel like the narration is happening to you. (And memory problems and other cognitive dysfunctions are already known negative and disorganized symptoms of schizo-spec disorders).Ugghhh, we*re running outta spoons here. But. Is there an article out there in plain black-and-white text that explicitly states, “schizo-spec disorders can cause plurality”? No, sorry, but you’re going to have to do the research on narrative self disorders/structural dissociation and minimal self disorders/ipseity and rub your two little brain cells together. And, to be quite honest, there may never be a paper like that, at least not in the near future, because there’s so much more going on in the research realm of schizo-spec disorders (such as ipseity, the root cause of schizo-spec disorders, how to treat disorganized and negative symptoms of schizo-spec disorders, the neurophysiology of schizo-spec disorders, etc). And, just because ipseity can cause plurality doesn’t mean it’s going to look and act and behave the same as structural dissociation (duh, they're two different disorders, although it is worth noting that pwSSD are more likely to be abused, and already having ipseity could mean we’re more likely to become a system since we go into the trauma without a solid minimal self foundation. It could mean we’re more likely to become a system, have a lower threshold for what counts as trauma, and perhaps there’s no age cut-off, since we never had a cohesive, integrated self to begin with. However, with non-schizo systems having a minimal self, opposed to schizo-spectrum systems not having a minimal self, the internal structures of a schizo and non-schizo system may be drastically different, but that’s a different conversation. Of course, this is just speculation on our* behalf, but it is a conclusion drawn upon by medical research.)

[too-many-mes]

Fellow system here! I don’t know what being polyfragmented means. Could you please explain it to me?

Polyfragmented DID is really difficult to explain because there's not really any literature on it beyond a few papers.

Generally, it means somebody who has a complicated system. Polyfragmented systems also tend to have a high number of alters, but that's not a requirement.

There is no set number of how many alters you have to have, despite what people might try to say. And having a large number of alters is not the defining feature of polyfragmented DID; it is the complex organization of a system that's more important.

Besides, most polyfragmented systems will tell you that they have no idea how many alters they have, but they know they're polyfragmented for other reasons (I myself can't tell you how many, but I know there are many based off of the many common features of polyfragmented DID that I highly relate to, my own feelings, etc.).

Here are COMMON FEATURES of polyfragmented systems:

Note that these are COMMON FEATURES and not DEFINING FEATURES. Not all polyfragmented systems will have these experiences, nor will they have ALL of these experiences, and these experiences do not DEFINE polyfragmented DID.

It's common for polyfragmented systems to have a history of trauma/abuse that lasted a very long time.

It's common for polyfragmented systems to have a history of trauma/abuse that started very early in life (as an infant, a toddler, etc.)

It's common for polyfragmented systems to have a history of trauma that occurred over many, many years (past teenage years, past adulthood, etc.)

It's common for polyfragmented systems to have a history of extreme and/or sadistic abuse (organized abuse, ritual abuse, sexual abuse involving animals, etc.)

It's common for polyfragmented systems to split alters easily, and frequently.

"As children they had been so bombarded with outrages that they had not been able to develop a cohesive and comprehensive system of alters within which their further traumata could be managed. Instead, new alters were formed frequently on an ad hoc basis, and many persisted, some becoming major, some highly specialized, and some fairly inactive. Clearly their families were chaotic and unsafe, as evidenced by the high percentage of incest victims." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

"All MPD patients were most unfortunate in their life experiences, but for many the abuse was unusual even by the norms of work with MPD patients." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

Having a large amount of alters may mean that many alters share overlapping traits, likes, dislikes, etc.

Having so many alters and so many alters with overlapping traits may make it difficult for polyfragmented systems to figure out who their alters are, figure out their system, etc.

It's common for polyfragmented systems to have alters who might seem like different "versions" of the same alter

Polyfragmented systems often might mistakenly believe that they had OSDD due to the nature of how similar their parts are, how difficult it is to discern between who is who, etc.

Polyfragmented systems may frequently find themselves discovering new alters frequently, sometimes daily/weekly/etc.

Polyfragmented systems may be more likely to feel as if they never have a sense of self, or only very rarely have a sense of self

While this is true for ANY system, small or not, I believe it's accurate to say that polyfragmented systems may be more likely to experience a presentation of DID that is not "obvious" to others.

"The more alters that a patient has, the higher the percentage of them that will appear less frequently or openly. To anticipate a point, the more alters that are both present and active, the less clearly is the patient likely to display the features expected to be found in the classic descriptions of MPD, which are based on the alternation of a small number of well-defined alters." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

"Another phenomenon that appears to have impacted on the manifest appearance of these patients, and thus upon their ability to be diagnosed, is order effect. First brought to the awareness of the MPD field by Frank W. Putnam, M.D., in a series of workshops and other presentations, this phenomenon relates to the fact that all alters are not the same all the time. Alter A may be somewhat different when it has been preceded by alter B than when it follows alter C. In situations in which many alters are switching with rapidity and facility, their appearance may not be as crisp and clear as when they are elicited in the clinical situation from a relatively placid baseline. In naturalistic circumstances, the alters of a highly complex and rapidly switching MPD patient may show few of the clear phenomena commonly associated with the condition." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

"Some multiples with subtle forms could be complex multiples with 26 or more personalities and personality states or polyfragmented multiples." -- DIAGNOSIS OF COVERT AND SUBTLE FORMS OF MULTIPLE PERSONALITY DISORDER

It's common for polyfragmented systems to have less integrative capacity, and less ability to cope with stress, leading to many polyfragmented systems splitting alters in response to any and all stressors.

"A substantial minority had developed a pattern of forming new alters in the face of trivial stressors and inconveniences, or whenever they felt cornered." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

It's common for polyfragmented systems to switch frequently, and switch easily, often instantaneously.

* This is not exclusive to polyfragmented systems; any system can switch frequently, easily, and instantaneously; I just believe that polyfragmented systems may be more likely to experience this, but not always.

"Extremely Complex or Polyfragmented MPD: Presence of such a wide variety of alter personalities with such frequent switching between alters that it is difficult to discern the outline of MPD and the multiplicity actually disguises itself." -- Common Presentations of MPD

"Switching between alternate identities has been reported to take anywhere from a few seconds. to 30 sec, to brief times less than 2–5 min. However, the switches that occurred during this study were rapid and appeared instantaneous. Some switches were readily apparent, while others were not, but for the most part the DID participants were able to identify when they had switched in the previous session." -- Measuring Fragmentation in Dissociative Identity Disorder: the Integration Measure and Relationship to Switching and Time in Therapy

It's also common for polyfragmented systems to have an extremely vast, vivid, and distinct inner world, but not always.

