distinguishing between AS and schizoaffective

Post Reply New Topic

What I found interesting about the perception of thought-insertion is that the thoughts themselves are pretty benign--the idea that you might be responsible for people's deaths--and can pop up in anybody's brain. The trouble seems to be how you perceive them, not the actual thoughts themselves. You could feel guilty and try to suppress them, and end up with OCD; or you could decide they are not your own thoughts (because you couldn't possibly mean them), and end up with a delusion. Which you end up with, or whether you can simply ignore the thoughts that you don't mean when they pop into your head like that, might have a lot to do with how your brain's wired to begin with, and how your hormones and thoughts interact. (BTW, isn't it true that you can't diagnose schizophrenia or schizoaffective disorder unless you have negative AND positive symptoms? So somebody who has nothing but one delusion would have another diagnosis, because schizophrenia is a syndrome, not a single symptom...)

No, it's not true. (Which is one thing that makes schizophrenia such a nebulous and inaccurate grouping of people.)

Here's the DSM criteria, for reference (relevant part bolded):

Diagnostic criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g., frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):

Episodic With Interepisode Residual Symptoms (episodes are defined by the reemergence of prominent psychotic symptoms); also specify if: With Prominent Negative Symptoms

Episodic With No Interepisode Residual Symptoms

Continuous (prominent psychotic symptoms are present throughout the period of observation); also specify if: With Prominent Negative Symptoms

Single Episode In Partial Remission; also specify if: With Prominent Negative Symptoms

Single Episode In Full Remission

Other or Unspecified Pattern

************

Diagnostic Criteria of Schizophrenia Subtypes

Paranoid Type

A type of Schizophrenia in which the following criteria are met:

1. Preoccupation with one or more delusions or frequent auditory hallucinations.
2. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

Catatonic Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

1. motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
2. excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
3. extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
4. peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
5. echolalia or echopraxia

Disorganized Type

A type of Schizophrenia in which the following criteria are met:

1. All of the following are prominent:
1. disorganized speech
2. disorganized behavior
3. flat or inappropriate affect
2. The criteria are not met for Catatonic Type.

Undifferentiated Type

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

Residual Type

A type of Schizophrenia in which the following criteria are met:

1. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
2. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

********************

So a person could get a diagnosis of paranoid schizophrenia based entirely on thought-insertion, believe it or not, if the person believed it was through a chip by the FBI (impossible, therefore "bizarre" delusion).

Oddly enough I got diagnosed with paranoid schizophrenia despite very prominent "negative symptoms" and catatonia (to the point where the bulk of my "therapy" involved getting me to stop looking like I had these things, rather than about my supposed "delusions" or "hallucinations"). They in fact considered my "psychosis" to have begun in infancy, in the form of "negative symptoms" (i.e. autism).

I asked them later about this, and they proceeded to think they thought the catatonia (i.e. my movement disorder) was caused by command hallucinations, and somehow so was flat affect, appearing unaware of people, slowness of movement, etc. Of course, they actually had told my parents before diagnosing me, that I was definitely not schizophrenic.

I did eventually come up with a belief about thought insertion. But the reason for it was primarily that the therapist I had told me in no uncertain terms that he was going to get into my head, destroy the person I was, and replace me with a copy of himself that would never leave. With a therapist like that having total control of my life over about a 9-month period (and having me captive 2/3 of that time), it makes total sense that I'd end up believing that sort of thing was possible. Then I read books (in new age bookstores) that said it was possible and actually came from beings in the stars, got put on meds that destroyed my capacity for rational thought, and there you go.

I find it disgusting that the result of this kind of therapy (which was heavily influenced by the work of Milton Erickson, who believed it was ethical to lie to patients and that involuntary trance induction was perfectly ethical as well -- my therapist specialized in what I now recognize as "confusion inductions"... and the therapist was also a real power-tripper who got off on this kind of thing) could be termed an innate and biological psychiatric condition. If this guy thought he could step into my head and replace me, then why wasn't he on the same toxic dose of Clozaril that I was?

