Schizophrenia and DID are complex mental health conditions that people often confuse for one another. While they have some overlapping symptoms, they are different conditions.

A major difference is that someone with DID has two or more distinct identity states, sometimes known as alternate identities, or alters. This is not present in schizophrenia. DID was formerly known as multiple personality disorder or split personality disorder, but clinicians no longer use these terms.

The term “schizophrenia” is derived from the Greek words for “splitting” (schizo) and “mind” (phren), so some people have taken this to mean “split personality.” People with schizophrenia experience symptoms that affect their thoughts, behaviors, and feelings, but they don’t have multiple distinct personalities.

While there’s some overlap between the two conditions, DID and schizophrenia are different in many ways.

There are a lot of misconceptions surrounding both DID and schizophrenia. Many people inaccurately believe that people with schizophrenia have “split personalities.” This isn’t the case.

This isn’t even technically true of DID. The Sidran Institute says that, although these personalities may feel or appear different, “They’re all manifestations of a single, whole person.”

While some symptoms do overlap between DID and schizophrenia, they are different in important ways, including their causes, treatments, and age of onset.

Causes

Neither condition has one definitive cause, but DID is associated with trauma while schizophrenia is more often associated with having certain genes.

Most people with DID have a history of severe childhood trauma. An estimated 90% of people with DID have a history of neglect or abuse. The condition can arise when a child dissociates as a defense mechanism to escape an intolerable reality.

Experts believe several factors play a role in the development of schizophrenia. A main one is your genes. Your environment, brain development and chemicals, and pregnancy complications may also be involved.

Which treatments work better

The first-line treatment for schizophrenia is a second-generation antipsychotic medication. Healthcare professionals may recommend a few other types of medications as well.

Along with medication, treatments for schizophrenia often include:

  • different types of psychotherapy (talk therapy)
  • family support
  • community-based treatment programs

On the other hand, DID doesn’t have an approved medication for treatment. People with DID may take meds to treat coexisting conditions — like antidepressants to improve symptoms of depression — but antipsychotics are unlikely to improve symptoms.

Talk therapy is the primary treatment for DID. Talk therapy helps the person to understand their symptoms and their causes, and to learn ways to manage dissociative episodes. Types include:

Age of onset

One of the major differences between DID and schizophrenia is the age when symptoms typically first begin showing up. Schizophrenia usually has a later onset — in someone’s late teens to 30s. DID symptoms, on the other hand, typically start showing up in childhood.

According to research from 2009, dissociative symptoms usually start between ages 5 to 10 for people with DID. Someone’s first alter may appear around age 6.

Hearing voices

While people with either DID or schizophrenia may hear voices, people with DID who do are reportedly more likely to start hearing them before age 18.

People with schizophrenia don’t usually start having hallucinations until their late teens to early 20s.

Differences in “hearing voices”

People with schizophrenia may experience auditory hallucinations, such as hearing voices. People with DID may hear voices too, with some differences. People with DID typically:

  • begin hearing voices earlier in life
  • hear more voices
  • experience voices that “talk” to one another
  • hear a combination of adult and child voices, whereas people with schizophrenia most often only hear adult voices
  • report they would miss the voices

Prevalence

About 1% of adults around the world live with schizophrenia. One study estimated that healthcare professionals diagnose schizophrenia in 5.1 per 1,000 people per year in the United States.

Worldwide, DID is diagnosed in about 1.5% of people. However, it’s often misdiagnosed, and some people may spend as much as 12 and a half years in treatment before they receive an accurate diagnosis.

Other notable differences

Memory loss, or amnesia, can occur in both schizophrenia and DID, but it’s more common in DID.

People with DID also have higher rates of derealization and depersonalization, according to research. For instance, if someone has “switched” to a different personality, they may look in the mirror and not recognize themselves.

People with schizophrenia may experience depersonalization and derealization, but this is less likely or happens less often.

Cognitive functioning issues and symptoms are often more common in schizophrenia than dissociative disorders.

There are a number of reasons why you might get DID and schizophrenia mixed up.

For starters, research has shown a high co-occurrence between dissociative disorders and schizophrenia spectrum disorders: Between 9% and 50% of people with schizophrenia also meet the criteria for a dissociative disorder.