"Over two-thirds had developed elaborate inner worlds, in which the personalities interacted among themselves to an extent that is far beyond the norm in MPD. These inner alters were quite crucial to these patients' psychological structure and could emerge and assume executive control." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

Here are some other things that Kluft's paper mentions about polyfragmented DID:

"Almost two-thirds developed complex splitting patterns so that more than one new alter emerged on each occasion of the formation of new alters. Some developed separate lines of alters, each of which divided further on each occasion of new alter formation. Some had developed a pattern of generating new alters in clusters, such as groups each of whose members served different functions, or retained different aspects of a terrible experience."

"A like number reported that others encouraged and / or manipulated their condition."

"Epochal divisions were common in most of this cohort as isolated phenomena, but played a major role in a substantial minority. With each major life change some or all of the alters were created anew, and their predecessors might either remain active or subside, and become covert or latent. The dynamics of such configurations usually reflect the wish to make a new start , rebirth fantasies, or anniversary phenomena."

"Those few MPD patients who analogize their plights to known myths or creative works (or who generate their own) may create a number of alters with little substance to fill in roles in their myth or reconfigure the present alters to parallel the personae of the myth/ creative work. With such patients, it becomes crucial to understand the communicative function of the myth rather than to become enmeshed within its details. One patient reconfigured her alters after reading J.R.R. Tolkien 's Lord oj the Rings, and presented a complex cadre of alters based on hobbits, orcs, and wizards; another used Shakespeare's Tempest, a situation that became clear when I encountered an alter called Caliban."

"Most MPD patients have alters based on identification, internalization, and introjection, but a small percentage have formed a massive number of alters in this manner as a defense against object loss. These patients were rejected by large extended families, and introjected their members, forming alters based upon them."

"A small number of MPD patients have attributed special power to particular symbols or numbers, and these come to influence their manner of alter formation. One patient felt the number seven had special meaning to her. She wore a ring with seven stones, and her alters emerged in groups of seven."

[auschizm]

Autistic people experience psychosis at a higher rate than the general population. And people with schizo spec disorders are likely to have strong autistic traits even long before they develop psychosis. On top of this, both diagnoses have a big general overlap in traits and experiences. And that's why I think we need to discuss "auschizm" just like we've started discussing auDHD

[schizosupport]

Kat asked me if I could help her out with adding some sources, and I realized a lot of the articles I've read about this during uni are behind a paywall, so here's a link to a google drive folder with some relevant studies for those interested!

A good place to start could be Barneveld et.al. (2011)'s article. Based in the fact that up to 35% of autistic youth go on to develop a schizophrenia spectrum disorder (dependent on the study), Barneveld and co. studied the connection between autistic and schizotypal traits in autistic youth. They found significantly higher rates of schizotypy in autistic youth than in control groups, across both negative, positive and cognitive symptoms. Higher scores on autistic symptoms scales was associated with higher scores on schizoptypy scales.

Another interesting study in there, by Eack et al. (2013), compared a group with schizophrenia with a group with ASD and a healthy control group on a number of cognitive and social-cognitive parameters. They found that there was no significant difference between the autistic and schizophrenic group, but both groups did significantly worse than the control group. (For reference, social cognition refers to basic social skills like reading other people etc., that are a part of the diagnostic criteria for ASD. So in other words, on average the schizophrenic people struggled similarly with social skills as the autistic people in this study).

I can also recommend reading Rapoport et al. 2005 and 2012 (and maybe Cannon (2002)) for elaboration on schizophrenia as a unique neurovelopmental disorder, which presents with delays in language development, motor skill development, cognition and social-emotional functioning in childhood way before psychotic illness onset.

So yeah, in short, there is a huge overlap between the autistic community and the schizo spec community in a bunch of interesting ways!

I hope this helps someone as a place to start looking into this!

[schizodiaries]

The closest schizophrenia-related concept to 'identity splits' I am aware of that comes from reputable sources is that of ego fragmentation also known as ipseity disturbances or self-disorders, which was talked about in Chapter 5 of Psychosis, Trauma, and Dissociation. I don't have the energy to summarize it all, but here are some informative sections from the chapter:

I consider this fragmentation or splitting of the ego to be a special form of dissociation, striking the ego/self along the five basic dimensions of vitality, activity, coherence/consistency, demarcation, and identity... ...the peculiar rigidity and fragility of the schizophrenic ego, which predisposes it to fragmentation, contrasts with the fluid ego states observed in DID and BPD. This ‘ego‐fluidity’ may protect those with DID or BPD from the extreme fragmentation and deterioration seen in the schizophrenic syndromes... ...The statements made by schizophrenic patients about their self‐experience and the relationship between their self‐experience and behaviour was the starting point for the study of ego‐pathology.

Below are pictures of the five domains of ego-pathology with quotes from schizophrenic patients that fit into them.

Trigger warning: unreality, derealization, depersonalization, paranoia.

Visit the r/piracy megathread to find this book's pdf for free if you want to read more - it's not an old or hard to find book at all, I probably downloaded it from z-library tbh

This is very insightful and informative, thank you very much for sharing!

[psychotic-gerard]

what's the difference between schizoaffective and schizophrenia?

schizoaffective’s existence is more debated than schizophrenia, for one’s, but the primary difference is “is there a persistent disordered mood component that appears with the schizophrenia but ceases to appear when the schizophrenia enters remission.”

if

the mood disorder (depression or mania) disappears when you are not experiencing schizophrenic symptoms

the mood disorder developed noticeably before the schizophrenia

the mood disorder developed noticeably after the schizophrenia

you probably will get a diagnosis of schizophrenia + a mood disorder, especially in the case of depressive episodes (mania is more complex)

if

the mood disorder persists even after schizophrenic symptoms disappear

the schizophrenic symptoms do not meet the criteria for schizophrenia

you probably will get a diagnosis of a mood disorder + [features of] psychosis

basically schizoaffective is just a mood disorder and schizophrenia together in a way that seems more closely linked than can be explained by having it as two separate disorders. it’s controversial because of that + theories that mania and psychosis is a continuum so this is a severe but genuine progression of schizophrenia as opposed to being a separate disorder, etc.