Anbuend, I glanced at your profile to see if your age was listed, but didn't see it. Did all of this happen in the 1960s-70s? That period of time is known for its highly controlling, cult-like therapies, as well as general over-diagnosis of schizophrenia.

Have you considered writing an autobiography? I think stories like yours need to be told to build awarness of autism and to emphasize inherent flaws that are part of the entire mental health system. The subjectivity, the manipulative and sadistic nature of "therapists" and "doctors", and the refusal of practioners to listen to the voices of the people they are trying to "treat".

I think the field attracts sadistic, controlling, awful human beings who hide behind their patients' illnesses and lack of credibility.

What you are describing is not psychotic, and it is a part of OCD. It is very common for people who have OCD to have real trouble with "bad thoughts" that suddenly materialize. The thoughts are bizarrely inappropriate, and do not seem to originate from the person's mind at all. They might suddenly think, "I am going to push my mother off the balcony" or think something else that is incredibly inappropriate, like something sexual about a family member. These kinds of thoughts are not the kinds of thoughts that doctors worry about in psychotic or sociopathic people. The difference between those thoughts and a very classic delusion of thought insertion (such as was described on this board) is that the OCD sufferer is horrified by the thoughts, knows they are not real, and has no intention of acting upon them. In fact, the OCD sufferer is usually terrifed that they may act upon them, and the thoughts cause absolutely enormous distress.

The classic paranoid schizophrenic delusions are all very common, which is interesting if you think about it. A really big one is that the radio and TV are talking to them- sending them special messages. Sometimes they end up believing a famous person is talking to them. David Letterman has had a lot of these, and I remember once seeing him make a joke about it in his monolouge. He said something like, "Margaret, it's time", or something to that effect, and I remember thinking that was really stupid of him. Paranoid schizophrenia is the most common type of schizophrenia, and almost 1 out of every 100 adults has it. There had to be schizophrenics out there who were reinforced by him doing that. Very unwise.

Actually, that seemed to be Callista's point - that the way a person with OCD would react to such thoughts is different from how someone with a paranoid delusion would.

Everyone always tells me that. As I noted in another post, it was the 1990s, I'm in my twenties. But my mother had mistakenly believed that a treatment center with a large amount of psychoanalytic influence would be better than the state institution the insurance wanted to send me to (they wanted to take custody away from her, too, so were already trashing her before I got to this place). We all found out how bad that was, because they were like throwbacks to the 1970s. Some of them had been trained back then. They took their idea of schizophrenia straight out of Frances Tustin, and blamed my mother for it. We had to go to family therapy where they told her that she had never allowed me to individuate my identity from her, and that this had caused me to become psychotic in infancy, and then (when I started creating an elaborate fantasy world in my teens and pretending it was real and that I was not human and my real people would come take me away, for how absolutely common that is see the title of this site as well as Attwood) schizophrenic.

That said, other parts of the psych system weren't so great either. But that place, despite being the prettiest and having the best advertising, was the worst, because they messed with our heads so badly. I'd rather take the physical brutality of some of the other places I was at.

In fact, when I was 19 or so, I found a book on cults. And after reading for awhile, so much of it hit home that I showed it to my parents and asked if that place was a cult. They said "In a manner of speaking, actually you're exactly right." That's how I started throwing that jerk of a therapist out of my head, so to speak.

But yes that place was a total throwback. What a lot of people don't understand is that changes in psychiatry's principles don't happen overnight. There are still people who believe the psychoanalytic view of autism, even in America, and are pushing it as more humane (obviously not to the mother!) than viewing people as biologically differing from each other. Believe it or not I was diagnosed with autism before I went to that place, and they just told my parents (when they brought it up) that it was childhood psychosis or childhood schizophrenia.

And yet they asked very perceptive questions of my parents at intake (such as "Does being touched feel painful to her?") and told them I was clearly not schizophrenic. Then they took me into a room with a psychiatrist, after admitting me, and ran down a list of the diagnostic criteria for schizophrenia and told me to tell him how I fit each one. No other diagnosis was mentioned. I was afraid of disobeying though (in the last place it had gotten me nearly killed by staff, would have been dead if it weren't for a VNA nurse coming through) so I gave him anything I could, and that was used against me for the rest of my time there, until they were shut down.



