Schizoaffective and dissociative?

I am diagnosed with both schizoaffective disorder and a dissociative disorder. The diagnosis of dissociation is pretty recent, though i have been saying i have dissociation ever since i sought treatment for psychosis (i was too afraid to seek treatment so i did it only when there was no other option) almost four years ago.

So basically, i have been wondering about the relationship of DID/OSDD and psychosis. Recently i have started to find that dissociative episodes can trigger my psychotic and manic symptoms, and that my every episode has basically had some sort of dissociative trigger. In fact, it seems that if i am in a type of remission i can handle huge amounts of stress without it triggering psychotic or manic symptoms and i even once (while i was very suicidal, i dont normally do any drugs) mixed a lot of drugs and alcohol and it didn't trigger anything, which is strange taking on account that my therapist said the drugs that i took could have killed me even without the alcohol, and the combination i took could trigger psychosis in a healthy individual.

My latest psychotic and manic episode was directly triggered by me trying to process some very severe trauma memories. I eventually started having possibly the most severe depersonalization i had ever had and like eight hours later the mania started to try to kick in. Later i became also psychotic but we managed to stop it by medication and also because i stopped digging into the trauma memories. My psychiatrist agrees that at least in this case the trigger was dissociative but we havent spoken about it more deeply.

However, when i told about how the episode was triggered to one psychiatric nurse who seems to be more knowledgeable about the dissociative stuff, she basically said that dissociation in itself can trigger symptoms that resemble psychosis and from what i gathered she was questioning my diagnosis of schizoaffective disorder. Now that i think about it she also once talked about how my symptomatology is very unusual and my medication response generally speaking is poor (both of which are facts confirmed by my psychiatrist) while we were talking about my dissociative symptoms.

I definitely meet the criteria for schizoaffective disorder and i do have a medication response, although the response was only partial before i was put on strong antidepressants, which somehow seem to have a strong antipsychotic effect in my case at least when combined with an antipsychotic (i still take 10mg of Abilify, which also definitely works but not without the adjunctive mianserine).

I also have to note that the psychosis never triggers dissociative symptoms (excluding a type of derealization), it goes the other way around.

So what i would like to know is that is anyone else here in a similar situation, where one has or has had a very wide range of clear-cut psychotic symptoms (possibly including some negative symptoms) and also has DID or OSDD?

I of course do not expect to find the answer to this very complex and difficult question about my diagnosis in here, but it would be nice if someone would share their experiences, if they are in any kind of similar situations. I just started a once a week psychotherapy with a therapist who also knows the dissociative stuff and its most likely to last for three years, so i am hoping i might find some answers and help to my symptoms there, but in any case it would be nice to know if someone is in a similar situation.

Welcome back. We agree with the nurse. Last time we talked, I think we even asked you to describe the psychotic symptoms because they might not be psychotic but dissociative.

A psychiatrist mistook it with us at one point. We had a major flashback we back then did not recognize as such, and he called it 'on the edge of psychosis'. This was 15 years ago and we saw a T who is specialized in schizophrenia afterwards who disagreed. We're not psychotic and we've never been psychotic.

The resemblence could be because they don't feel like your thoughts because they are the memories of another part.

We have it in many ways and it could all be described as psychotic by people who do not understand dissociation.

We sometimes smell things that aren't here now; flashback. We understood recently that this explains why some parts can't smell anything; dissociation.

We sometimes hear things (inside) that aren't here now; flashback or other parts.

We sometimes feel things happening with the body that actually don't happen now; flashback.

Etc. It could all be contained memory in very different ways.

Hi Someo559,

I’ve not been in that situation myself, but I know others who have, so you’re not alone.

If it helps you to know, some schizoaffective medications, can also treat dissociative disorders, so I would check that out as research is great to have under your belt.

Other than that, I just wanted to let you know you’re not alone out there.

SphinxMoth

Thanks for the replies, hoping for even more of course. Nice to see that people still remember me even though i just posted a couple of posts. My symptoms are not only the kind that would be 100% connected to trauma or dissociation like hearing the other personalities (i have only once heard voices when i was the most psychotic i have ever been, and even then it was just hearing people that were actually behind me having a conversation they didn't have, i also dont hear the other parts, i more like feel them and communicate with them without words) or delusions that would be limited to the trauma stuff (although when i had delusions they were mostly centered around that stuff). So we are definitely talking about either a dissociative psychosis or the schizoaffective disorder.

The tricky part is that from what i have gathered there is absolutely no way to fully differentiate between a dissociative psychosis and a psychotic disorder. From what i read, most of the time a dissociative psychosis would be a bit different from what im having, but then on the other hand just like the nurse said, dissociation can manifest in very strange ways.

