A) Someone who feels happy one minute and deeply distressed the next.B) Someone who treats you like a friend—or distrusts you completely—depending on the day.C) Someone who seems confused and disoriented, even though he’s in a familiar setting.D) Someone who sees things that aren’t there and hears voices that aren’t real. Answer: Any of these descriptions could apply to someone living with schizophrenia, a chronic type of psychotic disorder where people experience a combination of hallucinations, delusions, cognitive impairment and disorganization of thoughts and speech, says Dr. Brian Barnett, MD, a psychiatrist at the Cleveland Clinic in Ohio. But they might also apply to someone dealing with bipolar disorder or schizoaffective disorder—or even, in some cases, ADHD. Understanding what all these conditions mean and how they overlap or differ is important to getting the right diagnosis and optimal treatment. Let’s take a closer look at how schizophrenia is similar to, and different from, other psychological disorders.
What does psychosis have to do with schizophrenia?
Psychosis is the umbrella term used to describe symptoms for a range of psychotic illnesses, including schizophrenia. It also refers to bipolar disorder and depression, and can generally be applied to any mental disorder that involves becoming detached from reality, according to the National Institute of Mental Health. False beliefs, hallucinations, incoherent speech and inappropriate actions are all considered psychotic symptoms, and while they describe schizophrenia to a T, they may also apply to other conditions, like OCD or PTSD. In other words, a person with schizophrenia also has psychosis, but someone who is psychotic is not necessarily schizophrenic. Three in every 100 people will experience psychosis at some point in their lives, according to the National Mental Health Alliance, a nonprofit mental health advocacy group. Common psychotic symptoms include:
Hearing and seeing things that aren’t thereA detachment from realityPersistent false beliefs that can’t be altered despite evidence to the contraryStrong and inappropriate emotionsLack of emotionWithdrawalConfused thinkingLack of self-care
It’s worth noting that substance abuse can also mirror aspects of psychosis, but is not considered a psychotic disorder in the way schizophrenia and bipolar are.
How is schizophrenia related to bipolar disorder?
Of the major psychological conditions you may have heard of, schizophrenia and bipolar disorder probably top the list, in part because of their prevalence: About 20 million people in the world have schizophrenia, according to the World Health Organization, while the global prevalence of bipolar is around 45 million. At first glance, the hallmark symptoms of the two conditions don’t seem to share much in common. Bipolar disorder is characterized by extreme and unpredictable changes from feelings of euphoria or mania to lethargy and depression (hence the original diagnosis of “manic depression”). In schizophrenia, on the other hand, hallucinations and delusions dominate. Some people with bipolar will also go through periods of so-called “grandiose” thinking (that they have special powers, say) and may experience delusions, like believing they are a celebrity or have a special connection with God. “Psychotic features like this can make it difficult to distinguish between bipolar and schizophrenia,” says Dr. Barnett. “There is significant overlap between schizophrenia and bipolar.” In fact, a study of 1,469 patients in the Journal of Affective Disordersfound while those with schizophrenia tended to be younger, have more hallucinations and fewer extreme episodes of mania or depression compared to those who were diagnosed with bipolar, the degree of shared symptoms suggest the two conditions exist on a spectrum, with bipolar at one end, schizophrenia at the other and something called schizoaffective disorder in the middle.
How is schizoaffective disorder different from schizophrenia?
Combine some of the quirks of schizophrenia with aspects of a mood disorder like bipolar, and you wind up with schizoaffective disorder. This disorder, which usually begins in early adulthood, is fairly rare, affecting about one in every 200 people, according to the Cleveland Clinic. It’s also a bit of a controversial diagnosis. Initially believed to be a variant of schizophrenia, schizoaffective disorder came into its own in the past two decades as an increasing body of research suggested that despite similarities, certain symptoms of the two illnesses were unique. For instance, people with schizoaffective disorder may recognize the reality of their lives but feel detached from it, while people with schizophrenia struggle to tell the difference between reality and fiction. More recently, however, the validity of schizoaffective disorder as its own clinical diagnosis has been called into question again. In one study, researchers at York University in Toronto, Canada, went as far as to say, “Schizophrenia and schizoaffective disorder are largely indistinguishable on key cognitive, social cognitive and neural measures. The continuing separation of these syndromes in diagnostic systems and disease models is questionable and requires further attention.”
Understanding dissociative identity disorder (DID) and schizophrenia
On the surface, the connection between dissociative identity disorder, once known as multiple personality disorder, and schizophrenia seems straightforward: In both cases, people may assume ideas and behaviors not consistent with the reality of their situation. “These disorders are often confused by the general public,” acknowledges Dr. Barnett. “But dissociative identity disorder is very different from schizophrenia and schizoaffective disorder.” In DID, says Dr. Barnett, a person has at least two distinctive personalities that alternate to control a person’s behavior at different times. “People with DID also tend to have severe gaps in memory and usually have experienced extreme trauma during childhood,” he adds. And unlike schizophrenia and schizoaffective disorder, which are primarily treated with medications, people with DID are usually treated with psychotherapy. Meanwhile, some clinicians call into the question of the use of DID as a diagnosis. “It is best conceived as a construct used to conceptualize people who have intense and difficult to manage emotional states,” says Dr. Russell Margolis, MD, clinical director of the Johns Hopkins Schizophrenia Center in Baltimore. “It is a narrative used by some clinicians—whether use of this narrative is helpful is controversial.”