[sysboxes]

Hi, I saw you make a userbox on C-DID and I wanted to ask if you maybe have a good resource or something that explains what it is? cause I have DID but ive never heard it with the C attached... no worries if not. thank you!!

C-DID stands for Complex DID. Complex DID and Polyfragmented DID are the same thing, though some people may say that there are some differences.

(I’ll just refer to it as polyfrag for the rest of this for simplicity)

Polyfragmented DID is considered a more “complex” version of DID. The complexity comes from:

splitting patterns ~ splitting several alters/fragments at once, splitting a lot over a short period of time, and/or splitting more frequently or easily

fragments ~ not all DID systems have fragments whereas polyfrag DID systems typically have at least some, if not a lot. Often times polyfrag can have subsystems made up of fragments or they’ll have at least one group of alters who are fragments holding similar trauma or the same traumatic experience split up between fragments (example: one fragment holds the emotions or the fear, one holds the sensations, one holds the memories, etc. or they each hold bits of memory. Or whatever else, it varies)

System Structure ~ briefly mentioned above, but with polyfrag it’s primarily about the way the system is structured or the way the system functions. Meaning polyfrag have subsystems (an alter has their own system OR there is a group of alters who exist together or function as one collective), a system or group of alters separated from the “main” group of alters, etc

The person typically starts being traumatized and forced to dissociate in infancy or sometimes as a toddler (whereas with DID, you can start developing DID later on). Though this is not a requirement and not always the case.

With polyfrag DID, they’re usually forced to dissociate throughout childhood, sometimes even throughout being a teen and sometimes during adulthood or at least early adulthood

polyfrag systems can have high alter count, but this is not a requirement. And it’s typically that they have lots of fragments, not fully-formed/fleshed out alters. 

polyfrag systems do not have to switch frequently, though some do switch frequently or have a larger group of alters who help take care of daily things

Because Complex DID and Polyfrag DID are not actually medical terms, it’s hard to find reliable information on them. They are more just community terms for people to describe their unique experiences. Basically it’s a way to differentiate themselves from typical DID systems and a way to describe their more complex structure. Some therapists or medical professionals may describe someone’s DID as being complex or polyfragmented, but again, it’s not actually a medical term it’s more just a descriptor.

Every system is going to be different. Everyone uses these terms to mean something a little different. But the stuff I listed is generally what people use it to mean. 

Here’s some links below (again, these aren’t medical terms so there aren’t really medical papers or anything on it and it’s mostly just people in the community describing their experiences or what they consider polyfragmentation)

Someone on tumblr listing what a polyfrag system usually means

Someone on tumblr describing difference between DID and C-DID

Someone on tumblr explaining what fragments are

Someone on tumblr explaining what polyfrag is and quoting research

Someone on tumblr listing what C-DID could entail

A PDF of a medical paper on complex MPD (this paper is from the 1980s I think, when DID was still called MPD)

A polyfrag DID systems vent on Reddit about what being polyfrag is for them (I wasn’t really sure about whether to include this or not bc it is a vent but it’s also a good explaination of what polyfrag DID actually is versus what people portray it as on social media..)

(if any of this is wrong plz let me know we’re not perfect lol and I didn’t read through all of these links)

[too-many-mes]

Fellow system here! I don’t know what being polyfragmented means. Could you please explain it to me?

Polyfragmented DID is really difficult to explain because there's not really any literature on it beyond a few papers.

Generally, it means somebody who has a complicated system. Polyfragmented systems also tend to have a high number of alters, but that's not a requirement.

There is no set number of how many alters you have to have, despite what people might try to say. And having a large number of alters is not the defining feature of polyfragmented DID; it is the complex organization of a system that's more important.

Besides, most polyfragmented systems will tell you that they have no idea how many alters they have, but they know they're polyfragmented for other reasons (I myself can't tell you how many, but I know there are many based off of the many common features of polyfragmented DID that I highly relate to, my own feelings, etc.).

Here are COMMON FEATURES of polyfragmented systems:

Note that these are COMMON FEATURES and not DEFINING FEATURES. Not all polyfragmented systems will have these experiences, nor will they have ALL of these experiences, and these experiences do not DEFINE polyfragmented DID.

It's common for polyfragmented systems to have a history of trauma/abuse that lasted a very long time.

It's common for polyfragmented systems to have a history of trauma/abuse that started very early in life (as an infant, a toddler, etc.)

It's common for polyfragmented systems to have a history of trauma that occurred over many, many years (past teenage years, past adulthood, etc.)

It's common for polyfragmented systems to have a history of extreme and/or sadistic abuse (organized abuse, ritual abuse, sexual abuse involving animals, etc.)

It's common for polyfragmented systems to split alters easily, and frequently.

"As children they had been so bombarded with outrages that they had not been able to develop a cohesive and comprehensive system of alters within which their further traumata could be managed. Instead, new alters were formed frequently on an ad hoc basis, and many persisted, some becoming major, some highly specialized, and some fairly inactive. Clearly their families were chaotic and unsafe, as evidenced by the high percentage of incest victims." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

"All MPD patients were most unfortunate in their life experiences, but for many the abuse was unusual even by the norms of work with MPD patients." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

Having a large amount of alters may mean that many alters share overlapping traits, likes, dislikes, etc.

Having so many alters and so many alters with overlapping traits may make it difficult for polyfragmented systems to figure out who their alters are, figure out their system, etc.

It's common for polyfragmented systems to have alters who might seem like different "versions" of the same alter

Polyfragmented systems often might mistakenly believe that they had OSDD due to the nature of how similar their parts are, how difficult it is to discern between who is who, etc.

Polyfragmented systems may frequently find themselves discovering new alters frequently, sometimes daily/weekly/etc.

Polyfragmented systems may be more likely to feel as if they never have a sense of self, or only very rarely have a sense of self

While this is true for ANY system, small or not, I believe it's accurate to say that polyfragmented systems may be more likely to experience a presentation of DID that is not "obvious" to others.

