Psych Central

Diagnosed Bipolar But Could I Be Schizoaffective?

By Kristina Randle, Ph.D., LCSW

So around 2 years ago I was diagnosed Bipolar 1, PTSD, and social anxiety… But I’ve been getting a lot of hallucinations, delusions, issues with communication, etc.. Like right now for instance, I can’t stop laughing and quoting songs or lines from movies…or saying obscene things like “my vertabrae feels like a carnivorous dairy product”. Yes, this obviously could be mania, because I’ve been having problems with that for the past couple months, but I’m also hearing and seeing things, too. I keep hearing people talking bad about me, usually my friends’ or family’s voices, saying things like “you’re worthless, stupid, pathetic, ugly, blah blah blah”. A lot of the time I hear it when I’m alone and no one is there, which scares me. OR I’ll hear random voices I’ve never heard before, but I can’t make out what they are saying.

Also the hallucinations have been worrying me, too. Sometimes everything appears brighter or begins to look like I’m stuck in a video game. OR I’ll actually see strange things, like the print on carpets transforming into faces, or seeing actual people trying to talk to me through a TV (while the TV is off of course), or seeing a woman jump out of a poster I was looking at. The delusions are there, too…I can’t smoke a cigarette on my front porch because I really believe that someone is going to park their car and shoot me. Or I’ll have delusions that I’m possessed, or that people can read my mind and it freaks me out. What also scares me is when I’m hallucinating really bad all I can do is laugh hysterically and try to harm myself and say strange things like “egg salad brains”. Also I repeat myself a lot of the time without realizing it…

Apparently this has been going on for a couple years, maybe longer, but it was never brought to my attention until a few of my friends and family shared their concerns for how strange I can really act sometimes.

I just want to know if this can happen with those who have my combination of mental illness, or if I’ve been diagnosed incorrectly. I’ve read up a lot on schizoaffective disorder and most of the symptoms match up with me.

A. Diagnosing mental health disorders is not a straightforward process. Mental health professionals utilize the Diagnostic and Statistical Manual (DSM) as a guide but it is not a perfect system. I cannot say with certainty whether your diagnosis is accurate but it is possible that it is not. Some of your symptoms are more in line with schizophrenia or schizoaffective disorder than bipolar disorder. Disorganized speech is characteristic of schizophrenia and variants of schizophrenia. It is not unusual for individuals with schizophrenia to make odd comments or to use unusual language. This is sometimes referred to as “word salad.” Word salad, or the technical term schizophasia, is when an individual uses words in a sentence, for example, that have no relationship to one another. Their language can sound jumbled and confused.

What is unclear is what is causing your jumbled or confused speech. The cause may be uncontrolled mania or other symptoms related to bipolar disorder. It may also be symptoms of schizophrenia or related disorders. The problem is that it’s often too difficult to determine the exact cause.

In my experience, it is oftentimes the case that pinpointing the exact diagnosis is not nearly as important as receiving effective treatment. Your symptoms are clearly not under control. Out-of-control symptoms are indicative of an individual who is: not in treatment; not complying with treatment; or not receiving effective treatment. If it is the latter, then you may want to consider getting a second opinion, especially if you don’t agree with the diagnosis.

I’m sorry that I cannot give you a definitive answer. It is a complex question and there is no easy answer. It is good that you are taking an active role in educating yourself about other possible mental health disorders but please keep in mind what I mentioned above: treatment is often more important than the diagnosis. I wish you well. Please take care.

Dr. Kristina Randle

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Last reviewed: By John M. Grohol, Psy.D. on 12 Mar 2011

APA Reference
Randle, K. (2011). Diagnosed Bipolar But Could I Be Schizoaffective?. Psych Central. Retrieved on April 19, 2014, from http://psychcentral.com/ask-the-therapist/2011/03/12/diagnosed-bipolar-but-could-i-be-schizoaffective/

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