One peculiar thing is that i read that a dissociative psychosis is most of time or at least often connected to how hypnotizable you are. Well, no one has ever tried to hypnotize me, but its not really necessary because i can do it myself For example, if i imagine that my right arm is paralyzed, it becomes paralyzed, if i imagine that my right arm is stiff, it becomes stiff. Or the other way around, if a muscle is stiff i can self-suggest that it is relaxed and then it becomes relaxed. If i imagine feeling pain somewhere i start feeling pain there. I can actually even open my airways (i have asthma) or make my eyes excrete tear lipids (i have the type of dry eye where theres not enough lipids) by self-suggesting the lower eyelids to excrete tears (the lower eyelids excrete the lipids). I can basically do anything you could do with hypnosis with just self-suggestion. I dont even need to relax or focus too hard in order to do this. I have even noticed that i am maybe able to affect the psychotic and mood symptoms this way too, but the effect is very limited.

I think the only way to know for sure what my psychotic symptoms are about is to see how the psychotherapy affects the symptoms and whether i can have my meds reduced even more.

Does anyone know which meds are spefically used for dissociative disorders? I find it hard to find any in-depth information on Google. Im on Abilify 10mg, lamotrigine 150mg, mianserine 60mg and i usually take 0,5mg-2mg of lorazepam daily. We have also used quetiapine and haloperidol to calm down the episodes i have had recently. I have to note that i have had like probably 15 different medications tired and the only medication that has seemed to have any real effect on the trauma and dissociative symptoms is mianserine (which by the way is an older antidepressant from which mirtazapine was developed from), although mianserine and trimpramine are the only antidepressants i have been on (everyone was very reluctant to prescribe me any antidepressants because i have had manic episode but luckily they did because i would have definitely killed myself had the mianserine not greatly reduced my depressive symptoms).

Welcome back.

Dissociative symptoms are very common, and occur in many cases where there is not a dissociative disorder. Having these symptoms does not mean you have DID; in fact some people with DID have no other dissociative symptoms and most people with dissociative symptoms do not have DID.

In any event, if your objective is a more appropriate plan of treatment, the usual next step would be to get a thorough diagnostic workup. To evaluate the diagnostic symptoms begin with the Dissociative Experiences Scale (DES) and then add the MID or the SCID-D or other instrument that is useful for evaluating dissociative symptoms. You can do the DES on your own; print or save your responses to the DES to a file for later review.

There are separate instruments for evaluating psychotic symptoms; just be aware that for historical reasons most of the current instruments do not distinguish between psychosis and dissociation. A good diagnostician will be well aware of that deficiency, and frame their report accordingly. Just so you know, there is a fairly bright line between dissociation and psychosis: what you believe about what you experience. It is the all-important difference between "I hear the Voice of God" meaning "I don't know how else to describe it, and anyway I have no clue why this voice is talking to me!" (dissociation) and "I hear the Voice of God" meaning "I know only God can speak out of the air like this, therefore I must be hearing God, therefore I am the new Messiah" (probably psychosis). (I say probably because, well, who am I to say if any other person is or is not hearing God?)

You have already faced the most fearsome hurdle: you have gone inpatient and come out again.

We were about to be diagnosed with schizoaffective disorder, but I think we never were, but dissociation disorder instead. The reason for doctor thinking we were psychotic was because one of our parts is. He doesn't know the difference between his own fears and reality at all. But when I am in the body at the same time he is, I do know the difference. If he is alone, there is no question about him being out of all realities. He has kind of a flash backs, but from something that never took place like he remembers them. It would not be possible. I do not remember anything even near what he remembers, but on the other hand I do know I don't remember it all. So it can be his feelings and body sensations are a real flash back, just the reason which he think is the cause of them is not true.

About fitting into criteria of some other disorder: I have read people with DID always either fit or almost fit into the criteria of borderline personality, but it doesn't mean they have it. I fit into the criteria of 7 or 8 different personality disorders, and it is not possible to have them all, because some of them I allegedly have, rule out the other I according to test also have, like being dependent and avoidant at the same time. So it is clearly pure misdiagnosing. That test just doesn't fit to us.

I do have some other psychotic type symptoms also from time to time, like visual hallucinations. Most of the time I know they are not true, and sometimes when I don't, they still go over very quickly, and after it is over, I do know it was not true. I also have .. something else that totally run away from my mind trying to write about it. Well, I will come back and tell what it is, if I remember afterwards.

No, I got it back now.. we have sometimes these very weird experiences when it feels like just being particles floating in the universe or something like that. We realize it is a symptom when it happens, but I think it is very near the line between dissociative and psychotic symptom. It is very hard to function while it happens, we can see things being inside out and feel connection between shapes and colors etc. Very much like I could think acid trip could be like, but without any that kind of drugs, just our usual medication, and we do not like the feeling of loosing the reality we find familiar. It is scary, we fear we are gonna stay like that forever, but the symptoms have always gone away on their own. We escape from it by starting to sleep, and when we wake up, everything is again like it should be. Well, all particles definitely are there then also, but we experience the world again like human being, not like a pure consciousness on it's own.

Una+ wrote:Welcome back.

Dissociative symptoms are very common, and occur in many cases where there is not a dissociative disorder. Having these symptoms does not mean you have DID; in fact some people with DID have no other dissociative symptoms and most people with dissociative symptoms do not have DID.

In any event, if your objective is a more appropriate plan of treatment, the usual next step would be to get a thorough diagnostic workup. To evaluate the diagnostic symptoms begin with the Dissociative Experiences Scale (DES) and then add the MID or the SCID-D or other instrument that is useful for evaluating dissociative symptoms. You can do the DES on your own; print or save your responses to the DES to a file for later review.

There are separate instruments for evaluating psychotic symptoms; just be aware that for historical reasons most of the current instruments do not distinguish between psychosis and dissociation. A good diagnostician will be well aware of that deficiency, and frame their report accordingly. Just so you know, there is a fairly bright line between dissociation and psychosis: what you believe about what you experience. It is the all-important difference between "I hear the Voice of God" meaning "I don't know how else to describe it, and anyway I have no clue why this voice is talking to me!" (dissociation) and "I hear the Voice of God" meaning "I know only God can speak out of the air like this, therefore I must be hearing God, therefore I am the new Messiah" (probably psychosis). (I say probably because, well, who am I to say if any other person is or is not hearing God?)

You have already faced the most fearsome hurdle: you have gone inpatient and come out again.

Had i just had the symptoms i have now and had they begun only after the psychosis they would definitely be psychotic, since psychosis can cause dissociation too as you might have suggested. However, four years ago when i became aware of the dissociation the situation was basically that i had around 20 (im not sure about the exact amount because some of the parts only come out in special circumstances) parts/identity states with almost full amnesia between them and not being aware of their existence. I also had lost years worth of real memories that i recovered later.

Basically when i begun to become aware of the dissociation i was too afraid to seek treatment and started self-treating it. The goal was to survive until i turned 18 (had just turned 17 by the time i became aware of the symptoms) and could seek help without my parents being involved in the treatment and the child protective services being alerted. I managed to greatly reduce the dissociative symptoms by employing different therapeutic techniques but doing it alone was not very easy and since i had to pretend that everything was fine and do everything that i would have been normally doing (like going to school and doing volunteer work) it finally became too much and i went into psychosis. EDIT: I have to mention it took nine months before i went to psychosis.

So basically, psychosis does not make you have these kind of symptoms. Psychosis causes dissociation, but it does not make you have symptoms that would match DID/OSDD. Or at least if it would cause a similar clinical picture, one would have to be in full-blown psychosis, which i was not in (i havent actually ever been psychotic enough for that). I have also psychotic dissociation and at least for me its more like basic depersonalization and derealization, even though it kind of feels different than the dissociative one and is easily distinguishable because of that.

I have had some of the tests you mentioned done on me three years ago. I didn't score that high (like compared to people with clear-cut DID) but i did score high enough to have a dissociative disorder. My current psychiatrists has studied them but just like all the others, places very little value on them. Those tools are very useful when one is unable to tell about the symptoms, but at least in my country we believe that they are only of limited value.

My psychiatrists is a very experienced and high-ranking one and what he has been basically saying is that the only way i'll know for sure what my symptoms are about is through a long psychotherapy. He says that my case is very complex and that since we only see like 30 minutes on three week intervals, he is not going to start analyzing me any further since he does not have enough time. However, he has said and put it into my medical records that the symptoms i describe as dissociative are dissociative and he has also diagnosed me with schizoaffective disorder. I have to admit i dont have an official ICD-10 diagnosis of a dissociative disorder because if you have a schizophrenia-spectrum diagnosis, in ICD-10 you will not have any additional diagnosis (with the possible exception of substance addiction), the other symptoms will just be listed and described in the medical records. I still say that i am diagnosed with dissociation because technically i am, if a doctor writes in you medical records that you have dissociation then that i believe technically speaking is a diagnosis.