Hi everyone! In this video I’m going to talk about how to differentiate various mental disorders. Specifically ones that I have talked about: bipolar disorder, schizophrenia, schizoaffective disorder (which is bipolar or other mood disorder, and schizophrenia), borderline personality disorder, post-traumatic stress disorder, and dissociative identity disorder. I’ll have links in the description to each video I did on those for anyone who is interested. All of these have a lot of overlap and telling them apart can be a challenge. Especially when you have been misdiagnosed since the treatment is very different for each one. I’ll also be discussing the difference between psychosis and dissociation since they are not the same.
A general overview:
Bipolar is a mood disorder, which can have psychotic elements, both in mania and depression. Mood swings can be rapid cycling and can occur very frequently with little to no reason. [Bipolar]
Schizophrenia is a thought disorder, affecting the cognitive function of the brain. It is also a psychotic disorder. [Schizophrenia]
Schizoaffective disorder is a combination of schizophrenia and a mood disorder. Schizophrenia cannot be diagnosed if a mood disorder is present, and if psychotic elements are present during the time that the mood disorder is not, then it is schizoaffective disorder. [Schizoaffective Disorder]
Borderline personality disorder is characterized by intense mood swings, problems with self-worth, unstable interpersonal relationships, and impulsive, self-destructive behavior. It is a personality disorder, meaning it is a long-term pattern of behaviors, emotions, and thoughts that generally develop early and are inflexible. [Borderline]
Post-traumatic stress disorder is a condition that can occur after experiencing or witnessing a traumatic event. The trauma will cause an individual a lot of problems, making them paranoid, delusional, even psychotic, as the event relives itself over and over again in their mind. [PTSD]
Dissociative identity disorder is a dissociative disorder characterized by the presence of two or more different personality states that control an individual’s behavior. It is often thought of being triggered by severe childhood trauma. It is actually a common defense mechanism of the brain to dissociate from the trauma so the individual can live without the intense stress of the trauma. In other words, it segments the mind into two or more parts, some of those parts hold trauma, and others do not. However, dissociation can occur without trauma. [DID]
Mood Disorders vs. Thought Disorders
Bipolar and schizophrenia can share a lot in common. They both can include delusions and hallucinations. The difference being that someone with bipolar is having the delusions and hallucinations because of their mood. If they only happen while they are depressed, it could be major depressions. If it happens when manic, it could be bipolar. However, when the person has a stable mood, the delusions and hallucinations are not present.
With schizophrenia on the other hand, delusions and hallucinations are not dependent upon mood. If the individual has manic or depressive episodes, they do not have schizophrenia, since schizophrenia is independent of mood. They could have bipolar, however, the key difference is that when their mood has stabilized for at least two week, and they continue to have delusions and hallucinations, it could be considered schizoaffective disorder.
This is because the delusions and hallucinations are independent of the mood, but mood problems are still present, and thus schizophrenia and bipolar do not fit the diagnosis. So, it would mostly be schizoaffective disorder. The ‘affect’ in schizoaffective disorder means feelings/emotions. Thus ‘schizo’ describes the schizophrenia side of the disorder and ‘affect’ describes the mood element of the disorder.
Mood & Thought Disorders vs. Personality Disorders
Bipolar and borderline are often confused for one another. The main element they share in common is the unstable mood. Someone who is rapid-cycling bipolar can resemble borderline personality disorder, but they are not the same. Generally, someone with borderline can shift moods much more rapidly than someone with bipolar. The shift can also be independent of just being manic or depressed. For example, someone with borderline can change their opinion on someone or something very quickly. A perfect example is, “I love you, but I hate you.” Do they love the person, or do they hate them? Do they want them in their life, or would they rather do without them? It’s either all good or all bad. People with bipolar will typically not experience this ‘black and white’ form of thinking.
Additionally, people with borderline generally have more of a reason to have a mood change. While those with bipolar will have mood swings independent of what is currently going on in their life.
When it comes to schizophrenia, there can also be some common ground with borderline, primarily the paranoia and delusions. For someone with borderline, it is probably most likely due to past experiences. They could be paranoid that everyone is out to do them harm because of the abandonment they went through in their past. Someone with schizophrenia who has never been abandoned may have the same thinking, but it is independent of their past experience and thus not borderline. This is because schizophrenia is a cognitive impairment, while borderline is psychological development based on the individual’s surroundings during childhood. In other words, people with borderline may have no cognitive or learning impairment or disability.
Pretty much any personality disorder develops during childhood due to the environment the child is in. Bipolar and schizophrenia is usually completely independent of this. It can be more hereditary, or something else entirely.