"The more alters that a patient has, the higher the percentage of them that will appear less frequently or openly. To anticipate a point, the more alters that are both present and active, the less clearly is the patient likely to display the features expected to be found in the classic descriptions of MPD, which are based on the alternation of a small number of well-defined alters." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

"Another phenomenon that appears to have impacted on the manifest appearance of these patients, and thus upon their ability to be diagnosed, is order effect. First brought to the awareness of the MPD field by Frank W. Putnam, M.D., in a series of workshops and other presentations, this phenomenon relates to the fact that all alters are not the same all the time. Alter A may be somewhat different when it has been preceded by alter B than when it follows alter C. In situations in which many alters are switching with rapidity and facility, their appearance may not be as crisp and clear as when they are elicited in the clinical situation from a relatively placid baseline. In naturalistic circumstances, the alters of a highly complex and rapidly switching MPD patient may show few of the clear phenomena commonly associated with the condition." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

"Some multiples with subtle forms could be complex multiples with 26 or more personalities and personality states or polyfragmented multiples." -- DIAGNOSIS OF COVERT AND SUBTLE FORMS OF MULTIPLE PERSONALITY DISORDER

It's common for polyfragmented systems to have less integrative capacity, and less ability to cope with stress, leading to many polyfragmented systems splitting alters in response to any and all stressors.

"A substantial minority had developed a pattern of forming new alters in the face of trivial stressors and inconveniences, or whenever they felt cornered." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

It's common for polyfragmented systems to switch frequently, and switch easily, often instantaneously.

* This is not exclusive to polyfragmented systems; any system can switch frequently, easily, and instantaneously; I just believe that polyfragmented systems may be more likely to experience this, but not always.

"Extremely Complex or Polyfragmented MPD: Presence of such a wide variety of alter personalities with such frequent switching between alters that it is difficult to discern the outline of MPD and the multiplicity actually disguises itself." -- Common Presentations of MPD

"Switching between alternate identities has been reported to take anywhere from a few seconds. to 30 sec, to brief times less than 2–5 min. However, the switches that occurred during this study were rapid and appeared instantaneous. Some switches were readily apparent, while others were not, but for the most part the DID participants were able to identify when they had switched in the previous session." -- Measuring Fragmentation in Dissociative Identity Disorder: the Integration Measure and Relationship to Switching and Time in Therapy

It's also common for polyfragmented systems to have an extremely vast, vivid, and distinct inner world, but not always.

"Over two-thirds had developed elaborate inner worlds, in which the personalities interacted among themselves to an extent that is far beyond the norm in MPD. These inner alters were quite crucial to these patients' psychological structure and could emerge and assume executive control." -- The Phenomenology and Treatment of Extremely Complex Multiple Personality Disorder

Here are some other things that Kluft's paper mentions about polyfragmented DID:

"Almost two-thirds developed complex splitting patterns so that more than one new alter emerged on each occasion of the formation of new alters. Some developed separate lines of alters, each of which divided further on each occasion of new alter formation. Some had developed a pattern of generating new alters in clusters, such as groups each of whose members served different functions, or retained different aspects of a terrible experience."

"A like number reported that others encouraged and / or manipulated their condition."

"Epochal divisions were common in most of this cohort as isolated phenomena, but played a major role in a substantial minority. With each major life change some or all of the alters were created anew, and their predecessors might either remain active or subside, and become covert or latent. The dynamics of such configurations usually reflect the wish to make a new start , rebirth fantasies, or anniversary phenomena."

"Those few MPD patients who analogize their plights to known myths or creative works (or who generate their own) may create a number of alters with little substance to fill in roles in their myth or reconfigure the present alters to parallel the personae of the myth/ creative work. With such patients, it becomes crucial to understand the communicative function of the myth rather than to become enmeshed within its details. One patient reconfigured her alters after reading J.R.R. Tolkien 's Lord oj the Rings, and presented a complex cadre of alters based on hobbits, orcs, and wizards; another used Shakespeare's Tempest, a situation that became clear when I encountered an alter called Caliban."

"Most MPD patients have alters based on identification, internalization, and introjection, but a small percentage have formed a massive number of alters in this manner as a defense against object loss. These patients were rejected by large extended families, and introjected their members, forming alters based upon them."

"A small number of MPD patients have attributed special power to particular symbols or numbers, and these come to influence their manner of alter formation. One patient felt the number seven had special meaning to her. She wore a ring with seven stones, and her alters emerged in groups of seven."

[therapy101]

The PTSD Masterpost

Posts

Flashbacks

Complex PTSD

Dissociation

The 6 categories post

PTSD Criteria & Diagnosis

The difference between PTSD & trauma

Changes to PTSD criteria in DSM-5

PTSD diagnostic criteria

What is a criterion A level trauma?

Emotional abuse part 1

Emotional abuse part 2

Non-interpersonal trauma

Do suicide attempts count as a criterion A trauma?

Trauma from serious physical illness

Challenges in diagnosing PTSD

Can I have PTSD if I don’t have flashbacks?

Paranoia

CPTSD

(see also the CPTSD post, above)

Differences between CPTSD and BPD

CPTSD treatment

The Body Keeps the Score

Can trauma cause BPD?

Trauma Severity & PTSD

What is trauma? part 1

What is trauma? part 2

Is my trauma severe enough part 1

Is my trauma severe enough part 2

Is my trauma severe enough part 3

Can I have trauma without having PTSD? part 1

Can I have trauma without having PTSD? part 2

Is neglect trauma?

How likely is it that person will get PTSD after losing a parent to suicide?

What if I have PTSD symptoms but no trauma?

Why do some people get PTSD after trauma but others don’t?

Dissociation

(see also the dissociation post, above)

Is dissociation unhealthy?

Why do some people not want to integrate their dissociative identities?

Causes of dissociation

Can you dissociate if you don’t have PTSD or trauma?

PTSD & Memory

Is the trauma memory true? part 1

Is the trauma memory true? part 2

Can I recover my trauma memory?

On repressed memories

Out of body memories

How can I have PTSD if I don’t remember my trauma?

Is it possible that I experienced trauma even though I don’t remember it?

Recovery

Is recovery possible?

Is recovery from CSA possible?

Symptom fluctuation

Treatment for PTSD

Exposure treatment part 1

Exposure treatment part 2

Exposure treatment part 3

EMDR part 1

EMDR part 2

EMDR part 3

Cognitive processing therapy

Schema therapy

Time perspective therapy

Somatic experiencing

Critical incident stress debriefing

Do I need to do CPT or exposure to heal from PTSD?