They share some symptoms

One of the biggest reasons why people confuse the two conditions is their overlapping symptoms.

Popular culture portrayals may lead you to believe that hallucinations are unique to schizophrenia. However, people with DID, narcolepsy, and bipolar disorder, along with those who take certain substances, may also experience hallucinations.

Symptoms that DID and schizophrenia may have in common include:

  • visual and auditory hallucinations
  • issues with memory
  • suicidal ideation
  • difficulties sleeping
  • delusions
  • dissociation

Some of these symptoms are similar, so they may also be confused.

People with DID are typically more likely to have symptoms that overlap with positive symptoms of schizophrenia — the ones that involve altered perceptions, reality, and thinking. People with DID don’t often show many negative symptoms.

People with schizophrenia are less likely to experience dissociative symptoms. Those that do have them usually experienced some type of trauma.

DID is sometimes misdiagnosed

Healthcare professionals sometimes misdiagnose DID as schizophrenia.

It can be incredibly difficult to get a correct diagnosis of DID. According to research from 2016, only 60% of U.S. clinicians were able to accurately diagnose DID in an individual.

The clinicians misdiagnosed the condition as:

One reason for this confusion? Some clinicians might confuse someone’s belief that they have multiple identities with them experiencing delusions. The fact that both conditions can involve hearing voices and other overlapping symptoms can make diagnosis even more complex.

Other misdiagnoses

There are several conditions that can be confused with DID and schizophrenia, and possibly lead to misdiagnosis:

Multiple identities ≠ delusions or hallucinations

Some people confuse the multiple identities of DID for the delusions or hallucinations of schizophrenia, but they aren’t the same.

To break down the difference between these symptoms, let’s define them:

  • Delusions. False beliefs that are not based in reality. If you have delusions, you believe them despite evidence to the contrary, even if everyone else believes otherwise. There are many types of delusions, including grandiose, bizarre, persecutory, and somatic (involving touch or sensation).
  • Hallucinations. False perceptions — when someone sees, hears, or feels something that’s not actually happening. These sensory experiences feel real, but they’re not.
  • Multiple identities. Also called alternate identities or “alters,” these occur when someone has more than one personality state. This alternate personality may appear to function separately from another. Alternate identities may have distinct behaviors, memories, expressions, languages, ages, and more. For instance, an alter of a 30-year-old female could be a 12-year-old male.

Coexisting conditions can complicate diagnosis

Other conditions that may simultaneously occur in people with DID and schizophrenia can complicate your symptoms and diagnosis.

People with DID, particularly, have comorbid conditions or symptoms, such as:

Someone with schizophrenia may also experience:

Outdated diagnostic criteria

A lot of the confusion may also come from older diagnostic criteria. As we’ve learned more about mental health, the criteria have become more specific and clear.

Not that long ago, depersonalization was a big part of a schizophrenia diagnosis. Depersonalization is when you feel detached from yourself and your thoughts and feelings. It may feel like an “out of body” experience.

Neither condition has depersonalization listed as a necessity for diagnosis, but it’s now more commonly considered part of dissociative disorders. That said, some people with schizophrenia may still have it.

DID is a rare type of dissociative disorder. The main characteristic of DID is having two or more distinct personality states, also called alters or identities. People with DID may say they have more than one self in their mind or body.

The multiple identities are often distinct, with different names, mannerisms, and voices. They might have distinct histories and memories, ages, genders, sexualities, or interests. If you have DID, you might be aware of these identities or completely unaware.

Symptoms

Signs and symptoms of DID may include:

  • two or more distinct personality states that affect behaviors, consciousness, memory, and more
  • looking like you’re in a trance, blinking or rolling your eyes, or changing your posture when switching alters
  • dissociative amnesia — big gaps in memory that are more than just forgetfulness
  • dissociative fugue — losing your sense of awareness and engaging in some sort of travel away from home for a short or long period of time
  • depersonalization and derealization — feeling detached or disconnected from yourself or the world
  • behaviors of self-harm or suicide
  • hallucinations, such as hearing voices
  • sleep issues, such as insomnia or distressing dreams

For you to receive a DID diagnosis, these symptoms will affect your daily functioning and can’t be due to other causes, such as substance use or other medical conditions. However, someone with DID may use substances or have coexisting conditions.

