The 8 differences between psychotic and dissociative disorders

Do you know the main characteristics of psychotic disorders? And the dissociatives? In this article, in addition to answering this, we will know the main differences between psychotic and dissociative disorders.

As we will see, these are two completely different types of mental disorders, and we will verify this from their characterization and the development of their corresponding differences.

    Psychotic and dissociative disorders: what are they like?

    Before we delve into the differences between psychotic and dissociative disorders, let’s take a look at what each is (and what they consist of).

    1. Psychotic disorders

    Psychotic disorders are a type of serious mental disorder, in which strange or abnormal ideas and perceptions arise. There is usually also a loss of contact with reality; the “quintessential” psychotic symptoms are hallucinations and delusions, although they exist more.

    The DSM-5 (Statistical Manual of Mental Disorders) lists the following psychotic disorders:

    • schizophrenia

    • Brief psychotic disorder
    • schizophreniform disorder
    • Delusional disorder
    • schizoaffective disorder

    • Psychotic disorder due to other medical conditions
    • Substance-Induced Psychotic Disorder
    • Catatonia
    • Other specified disorders of the schizophrenia spectrum
    • Other unspecified schizophrenia spectrum disorders

    2. Dissociative disorders

    For their part, dissociative disorders are those in which they exist loss of integrative functions of memory, identity, perception, motor functions or consciousness.

    Its characteristic symptom is an alteration in the organization or structure of mental content (not so much an alteration of the content itself). Thus, there is a disconnection and a lack of continuity between memories, thoughts, actions, identity …

    It should be mentioned that dissociative phenomena do not always have to be pathological; there are dissociative phenomena which are not.

    In DSM-5 we find the following dissociative disorders:

    • Dissociative identity disorder
    • dissociative amnesia
    • Depersonalization / unrealization disorder
    • Another specified dissociative disorder
    • Unspecified dissociative disorder

    The most important differences between psychotic and dissociative disorders

    In this article, we’ve rounded up the top 8 differences between psychotic and dissociative disorders, although there are more.

    1. Main symptoms

    The first of the differences between psychotic and dissociative disorders is their symptoms; as we have seen, these are two independent and differentiated types of disorders, each with its own characteristics.

    In psychotic disorders, the main problem is one or more psychotic symptoms that involve a distorted perception of the present (Hallucinations, delusions, disorganized thoughts …); on the other hand, in dissociative disorders, there are no psychotic symptoms, but their main symptom is a discontinuity (or interruption) between our identity, our memory, our behavior, etc.

    So, as we can see, the main symptoms of the two disorders are totally different.

    2. Nature of symptoms

    The nature of the symptoms is also varied. Thus, psychotic disorders involve the appearance of one or more (psychotic) symptoms, establishing an incongruity between what the senses pick up and what the consciousness perceives; however, in dissociative disorders, there is loss of a function (memory, identity …) which functions in a limited way.

    3. Contact with reality / awareness of the disorder

    Another of the differences between psychotic and dissociative disorders concerns contact with reality.

    In psychotic disorders (eg schizophrenia), there is usually a loss of immediate contact with reality.; in contrast, in dissociative disorders no.

    In addition, in psychotic disorders, it is more common for the person to be unaware of their affect; however, in dissociative disorders, people are often aware of their “losses”. For example, this is clearly seen in dissociative amnesia, where significant loss of autobiographical memory occurs.

    4. Presence of cognitive impairment

    In psychotic disorders cognitive impairment or alterations can occur (and are common), Which generally affect attention, memory, decision-making, planning … These symptoms appear especially at advanced stages of the disorder (especially in schizophrenia).

    In contrast, in dissociative disorders these symptoms are not characteristic (minus the memory loss that occurs during dissociative amnesia or dissociative theft, although it is of a different nature).

    5. Duration

    Care should be taken in this regard, as there are different disorders in psychotics and dissociatives, and each has its own characteristics. However, the truth is that we can say that duration is another of the differences between psychotic and dissociative disorders.

    In general, psychotic disorders usually last longer (Some are even chronic disorders), and on the contrary dissociative disorders generally have a beginning and an end, that is to say a shorter duration, limited in time (days, months …). In addition, in the case of non-chronic psychotic disorders (eg brief psychotic disorder), their duration is generally longer than the duration of dissociative disorders.

    But let’s give examples. In the case of psychotic disorders, we think of schizophrenia; it’s chronic. If one thinks, on the other hand, of psychotic disorders induced by the substance, they are temporary and therefore have a shorter duration (also schizophreniform disorder, which lasts between one and six months).

    In the case of dissociative disorders, one thinks of dissociative theft or dissociative (psychogenic) amnesia; both disorders typically last between hours and months (more hours than months).

    6. Degree of incapacity

    Another difference between psychotic and dissociative disorders is their degree of interference in daily life or the handicap it produces (remember that we are still speaking in general, and that each disorder should always be analyzed in a specific way). Psychotic disorders are generally more disabling than dissociative disorders.

    7. Prevalence

    The exact prevalence of psychotic disorders in general is not known, but it is its prevalence is known in the case of schizophrenia (0.3-0-7% of the population, according to the DSM-5) or schizoaffective disorder (0.3% according to DSM-5).

    For its part, dissociation is estimated to occur in 2-3% of the general populationWhile dissociative disorders themselves, according to some studies (Loewenstein, 1994) have a prevalence of 10% in the population.

    8. Causes

    Another of the differences between psychotic and dissociative disorders concerns the causes.

    The causes of psychotic disorders are generally multifactorial (less in those induced by substances or other medical conditions). Thus, social, biological and environmental factors are combined in their etiology, although the hereditary factor of psychotic disorders must be highlighted (especially in schizophrenia, where monozygotic twins are known to have a 48% chance of suffering from of them).

    In the case of dissociative disorders, there are also multifactorial causes, although it is true that psychological trauma is often at the root. frequently (sexual or physical abuse in childhood, witnessing or having an accident, events where death is witnessed, etc.).

    Psychotic disorders most often appear, rather than following a trauma, following a very stressful period, which is combined with other etiological factors (biological or personal vulnerability, biological inheritance, etc.). In contrast, dissociative disorders often appear as a result of trauma or a situation that the person feels is very threatening or dangerous for them.

    Bibliographical references:

    • American Psychiatric Association -APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Panamericana.
    • Barrera, A. (2006). Cognitive impairment in schizophrenia. Chilean Journal of Neuro-Psychiatry, 44 (3): 215-221.
    • Belloch, A., Sandín, B. and Ramos, F. (2010). Manual of psychopathology. Volumes I and II. Madrid: McGraw-Hill.
    • Jongsma, HE et al. (2018). Treated incidence of psychotic disorders in the multinational EU-GEI study. JAMA Psychiatry, 75 (1): 36-46.

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