Psychedelics

Trauma informed care & cultural competence

Dissociation during treatment

PTSD & Working with Therapists

Isn’t it condescending for therapists to guide clients to their own conclusions?

Is my therapist judging me? part 1

Is my therapist judging me? part 2

Does my therapist think my trauma isn’t severe enough?

Do I have to tell my therapist specifics about my trauma? part 1

Do I have to tell my therapist specifics about my trauma? part 2

How should I tell my therapist about my trauma?

Can my therapist handle my trauma?

Can I ask my therapist if they have experienced trauma?

How do I tell my parents I have PTSD and need treatment?

Symptoms getting worse before they get better

Is it selfish to talk about trauma in therapy if my symptoms aren’t too bad?

Feeling worthless because I need help part 1

Feeling worthless because I need help part 2

Working in Mental Health

PTSD & working in mental health part 1

PTSD & working in mental health part 2

Working with perpetrators as a therapist

Preventing burn-out

Flight/flight/freeze response

PTSD & the military

Fainting during trauma

[schizotypal-culture-is]

In Schizotypal, what exactly constitutes as "odd behavior"?

Excessive reliance on analysis (often to add meaning to situations such as reading into a simple gesture or intellectualizing when handling emotions)

Carrying objects people typically wouldn’t have on them (crystals, weapons, a specific object that may hold some sort of personal significance, things “just in case”, something random you forgot you were carrying, etc.)

Making vague assumptions/loose connections between events (“It rained when I said it might, so I must be able to predict the weather.” “They didn’t wave back when I waved to them, so they must be mad at me.” “An object got lost after I had been staring at it earlier, so that must’ve been a sign it would go missing.”)

Talking to yourself frequently (having imaginary conversations, creating monologue to keep yourself focused, planning out future conversations, answering your own questions and responding to your own thoughts)

Reacting to internal stimuli (jumping in response to a feeling, scratching and picking at your skin, making eye movements unrelated to things in your surroundings, repeatedly checking behind you in an empty space)

Frequent disorientation and changes in cognitive ability (loss of direction in familiar settings, mixing up steps in a task, zoning out and coming to multiple times in a row, zoning out for abnormally long periods of time, forgetting what you’re doing, forgetting where you are, being unaware of the passage of time, appearing dazed or confused to others, becoming overwhelmed without clear reason)

Presenting traits of thought blocking or other thought disorders (losing your train of thought mid-sentence, taking long pauses when speaking or trailing off completely, finding words difficult to string together, blanking out on questions you should be able to answer easily, appearing distracted during conversation, frequently getting off topic after a lull in speech, forgetting what you were talking about, going on tangents and forgetting about the original story you were telling, inventing new words such as adding -ing to a noun in order to use it as a verb, speaking in riddles or metaphors, using language in ways that are hard for others to understand such as being vague or over elaborate, mixing up words, accidentally combining or misusing words, repeating an idea by using different words to express the same thought, interrupting yourself to add on an explanation, ruminating on the same subjects such as not allowing the conversation to move forward, expressing part of an idea without adding the full context or only adding context after the fact)

Dressing oddly (having an unkempt appearance, dressing to resemble fictional characters, wearing clothing that doesn’t match, dressing flamboyantly or with lots of bright colors, dressing in exclusively bland or worn out clothing, wearing the same clothes multiple days in a row, wearing clothing that is not suitable for the weather such as long sleeves during the summer or shorts when it’s snowing, wearing clothes that don’t fit such as a shirt that is two sizes too big, wearing only a certain type of clothing such as pants with elastic waistbands or fabrics of a specific material, having one or more “trademark” accessories that you always wear such as a jacket, scarf, or specific piece of jewelry, buying and wearing duplicate outfits or seeming to have a formula for how you dress, having a fashion style that predates modern era or fits in with a different cultural identity such as wearing hand-beaded jewelry, mythological patterns and symbols, or shopping for vintage)

Abnormal eye contact and visual/perceptual activity (having a flittering gaze, preferring to stare at the ground or off into the distance rather than at the person you’re talking to, being easily distracted by movement and changes in lighting, eye twitches or optical reflexes that may resemble twitching, having an unfocused gaze, having a fixed gaze or excessive focus on a single point in one’s vision, staring intently at patterns or details such as a wallpaper or the bark on a tree— may also report that the details are moving or that they’re simply just entertaining to look at, may describe blank walls as “breathing”, may become afraid when looking at objects in dim light or at a distance, may mistake your own limbs for someone else’s, think you might be dreaming or hallucinating real stimuli)

Mistrustful behavior and persistent social anxiety (being reluctant to give information to trusted sources, assuming negative intentions from others, being especially suspicious of strangers and people you don’t know very well, being excessively secretive about yourself, keeping close guard over your belongings, carrying weapons into safe environments, sleeping with weapons nearby, refusing to sleep in communal areas or finding it difficult to sleep with others around, taking precautions against the worst case scenario, assuming others are out to get you, finding it difficult to relax in the presence of others, isolating yourself for safety and disliking having to go out, taking a passive or accusatory stance towards people, discomfort with situations in which you have little knowledge of what will happen, avoidance of new environments out of a mistrust towards unfamiliarity, finding security in sameness and predictability)

[gray-gray-gray-gray]

Chapter 2 of Schizophrenia, Third Edition: The schizophrenia construct - symptomatic presentation

Most people with schizophrenia experience delusions and hallucinations, and many (but not all) experience disorganized thinking. There are also negative and cognitive symptoms.

For reality distortion, the delusions and hallucinations: A delusion is an unshakable, false idea or belief that cannot be attributed to the patient's educational, social, or cultural background, which is held with extraordinary conviction and subjective certainty, and is not amenable to logic. Delusions are divided into primary and secondary delusions: Primary delusions (more characteristic of schizophrenia) do not occur in response to something else such as a mood disorder or hallucination. Secondary delusions can be understood in relation to a person's background culture or emotional state.

