Psychosis versus Dissociation © Megan Snider 2012

The confusion among unskilled doctors, psychiatrists, and psychologists about the differences between psychotic disorders and dissociative disorders is absolutely horrendous. As I have shared on here before, I was originally diagnosed as psychotic and as having Schizophrenia. My “psychiatrist” was simply not smart enough to know the difference between literally symptoms and abstract symptoms. For example, check out the subtle differences between these two sets of symptoms:

 Example Number One: I say I don’t “feel” like I’m real. (This is dissociation because reality testing is intact. You don’t “feel” real, yet you know you are.)

Example Number Two: The world is not real between the hours of nine and five. Everything stops existing because the CIA has the world programmed to run on a huge computer system. (I know that sounded a little cliché—especially with the CIA reference—however, this would be an adequate runner up for a psychotic disorder.)   

Please notice that in example number two there is no I “feel” connection. Rather, everything is stated as fact. This is where the idea of reality testing comes in. According to “The Free Dictionary by Farlex”, reality testing is “an ego function that enables one to differentiate between external reality and an inner imaginative world and to behave in a manner that exhibits an awareness of accepted norms and customs. Impairment of reality testing is indicative of a disturbance in ego functioning that may lead to psychosis.”

Alright, so let’s boil this idea down in digestible bits. When you have reality testing, you can differentiate between your own internal and external reality. That means you may fantasize that you are the president, but you know that you are an English teacher. Also, over the course of derealization and depersonalization, you know that you and the world are really truly real, however you are in an altered state of consciousness where it simply doesn’t feel that way.

In contrast, people suffering from psychosis have no reality testing. Therefore, they are grossly unable to distinguish their own fantasies or internal thoughts from their external realities. Simply put, if they have a thought that they are being stalking by the FBI or something similar, this though can easily grow into a true belief.

As I learned in Abnormal Psychiatry in college, reality testing also have another component to it. It also is the ability to conjure up concrete facts. For example, I know my hair is blonde, my eyes are blue, I know when my birthday is and what state I am currently residing in. If you ask a psychotic person who he or she thinks he or she is, he or she may possibly respond that they believe they are “Jesus Chist” or “Napoleon”. Again, I am sorry to use such cliché examples, but they are the ones which seem to be best understood. Let’s look at how the “DSM V” labels psychosis and dissociation.

“DSM V” Psychotic Disorders

Attenuated Psychosis Syndrom (Proposed for Section III of the “DSM-5)

B 00 Schizotypal Personality Disorder

B 01 Delusional Disorder

B 02 Brief Psychotic Disorder

B 03 Substance-Induced Psychotic Disorder

B 04 Psychotic Disorder Associated with Another Medical Condition

B 05 Catatonic Disorder Associated with Another Medical Condition

B 06 Schizophreniform Disorder

B 07 Schizoaffective Disorder

B 08 SCHIZOPHRENIA

B 09 Psychotic Disorder Not Elsewhere Classified

B 10 Catatonic Disorder Not Elsewhere Classified

“DSM V” Dissociative Disorders

H 00 DEPERSONALIZATION-DEREALIZATION DISORDER

H 01 Dissociative Amnesia

H 02 Dissociative Identity Disorder

H 03 Dissociative Disorder Not Elsewhere Classified

Psychosis	Depersonalization-Derealization Disorder
Reality Testing is NOT intact	Reality Testing IS intact
Delusions	No delusions
Total infamous lack of insight	Temporary altered state of consciousness
Merging of internal and external worlds	External and internal worlds are kept separate

For further information, I suggest reading the DSM definitions of these disorders, including the DSM V which is a new and updated version coming out next year.

I also highly recommend scholarly psychiatric papers and Mayo Clinic articles realting to these disorders. Remember, knowledge is power. Just two days ago I saw someone on a forum describing Depreaonzalisation-Derelization Disorder. Another member on the group, who happened to be the first poster, was representing himself as an advocate for the ill. He said that that original poster was psychotic and needed to be put on antipsychotics immediately. Whenever I become involved in online forums, it is a disaster—I don’t think I need to tell you that. So, I shy away from them. However, I couldn’t let one person’s ignorance ruin another person’s life as my own “psychiatrist” had done to me. So I registered as part of the group and left a detailed explanation of my own symptoms and a link to the DSM V’s classification of dissociative disorders. We must stop misinformation. I’m not sure which is worse—stigma or ignorance. I believe in most cases that they are one and the same.

I apologize for the brevity of the post. I know there are a number of infinite details I could write about on this subject. I can sit and ponder it forever. However, writing about an illness you have yourself can only serve as a great trigger because you are reminding yourself of the fact that you have it altogether again. This would be like sending a combat veteran with PTSD back into the jungles of Vietnam. It is difficult for me to write about Depersonalization-Derealization Disorder. Yet, if I help one person come to terms with it, accept it, and be able to combat it better, then I will definitely keep writing.

© Megan Snider 2012
(c) Megan Allyce Snider 2012
Copr. M. Allyce Snider 2012
Copyright Megan Snider MMXII