How is Schizoaffective Disorder Different than Schizophrenia? Why Accurate Diagnosis and Treatment Matter
Schizoaffective disorder is often confused with other mental health disorders, particularly schizophrenia, leading to misdiagnosis and incorrect treatment. So how is schizoaffective disorder different than schizophrenia? By learning about the unique features of schizoaffective disorder, you can better understand what your loved one is experiencing and determine what kind of treatment is best to restore stability.
The work of psychiatry is, in many ways, the work of categorization, fitting symptomatologies into discrete diagnoses in order to give people a language for understanding their distress and a path toward alleviating it. But there are some illnesses whose symptoms look so much like those of other disorders that they often elude detection. They are mistaken for something else, and the person seeking care is unwittingly denied the care they need to heal.
Perhaps one of the most commonly misdiagnosed illnesses is schizoaffective disorder, a psychiatric condition that shares symptoms with multiple other mental health disorders, most notably schizophrenia. So how is schizoaffective disorder different than schizophrenia? By understanding the ways in which schizoaffective disorder overlaps with and diverges from schizophrenia, you can gain clearer insight into what your loved one is experiencing and open up a path to recovery.
A Story of Misdiagnosis
“I had my first psychotic episode 16 years ago when I was in college,” says Elizabeth Caudy. “I thought people were following me and that broadcasts on TV were coded messages meant for me.” Doctors didn’t know what was wrong with her. One gave her a diagnosis of schizophrenia; another said it was bipolar disorder, believing her psychosis to be the product of mania. Despite the diagnostic discrepancy, she started taking antipsychotics, which quelled the delusions but never quieted the voices in her mind, nor did it prevent her from plunging into deep emotional lows.
“Finally, four years later, I had my first meeting with my current and excellent psychopharmacologist. She asked me if my psychotic episode had been preceded by a period of mania,” Elizabeth says. “When I said yes, she changed my diagnosis to schizoaffective, bipolar type. This means that I have symptoms of schizophrenia and of bipolar disorder. I often think ruefully, I get two disorders for the price of one.”
While schizoaffective disorder was a frightening diagnosis that required quickly learning a new language of mental illness, the formal recognition of her disorder meant that she could finally start the process of finding effective treatment. Instead of just taking an antipsychotic, she could now be treated with mood stabilizers and antidepressants to alleviate the crushing highs and lows she used to cycle through unabated while misdiagnosed. But correct diagnosis didn’t just open the door to new pharmacological interventions; it gave her and her family a new understanding of what Elizabeth was experiencing, as well as a new vocabulary for talking about it.
How is Schizoaffective Disorder Different than Schizophrenia?
Elizabeth’s story is emblematic of how so many people experience both schizoaffective disorder and its misdiagnosis. The delusions and hallucinations that characterize schizophrenia are indeed there, and the acute nature of these symptoms often makes them take center stage when it comes to diagnosis. If a clinician focuses solely on these symptoms, or if the client doesn’t reveal accompanying mood disturbances, it is easy to see how misdiagnosis as schizophrenia can happen. Conversely, if a clinician or client focuses solely on mood disturbances and accounts for psychotic symptoms as features of mania or depression, it is easy to understand how schizoaffective disorder is mistaken for a mood disorder.
However, the defining feature of schizoaffective disorder is that both psychotic symptoms and mood episodes are experienced simultaneously, yet discretely. The nature of these mood episodes determine which type of schizoaffective disorder a person is experiencing:
- Bipolar Type: Includes manic episodes, which may be accompanied by depressive episodes.
- Depressive Type: Includes depressive episodes, but not mania.
What is unique about schizoaffective disorder is that its psychotic features are not tied directly to the presentation of mood episodes. While the two occur simultaneously, the psychosis itself is not a product of mania or depression, but exists independently. As Dr. J. Michael Bostwick of the Department of Psychiatry at the Mayo Clinic explains:
With schizophrenia—the thought disorder—or the psychosis, is present all the time. In schizoaffective disorder, the person essentially has the thought disorder all the time, with mood episodes superimposed upon it. So you can think of the psychosis as running in the background all the time in schizoaffective disorder with these mood episodes happening intermittently as well.
There is considerable debate within the psychiatric community about the nature of schizoaffective disorder. While some believe that schizoaffective disorder is “a variant of schizophrenia in which mood symptoms are unusually prominent,” others believe it “may reflect the co-occurrence of two relatively common psychiatric illnesses.” But for people who struggle with schizoaffective disorder and their families, these debates are largely irrelevant; what matters to them most is not how to categorize distress, but how to relieve it. Unfortunately, misdiagnosis and incorrect treatment can not only fail to adequately address your loved one’s symptoms but can actually aggravate them, creating dangerous conditions.
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Finding the Right Treatment
Today, there are more options available than ever before for the treatment of schizoaffective disorder. For most, these include pharmacotherapy in the form of antipsychotics, mood stabilizers, and/or antidepressants, as well as psychotherapy and life skills training to ensure the full range of symptoms are addressed. While families often worry about what a schizoaffective disorder diagnosis will mean for their loved one, many people are able to live stable, fulfilling lives with the right care.
Although some people with schizoaffective disorder can be successfully treated on an outpatient basis, people with severe presentations of the disorder or who are low functioning may need to seek care in a long-term residential environment to truly begin the recovery process. This may be particularly true for people whose illness has been effectively untreated as the result of misdiagnosis, leaving them without the benefit of early intervention.
Long-term residential treatment programs provide an ideal environment in which to engage in a comprehensive array of treatment modalities that seek to alleviate distressing symptoms while nurturing the insight and skills your loved one needs to thrive. Expert clinicians with the experience to correctly diagnose and treat schizoaffective disorder will design a personalized treatment plan for your family member that ensures they have the support they need at each stage of the recovery process. This includes judicious use of pharmacotherapy and continuous monitoring of medication efficacy, but it also goes beyond medication to foster self-awareness, self-esteem, self-efficacy, and emotional growth within an intimate therapeutic community. As your loved one moves through the treatment curriculum, they will gain greater independence and learn to manage their life both emotionally and practically.
Because schizoaffective disorder affects the whole family, it is also vital to choose a treatment program that invites meaningful family participation. Dedicated family programming gives you the opportunity to learn about your loved one’s illness, process your experiences, and connect with your loved one on a deeper level with the guidance of compassionate clinicians and peers. Together, you can open the door to richer, healthier relationships and create a promising new future for your family.
Hanbleceya offers comprehensive, long-term treatment for people living with mental health disorders as well as co-occurring substance use disorders. Contact us for more information about our renowned San Diego-based program and how we can help you or your loved one start the journey toward sustainable recovery.
Image Source: Unsplash user Jonatán Becerra