Primary delusions include delusional perceptions and delusional intuitions. Delusional pereptions are normal perceptions that are interpreted with a delusonal meaning. Delusions are extremely variable in content. The most common delusions may be delusions of persecution, delusions of influence or control, thought withdrawal, thought insertion, thought broadcasting, morbid jealousy, erotomania, delusional misidentification, grandiose delusions, and religious delusions. In schizophrenia, the most common is delusions of persecution. The content of the delusion is often determined by the maturational, social, educational, and cultural background of the patient.

People with schizophrenia experience abnormal perceptions mainly in the form of sensory distortions - real objects are distorted - and false perceptions - where a new perception occurs. In false perceptions, there are illusions and hallucinations. Illusions are transformations of perceptions. Hallucinations are perceptions without object. Hallucinations can occur in any sense (auditory, visual, olfactory, gustatory and tactile, somatic or kinesthetic.) Around 50% of people with schizophrenia experience auditory hallucinations, 15% visual, and 5% tactile. The most common hallucinatory experience are hearing voices (also known as auditory verbal hallucinations.)

Now for disorganization: most people with schizophrenia have different degrees of impairment in their thought processes. These are called formal thought disorders. The ones most prominent in schizophrenia are called retardation (taking a long time to answer questions, in its extreme form, mutism occurs), circumstantiality (giving unnecesary details but eventually getting to the point), tangentiality (never getting to the point in the first place), derailment (breakdown in association with no logical connection between thoughts), thought blocking (sudden break in train of thought), and perseveration (repeating of an idea until it is inappropriate). There is also illogicality, offering bizarre explanations for things, neologisms, the creation of new words, and paraphasia, using a word with a new meaning.

In general negative symptoms are conceptualized as things that people do not do. The distinction between positive and negative symptoms was first introduced by Reynolds (1828-1896) and Jackson (1834-1911). Kraepelin (1919) also described a framework for distinguishing between positive and negative symptoms. In many cases negative symptoms are present before the onset of psychotic symptoms, present through the psychotic phase, and persist to varying degrees once the positive symptoms remit. Negative symptoms most often include alogia (poverty of speech), blunted affect (reduction in emotional expressiveness), anhedonia (inability to experience pleasure), asociality, avolition (lack of motivation), and apathy. Negative symptoms are more important for prognosis than positive symptoms.

Deficits in cognition have been considered core features of schizophrenia all the way back to Kraepelin and Bleuler. It's been consistently shown that people with schizophrenia have cognitive deficits right at the onset of psychotic symptoms, and even in the prodromal period or well before showing any kind of symptoms. There has been a lack of standard assessment scales for cognitive symptoms. Cognitive impairment is associated with poorer prognosis and functional outcome, negative symptoms, and disorganized symptoms, but not with positive symptoms.

Now on movement disorders: the two most common abnormal movements in schizophrenia are mannerisms (odd and stilted movements that seem to have a purpose) and stereotypy (constant repitition of meaningless movements.) People with schizophrenia may be stuporous, with an absence of movements and speech while being fully conscious. On the contrary, one might become hyperactive in an excited variety of catatonia. Sometimes there is abnormality in the execution of movements like in the form of negativism, automatic obedience, or ambitendency.

While those are the symptoms of schizophrenia, there are other aspects that are critical to evaluation and treatment. First of is the developmental history and prognostic indicators. Accurately diagnosing psychotic disorders is incredibly important at early stages of the disease because the importance of early treatment has been shown in different meaures. This variable is usually the level of social functioning prior to the onset of the illness, and it's been shown that it could be an important factor in diagnosis, diseae progression, and outcome.

All of feeling, mood, affect, and motivation can be abnormal in schizophrenia. The rate of depression in schizophrenia varies in studies, found more prevalent in women and patients with first-episode schizophrenia. People with comorbid schizophrenia and depression have poorer long term functional outcomes in terms of poorer quality of life. There is also "post schizophrenic depresson", which is depression following or in conjunction with psychotic symptoms (it's also a subtype in the ICD 10.) Depressive symptoms could also be confounded with antipsychotic side effects and negative symptoms. Suicide is unfortunately a leading cause of death in people with schizophrenia, with up to 40% of people with schizophrenia attempting suicide at least once. Between 5% and 13% die from their attempts. Risk factors for suicide in schizophrenia are comorbid depression and substance abuse, feelings of hopelessness and loss, fear of mental disintegration, a first episode (especially in previously high functioning patients), and periods of exacerbation of psychotic symptoms.

Substance abuse is common in schizophrenia. Half of patients are also substance abusers at some time during their illness. Substance use has been associated with poor social adjustment, more hospitalizations and relapses, medication and non-compliance, and poor treatment responses. Since acute intoxication and withdrawal of substances can mimick schizophrenic disorders, the overlap in symptoms can make diagnosis hard.

Now for physical health; the heightened health risks in schizophrenia (cardiovascular disease, metabolic syndrome, carbohydrate and lipid metabolid disorders, etc) are associated with the medications used in its treatment. Since people with schizophrenia show a higher rate of tobacco smoking than the general population, people with schizophrenia have more respiratory symptoms and poorer lung function compared to the general population. The presence of diabetes is between 9% and 14%, dyslipidemia 43%, and hypertension 30%. People with schizophrenia on antipsychotics are more prone to obesity, which has a big impact on both physical health and self-image and adherence to prescribed medication. Despite this vulnerability to different physical illnesses people with schizophrenia are at risk for failing to receive medical services. They should have routine physical examinations, and their physical symptoms should be explored no differently.

Extra tidbits: Sexual dysfunction, sleep problems, and eating disorders are also not uncommon in people with schizophrenia. Social functioning deficits are a hallmark of schizophrenia, and impairments in adaptive life skills are a major source of disability in people with schizophrenia. Quality of life is usually lower.

[relatable-psychosis]

I'm trying to get an appointment with a psychiatrist at the moment, but it's taking a while so I thought I'd ask you something I've been wondering. So, I've been having a delusion, but I'm not sure if I've had other psychotic symptoms. I completely relate when I read about negative symptoms and some disorganised behaviour (eg. agitation, impaired self-care), but I also have depression. How do I tell the difference between depressive and negative/disorganised symptoms?

Let’s list them side by side, we’ll start with MDD, major depressive disorder, symptoms.

Depressed mood most of the day, nearly every day, like feeling sad, empty, hopeless.

Diminished interest or pleasure in all, or almost all, activities.

Significant weight loss when not dieting or weight gain (eg, a change of more than 5% of body weight in a month), or decrease or increase in appetite.