I've thought of writing about it, yes, but it's very painful. I did a presentation at Autreat one year about institutions in general (along with a non-autistic woman who was institutionalized in the seventies for a couple years, and had much the same experiences as me, we did this to show how uniform the treatment of people is, same no matter what your problem is -- she was put there for attempting suicide after her father and other relatives raped her, and her father etc. were never locked up anywhere). And that and doing the research for it, since we wanted to go beyond our own experiences, was so awful-feeling (to the point of making me nearly non-functional) that I haven't even wanted to try an autobiography since. The human instinct after trauma that severe is to avoid thinking about it for a reason, it really disrupts any attempt to function otherwise.



That is very true.

What is also true is... you should read the book The Lucifer Effect by Philip Zimbardo, if you haven't already. He shows how environments like that breed sadistic actions among otherwise decent people. I actually at one place, I was there on and off for nine months, and I met a guy who was really cool my second admission. He would talk to people and really try to get to know us. My final admission (which lasted a couple months then I was transferred to two other places), he actually was really... not mean, exactly, but cold and jaded and no longer friendly.

Other people managed to retain some amount of humanity working there. My psychiatrist there, the one who first diagnosed me with autism, he would always do things like sneak me candy in the isolation room. He had been trained decades ago, but his strategy with any patient was to talk to them and treat them like they were anyone else whether they responded or not. He'd met Temple Grandin (might have known her better than that, I don't know, but he at least met her), and knew a number of autistic adults (one of whom had tried to interview him about autism, but had such a monotone inflection that he started asking her, off the record, why she was interested -- she told him she'd been diagnosed autistic as a child, and when she was twelve years old they were celebrating her birthday in an institution and suddenly she realized that the words applied to her, and then she was able to connect meaning to words, and began speaking shortly after that, so they sent her home), so he knew how much it could vary, and as soon as he heard my developmental history that's the direction he went with it.

He's also the one who saved my life by having the foresight, when staff started really hating me, to assign me a one-to-one aide who came from an outside agency and had no ties to the sadistic culture at that place. (He himself sued the institution at least once, and was no fan of some of the staff there.) So when she saw me having trouble breathing she insisted they help me instead of just walk away like they had tried to do. (Unfortunately he didn't know, and I couldn't tell him, that the following day they in secret did the same thing to me again when the aide wasn't there, and told me that if I didn't do what they said they wouldn't give me anything to open my throat up again. This is the place before the place before the treatment facility I described above, which is why I was so obedient later.)

Anyway, there were always a few good staff, but some were by nature sadistic and hiding behind exactly what you said (there are still people who don't believe me even though my family was there and saw bruises all over my body but didn't know from what), and others were decent people in the outside world but became either detached and fearful or caught up in the sadistic atmosphere when they came to work. I read later that at some places like that, people who report abuse are severely threatened, I would not be shocked if that went on there. And this was at a private mental institution that looked fairly decent from the outside too, unless you knew what to look for (and generally only patients knew that stuff, our families had no idea and staff were quick to lie to our families; and often longer-term or repeat patients knew better than short-term patients, because short-term one-time patients were treated better -- although it also only takes a few days in the right (i.e. wrong) environment for things like Stockholm syndrome, identification with and gratitude towards a captor, to take place).

The best place I was at (later on, and only briefly a couple times), I really thought was a good place, but it turned out they were only good because the state was investigating a restraint death there at the same time I went there. 'They also had a nurse who was diagnosed with bipolar, and she was really cool to everyone because she knew what it was like.

