When I was about 22 years old, I was diagnosed with schizoaffective disorder bipolar type. I am 29 years old now, and still puzzled — What exactly constitutes schizoaffective disorder? Moreover, is the illness itself a diagnostic myth or a fact? No one wants to be labeled schizophrenic or even bipolar, but to be labeled schizoaffective — Is that a “worse” diagnosis or a “better” one?
In the DSM-5, schizoaffective disorder is defined as “an uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with criterion A of schizophrenia.” Criterion A of schizophrenia is all the classic schizophrenic symptoms, such as delusions, paranoia, hallucinations, etc.. So is schizoaffective, then simply, symptoms of schizophrenia combined with a mood episode?
A quick search about schizoaffective disorder on Google scholar yields results indicating otherwise. In one study, authors found that schizoaffective disorder is genetically related to schizophrenia and bipolar and that it is essentially just psychotic mood disorder which should be treated as such because labeling it as schizoaffective (a definition invented in 1933) causes people to see the specific illness as a unification of two other diseases, namely, schizophrenia and bipolar. This unification of two other distinct illnesses into one leads to substandard treatment, since what people are calling schizoaffective disorder is actually psychotic mood disorder, an illness in its own right.
So two question remain: Is schizoaffective disorder a myth or a fact? Possibly it is a myth, insofar as it should be seen as distinct psychotic mood disorder. Secondly, is schizoaffective a “worse” or “better” diagnosis than schizophrenia or bipolar? Well, there’s probably no way to judge such a question because all three illnesses, schizophrenia, bipolar, and schizoaffective (or, psychotic mood disorder) can lead to extremely grave consequences.
In my personal experience having the diagnosis of schizoaffective disorder, I have found that the DSM-5 criteria do not exactly match my symptoms. It is true that I had the delusions and paranoia of criterion A of schizophrenia, but I do not think I was ever really suffering from a concurrent major mood episode that was major depressive or manic. I do believe that the phrase psychotic mood disorder could more aptly define my illness, as it seems my mood is somewhat abnormal all the time, even on medication. I think if one is diagnosed with schizoaffective disorder, one should definitely take an antipsychotic at least, to control the schizoid symptoms, and then work with one’s psychiatrist to control the seemingly all- pervasive strange mood element of the illness. Just prescribing an antidepressant to control major depressive or manic symptoms may not be enough, and even prescribing a mood stabilizer may not make one’s abnormal mood better.
Personally, I think methods such as cognitive behavioral therapy should definitely be utilized to teach the individual diagnosed with schizoaffective disorder how to understand his or her own seemingly all-pervasive, strange mood better. This can lead to an acceptance of one’s own self, whereby the individual will not see his or her own mood disorder as something “black,” “ugly,” “demonic,” or otherwise stigmatized. CBT can teach the individual to simply note the differences in his or her own way of interacting with people compared to regular people, and then help the individual find ways of adjusting that seemingly automatic behavior properly.
Again, in my own experience, I do find that the diagnosis of schizoaffective disorder is tough to conquer. Psychosis, severe anxiety, severe depression, and mood disorder are all big challenges that should be tackled with a honed regimen of medication, CBT, and family support. Although I have been stable myself now for about five years, I am occasionally prone to outbursts if stressors get to high. Therefore, people diagnosed as schizoaffective should remember that they are only human, like everyone else, and may experience strange and sometimes even almost indefinable symptoms from time to time, even when taking medication diligently.
Regarding the percentage of people diagnosed with schizoaffective disorder, the numbers vary, but it is considered to affect less than one percent of people. This very low frequency can lead to terrible stigmatization, but we should remember that many illnesses are related genetically, even if they have specific genetic markers per disorder. To remember, for example, that schizoaffective disorder is genetically related to general depression (which affects a far greater number of people) can help reduce the stigma on schizoid illnesses.
Finally, people diagnosed with schizoaffective disorder should definitely be encouraged to interact in society in positive ways. This doesn’t necessarily mean throwing schizoaffectives down the typical path of work, play, and rest. Schizoaffectives may need special accommodations because they are actually such creative individuals themselves. In my own case, I have found writing to be a good outlet for connecting with people and society at my own pace. There is arguably no limit to the success an individual diagnosed with schizoaffective disorder can experience, and this fact must be remembered in our times when so many mentally ill people who accidentally commit crimes are thrown in prison, a place they truly do not belong to be in. Much of the schizoaffective’s success must truly come from within, but without social awareness of mood disorders, schizoaffectives may become stunted at times throughout their lives in unfair ways. Therefore, it remains crucial: do not blame schizoaffectives for simply oddball behavior if they exhibit it. Remember that the schizoaffective(s) you know may be some of the most creative and loving individuals you will ever meet.
References: Lake, Ray, C., Hurwitz, & Nathaniel. (2007). Schizoaffective disorder merges schizophrenia and bipolar disorders as one disease – there is no schizoaffective disorder [Abstract]. Current Opinion in Psychiatry, 20(4), 365-379. doi:10.1097/YCO.0b013e3281a305ab