Chapter 10. To Begin With ―Psychoeducation (2)

In sum, those who hold a key to the correct diagnosis and relevant treatment are the patients themselves. They need to arm themselves with the knowledge in order to get the most proper care for their illness. It is not limited to psychiatric illnesses but medical illness in general. Each doctor makes a best effort to diagnose the patient based on his clinical experiences and knowledge, but not without limitations or misunderstandings. In order to avoid misdiagnosis and inappropriate treatment, each patient should be well informed and should seek, if necessary, experts’ opinions.
However, not many patients are aware that many psychiatrists tend to misdiagnose dissociation as schizophrenia. Originally many dissociative patients think that hearing voices is a common experience for everyone and they may not hesitate sharing it with others. However, gradually they realize that it might be the case. After having some contacts with mental health professionals, they learn that discussing their experiences with their clinicians could be tricky and misleading as hearing voices are also crucial for the diagnosis of schizophrenia. Some of them may start seeking informed therapist on their own though internet or using other sources.

③ They tend to be misunderstood as having malingering

Some dissociative patients may give the impression that they are intentionally controlling their symptoms. Therefore they are often treated as malingerers or having factitious disorder (also known as Munchausen syndrome). One of my patients switched from her child personality to the adult host personality when she left my office. A staff nurse who was not familiar with dissociative disorder observed the scene and thought that the patient was deliberately controlling her symptoms. In fact, this type of swift switching is not uncommon. Dissociative patients do not hesitate to show different identity to their familiar clinicians while they try to hide as much as possible their other identities from other people.
In another case, a child personality shows up routinely with her therapist, until the therapist left the job and another therapist took over the case. This new therapist is reluctant to treat the patient’s dissociative symptoms as he was credulous to dissociative disorder itself. The patient’s child personality ceased to show up and the new therapist said to other staff, “You see, if you stop dealing with a child personality, he would not show up, and she is alright with it. Therefore, DID is essentially iatrogenic.”