In some cultures and religions, dissociation and possession or possession-like identities are an accepted norm, so dissociating in these ways wouldn’t be considered a disorder.

Causes and diagnosis

You may have a higher chance of developing DID if you experienced trauma or abuse as a child. Certain parenting styles, neglect, a lack of support or stability, and the ability to dissociate easily are also factors.

While it can be challenging to get accurately diagnosed with DID, reaching out to a mental health professional can be a positive first step. They’ll likely ask you questions about your symptoms, health history, and how you’re functioning in your day to day.

They might also use one of these evaluation tools:

  • Dissociative Experiences Scale
  • Dissociation Questionnaire
  • Difficulties in Emotion Regulation Scale (DERS)

Treatments

While it can be a long road, treatments like talk therapy make managing and living well with DID possible. Everyone’s treatment plan will be personalized, but DID treatments typically involve:

While no medications exist that treat DID specifically, healthcare professionals may prescribe meds to treat related symptoms or coexisting conditions.

Schizophrenia is a mental health condition that affects your thoughts, behaviors, and feelings. People often feel as if they’ve lost touch with reality, usually due to hallucinations and delusions. These are some of the most well-known symptoms of schizophrenia.

Schizophrenia onset usually happens in your teens to 30s. This is when someone has their first episode or starts showing prominent signs. Onset tends to occur earlier in males than females.

Symptoms

Healthcare professionals often break down the symptoms of schizophrenia into three categories: positive, negative, and cognitive symptoms.

Positive symptoms involve altered perceptions or thinking. You might experience:

  • delusions
  • hallucinations
  • disorganized thinking
  • unusual body movements, such as in catatonia
  • suicidal thoughts or behaviors

Negative symptoms can be considered the absence of something, such as motivation or emotional expressions. These might look like:

  • low motivation
  • difficulty planning or following through with activities
  • flat affect — a lack of emotional expression
  • speaking less
  • taking less pleasure in daily life
  • social withdrawal

Cognitive symptoms are those that affect your memory or attention. These symptoms can be subtle or noticeable, depending on the person. Some examples include:

  • trouble making decisions
  • having a hard time paying attention or focusing
  • difficulty using information that you’ve just learned

Causes and diagnosis

A number of factors may contribute to developing schizophrenia. They include:

  • genetics
  • environment
  • brain structure and function
  • changes or differences in neurotransmitters
  • social stressors

If you have schizophrenia, you might have received your first evaluation for the condition after experiencing your first episode of schizophrenia or psychosis. In many people, this first episode is severe enough to warrant seeking medical help or hospitalization.

According to the DSM-5, someone must meet the below criteria to receive a diagnosis of schizophrenia:

  • two or more positive or negative symptoms most of the time during a 1-month period
  • daily ability to function is extremely affected
  • continuous signs of issues must occur for at least 6 months
  • other mental health conditions or substance use aren’t causing the symptoms

A mental health professional will often talk with you about your health history and symptoms. They may try to rule out other conditions that may be causing your symptoms. To do this, they might give you mental health assessments and physical tests.

Treatments

There are many tools and treatments available to help you if you’re living with schizophrenia.

Treatment plans often involve a combo of:

  • medications, specifically antipsychotics
  • psychotherapy
  • family education, support, and therapy
  • coordinated specialty care (CSC), a treatment program aimed at recovery from your first episode of psychosis
  • assertive community treatment, a multidisciplinary team aimed to decrease hospitalizations and homelessness
  • coping tools

DID and schizophrenia are two mental health conditions that may be confused for each other, but they aren’t the same. It’s also possible to have both conditions at once or other overlapping conditions that make diagnosis difficult.

If you think you’re experiencing symptoms of these or another condition, consider reaching out to a mental health professional for an evaluation. If you’ve already received a diagnosis of DID or schizophrenia but don’t think it’s the right one, consider getting a second opinion.

Whether you have schizophrenia, DID, or another condition altogether, you can thrive with the right coping tools, treatments, and support.

If you’re looking for peer support, you can try the Connection Group or Family Support Group from the National Alliance on Mental Illness (NAMI).

Here are additional resources for DID:

Here are additional resources for schizophrenia: