I realize this is controversial, but “Schizophrenia,” “Schizoaffective Disorder,” and “Bipolar Disorder” are essentially useless terms. As I described in a recent post, there are far more differences within our diagnostic categories (e.g., Schizophrenia, Schizoaffective Disorder, Bipolar Disorder, etc.) than between them, and there is no pattern of symptoms that is unique to these conditions (i.e., all the symptoms are seen in other conditions as well). The symptoms vary across people with the same diagnosis, they vary over time, and they vary across episodes within the same person. So, it’s more useful to think of these as a collection of similar but distinct disorders. For that reason, often I talk about “serious mental illness” rather than “Schizophrenia” or any other diagnosis. “Serious mental illness” describes a collection of severe, chronic, and persistent mental illnesses that result in significant disability. Often, this includes Schizophrenia, Schizoaffective Disorder, & other psychotic disorders, plus Bipolar Disorder and the most severe and disabling forms of Major Depressive Disorder and OCD.
That being said, there are differences between these labels, at least according to the Diagnostic and Statistical Manual of Mental Disorders, the manual clinicians use to make diagnoses. So, here’s how it breaks down.
“It’s more useful to think of these as a collection of similar but distinct disorders.”
Schizophrenia vs. Schizoaffective Disorder
To be diagnosed with Schizoaffective Disorder, you have to either have a Major Depressive Episode (which itself has specific symptoms) or a Manic Episode at the same time that you have symptoms of Schizophrenia – delusions, hallucinations, disorganized speech or behavior, or “negative symptoms.” Plus, those symptoms of depression or mania must be present the majority of the time you have the symptoms of Schizophrenia. If you don’t have depression or mania that goes along with your psychotic symptoms or the depression/mania is present for only a brief period, you might have Schizophrenia rather than Schizoaffective Disorder. Schizoaffective Disorder also doesn’t require that the person has a major decline in how they function at work, in their relationships, or in taking care of themselves, whereas Schizophrenia does.
Schizophrenia vs. Bipolar Disorder with Psychotic Features
It is common for people with Schizophrenia to have occasional symptoms of depression or mania. If you only experience psychotic symptoms (delusions, hallucinations, disorganized speech or behavior, or “negative symptoms”) when you’re in the middle of a Major Depressive Episode or a Manic Episode, the proper diagnosis might be Major Depressive Disorder with Psychotic Features or Bipolar Disorder with Psychotic Features.
Schizoaffective Disorder vs. Bipolar Disorder with Psychotic Features
In Schizoaffective Disorder, the person must have a period when they have delusions or hallucinations for at least two weeks without any depression or mania. This contrasts with Major Depressive Disorder with Psychotic Features or Bipolar Disorder with Psychotic Features, where the delusions or hallucinations are confined only to the period when the person is depressed or manic.
In general, I think about it like this:
Overall, the distinctions between these conditions are made by the proportion of depression/mania symptoms a person has relative to the proportion of hallucinations or delusions a person has, plus the timing of those symptoms. Because those proportions change over time, the diagnosis can change as well. This is one more reason why it is useful to think of these as a collection of similar but distinct disorders.
Hope that helps clarify what is a very difficult distinction to make.
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Hayden C. Finch, PhD, is a practicing psychologist in Des Moines, Iowa, focused on helping you master your mental health.
