Corrine believes her “downward spiral” occurred initially when, at the age of 18, she began to experience the symptoms of mania. As a new college freshman, she had begun sleeping less and less—in order to spend time socializing, and as a result of cramming for tests. Her need for sleep diminished until she was sleeping less than two hours per night; there were even nights she didn’t sleep at all. Nevertheless, her energy continued to amplify. During this period, Corrine felt that she was “smarter” than she’d ever been, and could memorize all the study material necessary in virtually no time. Corrine’s friends experienced her as “talking non-stop” and “full of energy” during that period, but her high mood and positive feelings began to deflate as she grew more and more agitated. One night Corrine jumped from a train trestle into the cold river below to prove to her friends that she could do it and survive. As a result of the jump, she obtained a broken femur, after which, depression began to set in. Corrine’s studies had always mattered to her, but she soon felt unable to attend her classes. She eventually refused even to leave her dorm room and had begun eating less and less. As her grades dropped, she grew more and more despondent. Her normally high self-esteem had crashed, and she felt getting out of bed to be too much of an effort. This is when Corrine first began to experience symptoms of psychosis. It started with a “negative” voice, one Corrine first thought was coming from the TV, but which grew more and more personal in its declarations that she was “worthless” and “stupid.” Frightened of the voice and unable to tell her roommate, she placed ear buds in her ears and even slept with the music turned up high. When her parents’ calls to her went unanswered, they arrived at her university to check on her, but Corrine believed they had been sent by the voice. She was suspicious of her family and refused to communicate about what was happening to her. This auditory hallucination and paranoid thinking progressed into delusion; Corrine feared she was being watched—that someone was always in the next bathroom stall or outside the showers spying on her. She began to believe that the eyes in the photos of her dorm room were watching her, at first as tiny cameras she couldn’t detect, and then as the spirits of harmful beings. Corrine’s roommate returned from class one morning to find all of her photos had been pulled from the frames and shredded. When Corrine tried to defend her actions by insisting the photos had been watching them, her parents were called. They withdrew their daughter from classes, now 30 pounds lighter and appearing weak and ill, and brought her home to be hospitalized. There, she was eventually diagnosed with schizoaffective disorder.
Symptoms of Schizoaffective Disorder
It has been said that there is a continuum with bipolar disorder on one end, and schizophrenia at the other. Somewhere in the center of this particular spectrum lies schizoaffective disorder (SAD), which has features of both. The American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders lists the criteria for schizoaffective disorder as follows:
- An uninterrupted period of illness during which there is a major depressive episode, a manic episode, or a mixed episode
- During the same period of illness, delusions or hallucinations persisting for more than two weeks in the absence of prominent mood symptoms
- Symptoms meeting criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness
- The disturbance is not due to the direct physiological effects of a drug of abuse, a medication, or a general medical condition
- Bipolar subtype: if the disturbance includes a manic or a mixed episode (or a manic or a mixed episode and major depressive episodes)
- Depressive subtype: if the disturbance includes only a major depressive episode
For a person to be diagnosed with SAD, their psychotic symptoms must be present for at least a period of two weeks without the presence of a serious mood symptom—mania, depression, or mixed state.
Treatment for SAD
A combination of psychotherapy and medication holds the highest success rates in the treatment of schizoaffective disorder. Because schizoaffective disorder can be highly debilitating for sufferers—creating distress in relationships and occupation—a holistic approach to treatment is often seen as best practice. This kind of therapy includes an approach to healing “the psychological, social, and biological” components of the disorder. Patients benefit from a combination of supportive, client-centered therapies as well as a problem-solving approach. Many people who suffer from schizoaffective disorder have been told by their doctors that they will never recover, however the answer to the question of whether someone can recover from SAD is less definitive. Dr. Charles Raison, a psychiatrist at Emery University Medical School, explains that the answer to this question is more accurately “maybe.” He calls upon the “law of thirds,” wherein current research supports that 1/3 of sufferers will recover and go on to live “normal” lives, 1/3 will stabilize, and the remaining 1/3 will experience the progressive escalation of their symptoms. People who do recover often have the support of family, friends and therapists. Corrine was lucky in that her parents were not only proactive in seeking treatment for their daughter, but also that neither supported stigmas against the mentally ill. Both her parents had someone on their side of the family who had suffered bipolar disorder, and so were aware of the effects of mental illness on families as well as on its sufferers. It took time for Corrine to come around to her treatment, however. After 18 months of repeated hospitalizations and visits to different psychiatrists and therapists, she was able to admit that a course of medication and therapy was right for her, and that her symptoms had included a break from reality. She is 25 now, and a new graduate student. About mental illness, she says that it can be the thing that breaks you, or the thing that pushes you to grow.