Thought Disorders vs. Trauma & Dissociation
I think when most people think of someone being delusional and having hallucinations, they think of schizophrenia, but pretty much anything can have these features. You could be sleep deprived, dehydrated, or just extremely stressed and have these symptoms. So, having hallucinations and delusions can be a symptom of almost anything, so I don’t like to think of it as the determining factor of any disorder.
However, if it truly is caused by one of the disorders, finding the cause can be very difficult. When it comes to PTSD, delusions, paranoia, and hallucinations are usually trauma specific. In other words, people may hear and see things that remind them of the trauma they went through. They could be paranoid of being in a situation that would bring back memories of those events. These include locations, people, all those sorts of things. Other individuals, such as those with schizophrenia who may not have had trauma, suffer from delusions and hallucinations as well, but they are not related to any trauma. However, if they claim that it is related to trauma, it could be a delusion. Rather, the only way to know is by the individual’s support group, and how they view the individual, since the individual that is delusional may think something that doesn’t exist.
Someone with DID who has auditory hallucinations, technically they would be in the head, usually conversations between alters is what’s heard. This can be mistaken for external voices, which is mostly found in psychotic disorders, such as schizophrenia. This is one big problem with diagnosis. People go to the therapist and say they’re hearing voices and paranoid. The therapist sees this as bipolar or schizophrenia, when it could actually be borderline personality, PTSD, and/or DID. Treatment for these are very different. On one end, there is bipolar and schizophrenia which have psychotic elements, while borderline, PTSD, and DID mostly have trauma and dissociative elements.
When it comes down to it, if you think you have schizophrenia, the negative symptoms, such as social isolation, inappropriate expression of emotions, are more important to look at, as well as the positive ones. If you do not have the negative symptoms of schizophrenia, then you probably do not have it. You may have one of these other disorders, or something else entirely. This is one big thing when telling apart schizophrenia and dissociative identity disorder. Those with DID may have all the positive symptoms of schizophrenia, such as paranoia, delusions, and hallucinations, but will often lack the negative symptoms. As I said, if you lack the negative symptoms, then you may not have schizophrenia. Personally for me, the negative symptoms are much harder to deal with than the positive ones. It is difficult for me to express my emotions and to form relationships because I do not understand them and do not know how friends are made. That is a cognitive problem I have.
Someone without the cognitive impairment, again, probably doesn’t have schizophrenia. Someone with PTSD or borderline may avoid making friends or is too paranoid to get involved with others because of what has happened to them, but they may know how to make friends just fine. That is not a cognitive impairment, and thus probably not schizophrenia.
Another thing to note is that it is possible for someone with schizophrenia to have a delusion that they are multiple personalities. I have never encountered this, I don’t know how common it would be, but that is something to keep in mind. Of course if they do believe this, the negative symptoms would still have to be present if it was schizophrenia.
Psychosis vs. Dissociation
Psychosis and dissociation are very different, but can look almost exactly the same. It is possible to experience both at the same time, but that doesn’t mean they are the same. Psychosis is losing touch with reality, with what is really going on around you. While dissociation is becoming detached from yourself, who you are, or something that has happened to you. Individuals with dissociative disorders who do not experience psychosis will mostly not misjudge people’s motives. They are aware of what is going on around them. This is, however, until something is triggered. PTSD for example is a big one where an individual may be reminded of a traumatic event and begin to think they are back in that situation all over again, reliving it. That is a psychotic symptom. However, it’s not schizophrenia, it’s the psychotic element of PTSD, which can resemble schizophrenia. In this case, it is trauma specific, so it is PTSD.
It’s not really possible to be aware that you are having a psychotic episode until after it has passed. Main reason being is that your mind is impaired when psychotic. Everything that is running through your head at the time is real to you, but not to anyone else. That makes it pretty much impossible to tell if you are experiencing a psychotic episode.
From a personal standpoint, since I do experience both psychosis and dissociation, I have to rely on other people to tell me what happened so I know what I experienced. For example, there have been times that I have woken up the next morning after a social gathering or some kind of other event that had the potential of causing me a lot of stress. When I wake up, I don’t really remember the previous day, mainly just bits and pieces and it’s difficult to put the whole picture together. I’ve asked my family who would’ve been around me the previous day what I did. If they say that I was acting off and anxious, perhaps doing some weird things, then I know it was probably due to psychosis. However, if they say I was acting normal, talking with people, showing a lot of confidence, then I know it was probably due to dissociation. Whatever the case may be, it is extremely stressful for me and I can only hope that I didn’t do something I would regret and not remember doing.
So, I hope this video was informative. Thanks for watching!