Insomnia or hypersomnia (excessive sleepiness, excessive time spent sleeping).

Psychomotor agitation (symptoms that stem from anxiety like pacing, wringing hands, biting skin around nails) or psychomotor retardation (slowed speech, speech decreased in volume) that’s observable by others.

Fatigue or loss of energy.

Feelings of worthlessness or excessive or inappropriate guilt which may be delusional.

Diminished ability to think or concentrate, indecisiveness.

Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation with or without a specific plan, or a suicide attempt.

Aches, cramps, pains without a clear physical cause.

Negative symptoms, which are considered less prominent in other psychotic disorders but a substantial portion of the morbidity in schizophrenia.

Diminished emotional expression. Reductions in the expression of emotions in the face, eye contact, and movements of the hand, head, and face that normally give an emotional emphasis to speech. Monotone speech as a result of reduction in prosody. Severe reduction in emotional expressiveness is also called flat affect, meaning the person has no emotional expression and may not react even to circumstances that evoke strong reactions in others.

Avolition. A decrease in motivated self-initiated purposeful activities, a restriction in initiation and production of goal directed behavior. It’s different from lack of interest ‘cause a person with avolition can want to complete a task but not have the ability to motivate themselves to do it.

Alogia. Reduction in speech output. There are no spontaneous additions to conversation and there’s a lack of content in replies which are brief and concrete. Go here for an example. Alogia’s considered both a positive and negative symptom since it presents in disorganized speech.

Anhedonia. The absence of experiencing pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced.

Asociality. The apparent lack of interest in social interactions (should be distinguished from a manifestation of limited opportunities for social interactions).

Some people add cognitive impairment in with other negative symptoms and I will too. This means impairment in memory, attention, problem solving, working memory, concentration, processing speed, and social cognition

Excerpt from an article on schizophrenia and depression-“Questions about their interest in things and activities may be more useful in differentiating depressive symptoms. For example, a loss of interest in usual activities is common in depression. In contrast, patients with negative symptoms of schizophrenia alone may describe their interests in a bland and affectively restricted manner.” [x]It’s suggested a way to differentiate negative from depressive symptoms is to look at how negative symptoms show flat affect and depressive ones don’t. Alogia to the degree of being termed alogia doesn’t appear in depressive symptoms either. If you look at the symptoms side by side, many nuanced and some stark differences begin showing themselves.Since you mentioned disorganized behavior, I’ll also throw in these definitions from the symptoms page.Disorganized behavior: behavior considered inappropriate to the situation at hand, causing disruptions to goal-related activity, and impairments to one’s ability to take care of themselves or interact with others. Examples: not responding to one’s environment, wearing a winter coat in summer, inappropriate laughter, unpredictable emotional responses, social disinhibition.Disorganized/abnormal motor behavior: may range from childlike “silliness” to unpredictable agitation, leading to difficulty in performing daily activities.Catatonic behavior is a decrease in reactivity to the environment. There’s resistance to instructions (negativism); maintaining a rigid, odd posture; complete lack of verbal and motor response (mutism and stupor); purposeless, excessive motor activity without clear cause (catatonic excitement).There can be repeated stereotyped movements and echoing of speech.- Mod Alex

[cluster-a-culture-is]

since you typically recommend the EASE and the EAWE as resources, I'd like to also recommend the Perceptual Aberration Scale (PAS; Chapman, Chapman, & Raulin, 1978) and Magical Ideation Scale (MIS; Eckblad & Chapman, 1983) - they may be a tad old, but the book i'm reading (Psychosis, Trauma and Dissociation) mentions that they're widely used in measuring schizotypy and tend to be used in professional studies when assessing for schizotypy in a person! I'm not sure if they can be found online easy or not since I haven't looked yet, but I wanted to put the info out there anyways.

thank you for the info!

[sysmedsaresexist]

Changes from the DSM III

It's so interesting to see how the DSM has grown and changed over the years.

Especially that last one!!!

[schizopositivity]

Friendly reminder that antipsychotics don't cure schizophrenia. They don't even treat schizophrenia fully. They only treat the psychotic symptoms aka the positive symptoms. (And lots of people on antipsychotics don't have all their psychotic symptoms disappear, sometimes it only helps a little bit). Meanwhile our negative and cognitive symptoms cannot be treated fully (or at all depending on the person) with medication, and they greatly affect our lives and tend to get more severe as we age. So please don't assume that a schizophrenic person on antipsychotics is basically not mentally ill anymore cause there's a shit ton more we have to deal with on a daily basis, even if our psychosis is treated and no longer affecting us.

[sysmedsaresexist]

I've heard one of my posts is causing waves

Here's some more things that are normal in DID/OSDD systems, and some weird myths, in no particular order

- Not realizing you're a system until later is normal (average age of system discovery is 18-21)

- It's rare for children to display distinct alters (not impossible, just a rare occurrence in a rare disorder (based on numbers, it's considered rare, yes), alters tend to form in mid-teens)

- Feeling as though you "created" an alter is normal (related to unconscious feelings of control over an uncontrollable situation, and/or tricking yourself into an explanation, also, if you have a need to be filled, the brain WILL provide)

- "mixed origin systems" are totally normal for DID/OSDD. I have a couple alters that could be considered "endogenic", but I'm really just... DID, with normal alters forming in normal ways

- Alters forming at any age/time is normal (you can form a brand new alter at fifty, after having undergone complete fusion, once the ability is there, it's always possible to split)

- Alters don't always appear immediately after a traumatic event (alters can take YEARS to come to front after forming, making it impossible to tie them to specific events unless THEY'RE aware of the connection)

- Alters can form from stress, not just trauma (and the brain is notoriously good at hiding how stressed you are from yourself)

- Comfort splits ARE normal in DID/OSDD

- The amnesia criteria in DID doesn't mean you need to experience amnesia day-to-day, you still have DID if you can't remember childhood events but have good communication now

- The dysfunction criteria is redundant and circular, where the symptoms themselves fulfill the criteria, and as per the DSM, doesn't imply any inherent need for treatment or distress-- so being happy, loving your system, feeling like your system helps you more than it hinders you, all normal (and good!) but still DID/OSDD

- OSDD 1a does not involve alters as they're known, but states or modes that influence you, and amnesia occurs during these periods of influence; OSDD 1b involves "emotional amnesia" only (which is just a stupid, fancy word for dissociation (an emotional disconnect from a memory) that doesn't actually exist in the medical world)

- You can have as many EPs and ANPs as you'd like. The majority of systems with OSDD feel as though the one ANP theory doesn't fit them, and there have recently been updates to theories to acknowledge this

- Integration is the lowering of dissociative barriers to allow for better communication between system members, and is absolutely necessary for functional multiplicity (fusion is the joining of two or more alters). These definitions come from the ISSTD, and it IS recognized by the ISSTD that integration and functional multiplicity are viable and attainable treatment goals. Keep this in mind when conversations about these topics come up-- if you can communicate clearly with alters, you're already well integrated. It's not scary, it's not bad, and no one can or will make you fuse.

