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When Eugen Bleuler created the diagnostic category Schizophrenia in 1908, psychotic symptoms were not considered a core component. Indeed, Bleuler recognized that trauma could cause some psychotic symptoms and that auditory verbal hallucinations could be dissociative in nature (Bleuler, 1950/1911). Unfortunately, these insights were soon forgotten, and for the past half-century, schizophrenia has been viewed as the paradigmatic psychotic disorder. Researchers and clinicians working with persons diagnosed with psychotic disorders rarely consider dissociative disorders, or even posttraumatic stress disorder, as a differential diagnosis. On the other hand, those working in the dissociative disorders field have long recognized that psychotic symptoms, including voice hearing, are common in dissociative disorders (Moskowitz, Mosquera & Longden, 2017). In this context, it is argued that dissociative and posttraumatic disorders are often misdiagnosed as schizophrenia, or other psychotic disorders, with profound clinical implications; importantly, while the treatment of choice for psychotic disorders has long been medication, intense psychotherapy is the treatment of choice for posttraumatic and dissociative disorders.

This webinar will present evidence for the above, along with explanations for the presence of psychotic symptoms in posttraumatic (including ICD-11 Complex PTSD) and dissociative disorders (Moskowitz, Heinimaa & Van der Hart, 2019). While the presence of psychotic symptoms is not useful as a differential diagnostic tool, certain aspects of delusions and hallucinations may aid in differential diagnosis. Dissociative symptoms provide a more solid foundation on which to distinguish between psychotic, posttraumatic and dissociative disorders; the most relevant dissociative symptoms in this regard will be highlighted. These clues to differential diagnosis, and the conceptual and clinical implications of these differences, will be discussed and important unanswered questions raised.