Delusional disorder versus schizophrenia
When a person starts believing things that are not grounded in reality, schizophrenia is one possible diagnosis. Delusional disorder is another. The two conditions share common ground, but you can tell them apart in a few key ways.
Bizarre or believable:
While people with both conditions have delusions, in delusional disorder these fantasies are somewhat believable (my boss is spying on me) while in schizophrenia these delusions are bizarre and unbelievable (my boss is secretly working for the CIA).
Quality of life:
People with delusional disorder tend to have milder symptoms that are less disruptive to daily life. Meanwhile, untreated schizophrenia has a direct impact on a person’s ability to function successfully in society.
Hallucinations:
Hallucinations are one of the hallmarks of a schizophrenia diagnosis, impacting the way a person talks and acts. In delusional disorder, hallucinations are rare.
Treatment:
Because people with delusional disorder experience less impact on day to day life, and in general have milder symptoms, psychotherapy is often the preferred method of treatment. Meanwhile, the severity of schizophrenia symptoms often requires medication to treat.
From schizophreniform to schizophrenia
If you’ve been hearing voices, seeing things that aren’t there, or having trouble with rational thinking for several weeks, your doctor may talk with you about schizophreniform disorder. “Schizophreniform disorder is used to describe individuals so early in the course of schizophrenia that the diagnosis is not certain,” explains Dr. Margolis. It applies to those experiencing psychotic symptoms for one to six months, adds Dr. Barnett, while a full six months or more is needed for a clinical diagnosis of schizophrenia. About one in 1,000 people will develop schizophreniform disorder, and it occurs equally in women and men, most often between the ages of 18 to 24, according to the Cleveland Clinic. It may resolve on its own in some people (for reasons scientists are still trying to understand), “but about two-thirds of people with schizophreniform disorder will go on to develop schizophrenia,” Dr. Barnett says. Given that the progressive relationship between the two disorders, not surprisingly, symptoms of schizophreniform and schizophrenia are the same: confused thinking, delusions, hallucinations, difficulty grasping reality and inappropriate comments or behaviors.
Schizotypal disorder versus schizophrenia
They may sound similar, but schizotypal disorder (also known as schizotypal personality disorder) and schizophrenia are distinct conditions. “Schizotypal is a personality disorder where people tend to be loners and often have unusual beliefs like superstitions or strong interest in the paranormal,” says Dr. Barnett. These people are often paranoid and can speak or act in strange ways, he says, but “they rarely come into treatment since they don’t have overt episodes of acute psychosis that bring them to the attention of authorities, and these individuals don’t believe there is anything problematic about how they view the world so they aren’t seeking help.” While people with schizotypal disorder may briefly experience psychotic symptoms, one of the key ways they differ from those with schizophrenia is their ability to understand the difference between their distorted ideas and reality, according to the Mayo Clinic in Rochester, MN. Other symptoms may include:
Being a loner/lack of friendsFlat emotionsInappropriate thoughts and behaviorsEccentric beliefs or mannerismsSuspicious and paranoid thoughtsBelief in special, unfounded powersPeculiar patterns of speechOdd approaches to dressing
What to know about schizoid personality disorder and schizophrenia
The diagnosis of schizoid personality disorder is a controversial one—and if you’re beginning to detect a pattern here, it’s because there will always be a dose of clinical subjectivity when it comes to deciding which clusters of behavior and thinking are worth a unique diagnosis, and which ones are best positioned on a spectrum for one overarching condition. Some studies, like one in the Journal of Personality Disorders, conclude that schizoid personality disorder does not have enough unique characteristics to be classified as its own condition, and its traits would be better served as a part of a dimensional model for personality disorder. “Schizoid personality disorder is used to describe people who are not very social, and who may seem to others cold, withdrawn and detached,” says Krista Baker, program manager for adult outpatient services at the Johns Hopkins Schizophrenia Center. Some studies even suggest schizoid personality disorder shares enough in common with autism spectrum disorders to be considered part of that spectrum as well. In a study of 72 young adults with and without autism, researchers at the Washington University School of Medicine in St. Louis, Missouri, found that 50 percent of those with autism frequently experienced three or more symptoms of schizoid personality disorder. As for how schizoid personality disorder relates to schizophrenia, that’s less clear. “There appears to be genetic overlap with schizophrenia,” says Dr. Barnett. “And schizoid personality is more common in relatives of people with schizophrenia.” Similar to schizoaffective and bipolar disorders, he says, there may be a spectrum that includes schizoid and schizotypal personality disorders and schizophrenia.