So I don't want to paint a wholly awful picture of the people. Some were truly good at remaining decent people through all that. Some tried and couldn't. Some were afraid to stand up to the scarier ones. And some were just caught up in the power role in a way that made them unintentionally abusive. And some were truly nasty. That Zimbardo book really explained a lot of how that happens, and suggests that only if we're aware of our tendency to behave that way, and also try to create situations that are not structured that way power-wise, can we (any of us) avoid turning into monsters in that situation. That's why it's called the Lucifer effect since Lucifer was at first an angel and turned into the devil, and the point is even most good people can do evil acts when put in the staff role and handed that much power. (I'd also add that staff are at the bottom of the power hierarchy of the employer, but above the patients. So that makes patients the only people staff can safely take out their frustration on.)

So anyway, sorry for the super-long reply but wanted to explain some things. The reason I can tell the really awful stories by the way, is because those ones are unambiguous, and therefore less painful to remember than the more nebulous and unpleasant things that happened there, that I can't describe easily, and when I try that's the part that gets unpleasantly nasty to remember. The physical abuse is bad but it's better (at least, in a lot of our estimation, not in everyone's since everyone takes abuse differently) than the complex mind games that go on in most of those places.

The difference between OCD and paranoid schizophrenia is not anywhere near that simple. An intrusive thought is not a delusion of thought insertion, with the only difference being "how you react to the thought". The two are quite different. You also cannot cause yourself to develop OCD by suppressing your thoughts or cause yourself to develop a delusion. You may cause yourself a great deal of anxiety, but there isn't much chance a person with no propensity to OCD or a delusion could think themselves into having an illness they didn't have before.

Of couse I didn't point that out in my last post because I wasn't trying to criticize Callista, I just thought it might be helpful to some people who may have intrusive thoughts to give examples of the differences between intrusive thoughts to reassure them. Do you have some kind of problem with that?

Last edited by MariaRenee on 03 Aug 2008, 9:00 pm, edited 1 time in total.

Yeah, I'm convinced I had severe OCD in childhood, and less of it now, although I've never been diagnosed. I used to have thoughts about all sorts of horrific things, not necessarily me doing them, but like someone I cared about with an ax through their head (no clue where the ax came from, it was just there), and then I would have to do all sorts of things to avoid the thoughts, sometimes just move a certain way a certain number of times, others to avoid some particular thing for absolutely no reason, etc. When they started fishing for "delusions" and "hallucinations" I wasn't always sure they didn't mean my OCD thoughts (since they seemed absolutely sure I had them), so I generally gave them material from that and just acted along with them like it was voices or seeing things or whatever. And I wasn't sure my constant fear didn't mean paranoia, etc. (After you're in those situations for long enough, you really can start to wonder if you're losing your mind, especially if they tell you your mind can't be trusted to know reality from fantasy.)

Then when I later read about OCD that was absolutely spot-on what was happening with me, although it mellowed in adolescence somewhat, and by adulthood even more. So in a manner of speaking I was crazy, just a totally different kind.

Well, I am really impressed with you, anbuend, and I hope that someday you feel confident enough to tell your story. I really do understand the trauma, though. Maybe someday. I do believe that psychoanalysis is cult-like, and has caused great harm to people.

Try a test. Go underground to a place where wireless communication signals can't penetrated. If the voices continue, either they aren't real (or,rather, they are real but they're coming from a part of your mind you're not fully conscious of) or an incredible wireless communication system exists or there's an actual computer in your chip. The latter two explanations don't make any sense because those things would be being marketed commercially.

There's also the fact that there's no reason for the FBI or any organization to waste time and money on messing with your head.

Yes. I was a lot more wordy than I needed to be. I was wrong about the paranoid schizophrenia, though. You don't need negative symptoms for that.

Re-checking: A single non-bizzare delusion wouldn't be enough for a diagnosis of schizophrenia--"My husband is a member of the Mafia", for example. (Because some husbands really are in the mafia... as opposed to, "My husband is an alien.") There's some diagnostic label for only having one... And of course there's paranoid personality disorder, which has to do with not-quite-delusional paranoia...

It's incredible how easily your mind can trick itself, isn't it? I mean, realistically we don't even perceive the real world, only a filtered version; if we had to do that, we'd be in constant shutdown from the flood of information.

