Dissociation and Schizophrenia: an Historical Review of Conceptual Development and Relevant Treatment Approaches

This paper provides an historical perspective regarding the role of dissociation in the development of both etiologic theory and treatment paradigms for schizophrenia. References to the concept of dissociation are drawn from classic writings on dementia praecox, and from Bleuler's (1911) original conception of schizophrenia as a splitting" of the personality. An accurate diagnostic distinction between schizophrenia and dissociative disorders, such as dissociative identity disorder (DID) and brief reactive psychosis (BRP), often has been difficult to ascertain due to the presence of Schneiderian First-Rank Symptoms (FRS) in both types of disorders. The traditional Schneiderian FRS, once thought to be indicative symptoms of schizophrenia, now are viewed as characteristic diagnostic indicators ofDID. Research and theory pertaining to differential diagnosis between schizophrenia and trauma-related dissociative syndromes are reviewed. Early psychodynamic treatment paradigms for schizophrenia and contemporary treatment paradigms for dissociative disorders are compared. Relevant diagnostic and treatment implications for the field ofdissociative disorders are emphasized.