- CPTSD, the basis of dissociative disorders and DID, presents very differently from PTSD -- mostly presenting as a negative view of the self and vigilance rather than the flashbacks and nightmares you'd see in PTSD (it's quite similar to BPD, but the view of the self is negative rather than unstable). If you resonate with some aspects of BPD and have a system, and you don't experience the "typical" presentation of PTSD, that's normal. That's CPTSD (complex PTSD, not chronic PTSD), maybe read up on it.

- You don't need to know your trauma to acknowledge that you have DID/OSDD, and no one should be pushing that you search for trauma. Who cares, move at your own pace, maybe you'll never figure it out, and that's perfectly fine. People who push others about their trauma will face my wrath.

- Trauma isn't an action, but a REACTION to an event. What traumatizes one person, may not have any effect on another person, and vice versa. This isn't about what might have happened to you, but how you felt about it. There is no Trauma Olympics, and people who play that way are ridiculous. Trauma reactions are personal and unique, and come from anything-- bullying, isolation and loneliness, abuse. And yes, other disorders can make you more susceptible to trauma reactions. Having autism or ADHD or BPD, EDs, psychosis, schizophrenia-- all of these create more opportunities for trauma reactions, and make someone more susceptible. That doesn't mean you're not trauma based. It doesn't mean those things caused your system. It means those things made it harder for you to navigate life and left you more susceptible to trauma. That's it.

- MADD is typically trauma based

There's so, so many more. Other DID/OSDD systems, feel free to add on, endogenic systems, ask if something is normal.

[sysmedsaresexist]

I’ve been asked for some sources and I’m happy to provide! Thank you, friendo, for your patience <3 Getting things done in a timely matter is hard when you have 12 sets of priorities.

1) Are comfort splits normal? Yes! This is a PDF, careful if you’re on phone, but I’ll highlight the important bit. This is a bit of an older paper by Kluft about dealing directly with alters in therapy, and it discusses, “DID patients who are extremely avoidant, obsessive, or without strong nondissociative defenses are prone to develop larger numbers of alters. For the group without strong nondissociative defenses, dissociation is not a last-ditch defense--it is their first response to stress... [They] imaginatively transform their histories to conform to myths, movies, television shows, or pieces of literature and generate large numbers of alters to play roles in them.” When he says “large numbers” we’re not only talking about polyfragmented systems (he wrote other papers specifically about that). In this case he’s talking about a feedback loop in patients with low dissociative barriers-- forming one alter and then another to support that alter, and then another to support that one, and on and on. It’s in reference to ease in which some people gain alters, especially from media that they are interested in.

From Coping With Trauma Related Dissociation

From The Haunted Self:

2) Do 'most systems  discover themselves at 18-21'? This one is a little bit of a... confusing topic and it’s currently changing at an ever-increasing rate. The ability to recognize symptoms in oneself has become much easier with current media and the internet at our fingertips. This figure it based on the community currently in the clinical population. For decades, it’s been possible for those with DID to go their entire lives without ever realizing they even had a dissociative disorder, let alone alters. This is based on the very nature of DID, confusing presenting symptoms, and on the lack of resources available to older individuals at the time they experienced onset.

While alters can appear at any age, we’re talking about the self-realization of symptoms. The below states that self-discovery would occur around early twenties. [x]

Only five percent of people display overt symptoms, or clear symptoms of specifically DID. Instead, they display an array of symptoms indicative of several different disorders. From childhood, these symptoms can put someone on the path of treatment and diagnosis for something entirely different, and symptoms are explained away under another label. For example, shifting identity states, needs, and wants can also be seen in BPD, and it can take years before those states are acknowledged by either patient or clinician as alters.

Prior to the internet and easily accessible support groups online, patients were often left to figure it out themselves, and the lack of recognition and awareness of DID left many questioning their experiences for years. 18 is typically when adolescents leave the house for the first time. This removal from their traumatic environment allows someone to start exploring their experiences in a safer way, often leading to the first indication that something more serious might be happening.

This is also typically when heavily regimented schedules change, and a person gains more social freedom. From this, potential instances of amnesia and alters are often pointed out by friends and more easily recognized. For example, someone in their last year of highschool might be asked, "how was school today?" and without hesitation will answer, "it was fine, the usual," despite the fact that they don't actually remember their day. This is an example of "amnesia for amnesia". Because grade school and highschool is a daily occurrence with a relatively unchanging schedule (ie, math in the morning, SS in the afternoon, gym after lunch, and history last) that moves at a slow pace, losing a single day or memory is very likely to go unnoticed.

In contrast, college typically has one class only once or twice a week for a longer period of time and the pace of learning is much quicker. Losing a day of memory here would be much more easily noticed. Freedom to go out with friends at any time allows for more opportunities for people to notice shifts in personality, and there's more social outings that could be forgotten.

3) 'alters can  form from stress, not just trauma'? See the first quote in point 1 as a highlight of this. In addition, stress and childhood trauma are intrinsically related [x]. Childhood trauma often leaves someone with a lifelong vulnerability to stress, and their ability to handle that stress is significantly impaired. This can lead to worsening symptoms and a reliance on negative coping mechanisms (such as dissociation). [x] This means that once the mechanisms are there, some people can split at literally the smallest inconveniences. The mind is also notoriously good at hiding how stressed you are, so you may not even realize that you're stressed at all [x] [x] [x].

4) children don't display distinct alters?

From the DSM 5

ICD 11

ISSTD Children Treatment guidelines (PDF)

I like this section from Healing the Fractured Child on what it could look like.