What does autism have to do with schizophrenia?
Here’s something you might not know: Until midway through the 20th century, autism was considered a form of childhood schizophrenia, and in fact, both conditions share certain genetic variants. But research in the last 50 years has also found striking differences—along with similarities—between the two disorders, leading scientists to believe they are unique conditions that overlap in how they are expressed. For instance, people with autism and schizophrenia share clinical features such as withdrawal in social settings, difficulty communicating with others and trouble making eye contact when speaking. But while autism has gained recognition in the U.S. for the challenges it poses for families grappling with the disorder, schizophrenia remains a stigmatized condition.
Anxiety and schizophrenia
Possibly in part due to that stigma, people with schizophrenia are also at risk for anxiety disorders. According to researchers at the University of Cape Town in South Africa, 65 percent of people with schizophrenia experience symptoms of anxiety, and 38 percent suffer from a clinical anxiety disorder as well. Anxiety can be difficult to diagnose in people with schizophrenia because symptoms like hallucinations and delusions can mask a person’s true feelings. While about half the people with schizophrenia report feelings of anxiety prior to their first psychotic episode, others develop symptoms of anxiety disorders after their schizophrenia disorder. That may be due to a response to the psychotic episodes themselves, says a study in Schizophrenia Research and Treatment—in other words, the fragmented, false reality that schizophrenic people live in, where they see and hear upsetting things that are not really there, can trigger bouts of anxiety.
How schizophrenia relates to OCD
Intuitively, you might be able to see some overlap between obsessive compulsive disorder (OCD) and schizophrenia. They are both mental disorders that involve people acting in irrational ways or feeling compelled to perform inappropriate behaviors, despite evidence suggesting the behaviors are not warranted. And indeed, although OCD affects just one percent of the population, a full 25 percent of people with schizophrenia also have symptoms of OCD, according to the International OCD Foundation, a nonprofit organization that provides resources and support to those with OCD. While scientists are not yet certain of the causes for both disorders, research does show that in people who have both, OCD tends to develop first in early adulthood. Moreover, both disorders are linked with low levels of the hormone serotonin, and both appear to be associated with mutations in the SLS1A1 gene, according to a study in Complex Psychiatry. Complicating matter, certain medications used to treat schizophrenia have been linked to an increase in certain OCD behaviors.
What does ADHD have to do with schizophrenia?
And finally, although schizophrenia is a very different mental health challenge to attention deficit hyperactivity disorder (ADHD), they share in common a fundamental inability to focus and organize thoughts in a coherent manner. But research in the Archives of Clinical Neuropsychology suggests that while on the surface these behaviors look similar, the underlying mechanisms are quite different for inattention in ADHD versus schizophrenia, and for that reason, approaches to treatment will differ as well. With any of these disorders, it’s virtually impossible for the average person to know for sure if certain symptoms are a sign of one condition over another. If you’re concerned about your mental health, or things you or a loved one have been experiencing, talk with a licensed therapist about what’s going on. Receiving the best treatment possible starts with getting the right diagnosis. Up next, learn more with the Top 25 Schizophrenia Podcasts, Books, Instagram Accounts and Documentaries
Sources:
Brian Barnett, M.D., psychiatrist at the Cleveland Clinic in OhioRussell Margolis, M.D., clinical director of the Johns Hopkins Schizophrenia Center in BaltimoreKrista Baker, program manager for adult outpatient services at the Johns Hopkins Schizophrenia Center in BaltimoreNational Alliance on Mental Illness: “Psychosis.”World Health Organization: “Schizophrenia.”World Health Organization: “Mental Disorders.”Cleveland Clinic: “Schizoaffective Disorder.”Journal of Affective Disorders: “A Comparison of Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder: Results From the Second Australian National Psychosis Survey.”Journal of Clinical Psychiatry: “Schizoaffective Disorder: A Form of Schizophrenia or Affective Disorder?”Schizophrenia Research Cognition: “The Continuing Story of Schizophrenia and Schizoaffective Disorder: One Condition or Two?”Cleveland Clinic: “Schizophreniform Disorder.”Journal of Personality Disorders: “Schizoid Personality Disorder.”Psychiatric Times: “Autism and Schizophrenia.”CNS Drugs: “Anxiety in Patients With Schizophrenia: Epidemiology and Management.”Schizophrenia Research and Treatment: “A Possible Link Between Anxiety and Schizophrenia and a Possible Role of Anhedonia.”International OCD Foundation: “Schizophrenia and OCD: A Consideration of Schizo-Obsessive Disorder.”Frontiers in Pharmacology: “Comorbid obsessive-compulsive symptoms in schizophrenia: contributions of pharmacological and genetic factors.”Complex Psychiatry: “Characterization of a Novel Mutation in SLC1A1 Associated with Schizophrenia.”Archives of Clinical Neuropsychology: “Differentiating attention deficit in adult ADHD and schizophrenia.”
