Schizophrenia and dissociative identity disorder (DID) are two very different — but often confused — mental health disorders.

Schizophrenia is a mental health disorder with prominent traits of reality distortion. Hallucinations, delusions, and disorganized thinking are known traits of psychosis — experiences where your brain perceives things that aren’t real.

Dissociative identity disorder (DID), once known as multiple personality disorder, is a mental health condition with recurrent amnesia and two or more distinct personality states.

While these conditions may share certain features, they’re very different at the core.

DID and schizophrenia aren’t the same. Schizophrenia is a psychotic disorder, which means diagnostic symptoms center on altered reality perception.

While psychosis can occur in DID, too, it isn’t considered a prominent feature required for diagnosis.

DID is classified in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision, (DSM-5-TR), as a dissociative disorder. It involves a disruption in your identity, memory, and consciousness.

Living with DID means experiencing distinct alternate personalities, which are not a part of schizophrenia.

“The primary difference between schizophrenia and DID is that in schizophrenia, a person typically experiences one set of symptoms,” explains Dr. Carolina Estevez, a clinical psychologist from Miami, Florida.

She adds that in DID, you experience a disruption of identity and may display multiple distinct personalities that control your behavior at different times.

The dissociated identities may have their own unique names, characteristics, mannerisms, and even voices. They can be triggered by stressful situations, which can cause them to become prominent in your life.

“These episodes are usually followed by an amnesic state, in which the individual will have no memory of the episode,” she says. “In summary, schizophrenia is characterized by one set of symptoms, while DID involves multiple distinct personalities that may be triggered by stress.”

DID and schizophrenia do share some features that can contribute to confusion between the two disorders.

You might experience auditory hallucinations in both schizophrenia and DID, for example. Estevez indicates both conditions can lead to profound changes in behaviors, thinking, memory, emotions, and relationships with others.

Additionally, both disorders may be accompanied by symptoms resembling mania or depression.

Schizophrenia symptoms

Schizophrenia symptoms include:

  • delusions
  • hallucinations
  • disorganized thinking (also known as disorganized speech)
  • negative symptoms (more info below)
  • disorganized or catatonic motor function
  • difficulty focusing
  • poor memory
  • challenges making decisions and processing information
  • self-harm
  • depression
  • anxiety
  • disrupted sleep
  • inappropriate emotional displays
  • depersonalization
  • derealization
  • anosognosia
  • aggression
  • decreased interpersonal functioning

What are negative symptoms in schizophrenia?

Negative symptoms are those that indicate a loss of ability. They include:

  • diminished expression of emotions
  • decreased speech output
  • inability to experience pleasure
  • social disinterest
  • lack of desire to engage in self-motivated activities
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DID symptoms

While different personality states can vary significantly for each person living with DID, underlying experiences often include:

  • depersonalization
  • auditory hallucinations
  • uncontrollable thought streams
  • volatile emotional swings
  • radical changes to attitudes, personal beliefs, and preferences
  • seizures
  • dissociated travel
  • paranormal-based personality states
  • anxiety
  • substance misuse
  • self-harm
  • flashbacks
  • suicide ideation

To receive a schizophrenia diagnosis in the DSM-5-TR, symptoms must be present for most of the time during a single month and must include two or more of the following:

  • delusions
  • hallucinations
  • disorganized thinking (also known as disorganized speech)
  • negative symptoms
  • disorganized or catatonic motor function

Of these, delusions, hallucinations, or disorganized thinking must be one of the symptoms experienced.

The DSM-5-TR criteria for DID are:

  • 2 or more distinct personality states, which in some cultures may be described as states of possession
  • recurring memory gaps in everyday events, traumatic experiences, or important personal details
  • symptoms are impairing and cause significant distress
  • experiences can’t be attributed to accepted cultural or religious practices
  • symptoms aren’t linked to substance use or another medical condition

Can you have schizophrenia and DID?

Yes. It’s possible to live with both schizophrenia and DID.

DID misdiagnosed for schizophrenia

According to Megan Tangradi, a licensed professional counselor from Northfield, New Jersey, misdiagnosis of DID as schizophrenia is common, particularly in people with a history of trauma since both conditions can present with symptoms of psychosis.

“Not all psychiatrists are trained to recognize the subtleties between these two disorders; therefore, talk [with] a mental health professional who is knowledgeable and experienced in diagnosing DID, as well as treating both conditions,” she explains.

Estevez adds the terms schizophrenia and DID are often used interchangeably due to the misconception that being schizophrenic and hearing voices means a person has multiple personalities.

The exact causes of schizophrenia and DID are unknown, but underlying factors also set these conditions apart.

“DID is often caused by a traumatic childhood event and the disorder typically develops before the age of 9,” Estevez explains. “On the other hand, schizophrenia develops from physical irregularities in the brain, like a dysfunction in neurotransmitters, damaged brain tissue, or an imbalance in the brain’s chemistry.”

DID is considered a defense mechanism — your brain’s attempt to distance you from something overwhelming.

Both DID and schizophrenia can benefit from specific psychotherapy; however, antipsychotic medication is the first-line treatment for schizophrenia to help manage symptoms of psychosis.

Medication may be used for DID if you’re experiencing mood symptoms or other challenges like sleep disruption, but therapy is the primary treatment approach.

“DID is not a chemical imbalance in and of itself (although there may be co-occurring disorders), which means it is primarily treated through trauma therapy specialized for DID,” says Libby.

DID and schizophrenia are separate mental health disorders. While they can both feature symptoms of psychosis, schizophrenia doesn’t involve multiple personalities and has different underlying causes.

Hearing voices in schizophrenia can be mistaken for identity dissociation, making it common for DID and schizophrenia to be used synonymously.