ND Review: DID ≠ Psychosis

Quora question:

What causes DID it personality disorders in someone and do they experience psychosis as well as losing time?

I wanted to tackle the issue of psychoses and neurodivergence of any kind, including plurality, because I believe it is an important subject.

Unfortunately, psychotic behaviour is more in the eyes of the beholder than based in science.

Causes and effects

Fear can be justified by experiences!

So, first of all, let’s have at a brief look at how one “earns” the plural badge for this human feature to be considered disordered. Obviously, I do not only refer to DID, but to all dissociative disorders and inherent multiplicity.

And maybe I need to put a Trigger Warning here, but I do need to paint as real a picture as possible for people to understand the point that I am trying to make. Plurality is brought about by experiences that are beyond comprehension and imagination. Those who watch gory horror movies for fun, might not have the emotional capacity to empathise with what I am saying.

But imagine being in a situation with no escape. Respite comes for a few seconds at a time, if at all … fear is permanent. One never knows what is going to happen next. Life is always in danger. Pain is comfort, unliving a longing. Sleep is dangerous, if one sleeps there’s nightmares, and one is always woken up for some nefarious reason. Recognising the faintests of sounds knowing what they will bring, those footsteps means this will happen, the clanging metal sound will bring something else, etc. And not even trying to escape, because that would be a sign of hope, but hope is long gone. A perennial lamb to slaughter.

Also, abusers tend to have really weird patterns of behaviour that may seem harmless at times to the inexperienced observer, and those habits become imprinted in our brains.

Not forgetting, people with dissociative disorders tend to be suggestionable, so more likely to believe what they are told, and to learn behaviours; i.e. more susceptible to conditioning.

Psychoses in context

When looking at DSM-5-TR, there is a lot being told about psychotic disorders, with a few pages specifically dedicated to the 5 indicators starting on page 87 .

A great deal on emphasis is placed on a ”Clinician-Rated Dimensions of Psychosis Symptom Severity” which is very dangerous.

All those symptoms are assessed rather subjectively depending on the clinician’s own knowledge, experience, understanding, and not forgetting cognitive and emotional capability and a capacity for critical thinking.


  1. What is the difference between an hallucination and a flashback? When a person lives through a flashback, those sensations can be considered hallucinations if one is not aware, especially if there is some Dissociative Amnesia present.
  2. What is the difference between a delusion and a real experience-driven fear? For example, if someone tells me that they have a microchip implanted in their brain, I will consider the possibility of an introject or an alter revealing “secrets” before thinking it is a delusion. We must never forget how persistent trauma indelebly burns certain memories and survival mechanisms into our brain and nervous system.
  3. Disorganised speech can be misinterpreted. If a person is having a flashback that brings on some fears, their speech will be affected. If someone is an ADHDer they might be accused of disorganised speech inappropriately too, etc.
  4. Abnormal psychomotor behaviour, again, can be misinterpreted. WIth an appropriate understanding of a person’s circumstances it is possible often to identify this as ticks, stims, or reactions to flashbacks or alter’s intervention.
  5. Negative symptoms can be a learned response and can be misinterpreted. A person who is regularly abused is understandably going to express their emotions differently


From my own personal experience and by engaging with others who have a range of dissociative disorders, I don’t believe that accusing a person of being psychotic is helpful. On the contrary it can perpetuate the abuse received, contribute to impact patients’ mental health negatively, especially when inappropriate medication is prescribed, and therefore delays recovery.

I firmly believe that therapists should have personal experience of the disorders they treat. We are going in the right direction with the normalisation and legitimisation of peer support, but this is only a small step in a long path of change that we must begin walking.

I will leave you with a little info on how DSM is currently being compiled and the problems associated with subjective areas of interests being called science. 🩵

Originally posted at AG’s answer to What causes DID it personality disorders in someone and do they experience psychosis as well as losing time? in ALTERnate REALity

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