Schizophrenia and dissociative identity disorder (DID) are serious mental health disorders that can have a significant impact on a person’s life.  Many might not consider incorporating complementary and alternative medicine as part of the treatment plan. However, new evidence is emerging about how acupuncture can successfully treat several mental illnesses like anxiety and depression. A case report recently published by NUHS faculty Brett Martin, DC, MPH, MSAc, and a former intern shows promise for using acupuncture to treat both schizophrenia and DID, too.  

The report titled, “Inclusion of Acupuncture as an Adjunct Therapy in the Management of a Patient with Schizophrenia and Dissociative Identity Disorder,” by Dr. Martin, and then intern, Rachel Wroblewski, explores using acupuncture to treat a 68-year-old male patient at NUHS’ Whole Health Center in Florida, who was diagnosed with schizophrenia at age 25 and DID at age 53.  

In this blog, Dr. Martin discusses schizophrenia and DID along with his effective approach for this patient.

What is schizophrenia and dissociative identity disorder (DID)? 

Schizophrenia is a disabling mental disorder that causes symptoms such as delusions, hallucinations, catatonic states, abnormal behaviors and distortion of speech. Individuals with schizophrenia are more likely to develop DID. While sometimes featured in movies, DID is not always accurately portrayed. The movie Split is one example. Unlike the movie, the main identity of the person along with the other personas are present at all times. The other personas will say things that change behavior and cognitive function. They may make the person self-conscious or paranoid. Unlike DID, schizophrenic patients do not experience another persona in their mind, occupying space.  

While influenced by genetic factors, schizophrenia and DID can be caused by significantly traumatic events and chronic stress, particularly during childhood. Sometimes a patient will assign trauma experienced to a persona rather than themselves. It’s one way that the mind tries to cope in order to get on with life.   

The patient in this case report experienced auditory hallucinations along with one or 2 personas, in addition to his main identity at any time and as many as 5 others. At the beginning of his care, the personas were mostly negative, berating the patient, while one served as an ally providing guidance and protection but was not often present. One persona was associated with the sexual and physical abuse he had experienced in childhood. Two other personas were similar to parental roles that seemed to be in place of his actual parents who were neglectful.  These voices would often cause the patient to fall into a catatonic, depressive state for several hours. 

How traditional Chinese Medicine views schizophrenia and DID 

In Traditional Chinese Medicine, schizophrenia is related to a kidney yin deficiency. Traumatic events or chronic stress depletes yin or the body’s life essence. The kidney in particular is affected because it is associated with fear.   

Excessive fear caused by chronic trauma damages kidney essence, creating a yin and yang imbalance. Yang energy rises and disrupts the mind, impeding mental function and maturation, resulting in delusions and abnormal behaviors. Using the 5-element theory perspective, kidney, which is associated with water is not able to balance the fire element of the heart, which represents mind/spirits, thus causing damage.  

Based on this TCM perspective, various acupuncture points were used to reinforce kidney yin energy in the patient. 

Integrating acupuncture into conventional treatments

Most conventional treatments like anti-psychotic medication and mood stabilizers are commonly used to control symptoms. However, they don’t necessarily help with the social withdrawal, apathy or cognitive deficits that patients experience. Many patients do not tolerate medication well. Some medications can even increase the risk of mortality. Side effects like dry mouth, weight gain, movement effects and sedation can also make a patient less likely to take them on a regular basis. Behavior therapy with a psychiatrist doesn’t always work either.  

By receiving acupuncture in addition to medication and behavioral therapy, the patient in this case study was able to see profound improvement in his symptoms. Based on psychiatric rating scale, which measures the severity of symptoms, the patient scored 80.5 out of 126 between October 2018 and January 2019. After treatment, the patient’s symptoms improved to 57.33 on the 126 scale from January 2019 to November 2019. Overall, he became less irritable, paranoid and stressed. When he previously scored these symptoms consistently as a 5 (moderately severe), 6 (severe), 7 (extremely severe) on a 7-point scale, they reduced to a 2 (very mild), 3 (mild), 4 (moderate).  

Once acupuncture was incorporated, negative personas that were once always there started to disappear and become much less prominent. His ally persona became more present. Another ally that wasn’t there before was created, which told him the truth and helped him calm down. 

Impactful approaches to treating schizophrenia and DID   

1. Establish trust with the patient   

Two of the most important aspects to treating this condition are establishing trust and consistent care. Currently there’s only a handful of studies that have been done on acupuncture treatment for schizophrenia and none on acupuncture treatment for DID.  The studies on acupuncture treatment for schizophrenia all have mixed results that show some aspects improve while others do not. One of the reasons for this may be because patients, who are often experiencing paranoia and delusions don’t easily trust other people, health care professionals in particular, especially if there are a lot of different professionals performing trials.   

While receiving care at NUHS’ Veteran’s Clinic, the patient received care from different interns every six weeks as part of standard clinical rotations. At first, the patient would show improvements but when new interns provided care, his symptoms would worsen. After discovering this, I took over the patients care and was able to establish trust.   

2. Understand the mechanism behind the condition

The mechanisms or what causes schizophrenia and DID should be well understood before assigning treatment. How the condition affects the body can influence the acupuncture points that are used. It also helps to look at acupuncture from a physiological perspective, not just a TCM perspective. This helps patients and other health care professionals better understand the care.  

On a physiological level, schizophrenia and DID can cause alterations in the levels of neurotransmitters like GABA and dopamine. This can significantly impair cognitive functions, causing delusions. Dopamine receptors, which affect movement, emotions, and the reward system, can also be abnormal. NMDA receptors, which help regulate memory function, may be defective, as well, disrupting neuronal function.  

3. Use acupuncture points that relieve anxiety, lower stress levels and improve overall mood  

While there aren’t many studies directly related to acupuncture’s effectiveness for schizophrenia and DID, research has shown that certain acupuncture points can help regulate GABA levels, which can help induce a state of calm not just in DID patients, but patients with anxiety as well. Studies have also shown acupuncture can help with withdrawal symptoms from addiction, which, like schizophrenia and DID, affects dopamine and GABA levels.   

According to a 2019 study, another one of the physiological effects of acupuncture is that it helps reduce cortisol, which controls stress levels. In the patient, stress is one of the factors that exponentially aggravates his symptoms. By reducing stress levels, other personas the patient experienced, particularly the negative ones, came up less. The positive persona, who defended him against the other voices, showed up more often.  

While the patient in the case study still experiences different personas during certain times of the year, typically associated with family such as the Fourth of July, Thanksgiving and Christmas, he was eventually able to do regular day to day things, including going to the gym for the first time in years and even took part in a group yoga class. Something he was never able to do before. He started to feel normal, he felt better.   

It’s important to recognize that when treating a mental health condition, most likely you’re not going to cure the condition, but you will see some pretty good improvements that help the patient manage his condition and lead a better quality of life.