I wonder if there's a diagnostic category for benign hallucinations, like voices that don't cause distress or distraction. Some people have those and have no trouble with life.

Unfortunately, a lot of people assume hallucinations do cause trouble regardless of whether they do or not. Although hallucinations in some context are considered okay (while falling asleep, waking up, or hearing people call your name when nobody is).

I have had the same thoughts about our minds tricking themselves. Hallucinations just seem like that filtering mechanism going awry in some way. And the fact that hearing people call your name is considered within the realm of normal, is a good indication of that -- those filters are very well set up to hear your own name, so it makes sense they'd sometimes give false positives. When I was last on prednisone, which makes me hallucinate sometimes (and is basically a pill that does something to the hormone that regulates all other hormones, therefore not a fun experience), I always heard people opening and closing my door, or knocking, because I'm always listening for that anyway.

Exactly! I would have to sit on my hands to push out the thoughts of my wrists getting cut open. Also I had to eat my sandwiches in certain ways, in exactly 20 bites in a particular pattern. Some other stuff, too, but that mostly faded by the time I was a late teenager/adult.



Yeah, when I was sitting and waiting to be called for a radio interview, I would think the phone was ringing - sometimes I'll hear my phone's ringtone at a random time. So now, in addition to people's names and classic phone rings, there's going to be a lot of people I bet with "ringtone hallucinations". "Doctor, I keep hearing a digitized version of Bohemian Rhapsody, but nobody's calling."

Unfortunately, benign hallucinations of a less common sort, would still be something that most people would be inclined to hide, unless they are really sleepy or under conditions where it'd be considered normal.

Whilst some don't see Autism/Asperger's this way [as they experience it in their own way], it is how I experience it:

Autism: not recognizing that others exist (this changes over time in manifestation, but the feeling of people not being real stays)
Schizophrenia: not recognizing that the things your mind is projecting don't exist (it may change over time with insight and awareness)

Both share certain traits in relation to social interaction, like poverty of speech, social withdrawal, the flat affect; ASDs have more along for the ride, i.e., greater impairments in nonverbal [and verbal with Autism] communication, greater problems with social reciprocation and empathetic relatedness.

I played cards with a lady who had Schizophrenia at a psychiatric hospital; retrospectively, I could see the flat affect with its lack of emotional inflection, but she initiated all of the communication with me, and finished it, whilst looking at me how everyone else has (I, the master of the sideways glance).

Personally, I find that it'd be hard to determine whether a child has genuine hallucinations and/or delusions, and if they aren't just stemming from an active imagination [which people with AS have].

What about forms of "schizophrenia" that don't have to involve delusions or hallucinations, such as simple schizophrenia, catatonic schizophrenia, and disorganized schizophrenia?

(Ones where in some cases the only reason most autistic people are not diagnosable with one or another of them is Criterion F.)

Simple Schizophrenia, i.e., the negative symptoms only, was removed from the latest DSM, I know the ICD-10 still has it; I've read that people equate such, as well as Schizoid PD as being of the same family as ASDs, just with bits missing (i.e., they're more alike than not, kinda like the HFA/AS comparison). People with those prior tend to obsess over a single interest, like those with ASDs (AS particulary), as well as the social problems I listed before; they just don't seem to have the nonverbal problems (not that I'd know personally, as I'm just reiterating what I've read, other than my card game with the lady with Schizophrenia).

I suppose one could say that they have a greater ability to connect with others in the sense that they innately feel that others exist (empathy), so they may not appear as impaired in social reciprocation (they can talk to that which they feel; if one doesn't feel anything, why is there a need to talk? Most people don't talk to rocks), even though those with Schizophrenia/Schizoid PD avoid people and prefer solitude (which is different to adults with AS; AS adults tend to present differently than when they were children, which was more passive--I've found this to be the case in my experience).

Concerning the OP, Schizoaffective Disorder is a hodgepodge of many disorders joined together (Schizophrenia Spectrum Disorders and mood disorders); it's quite rare in children.