Schizo? Yes, YOU! Well?

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I know many people with Asperger's syndrome have been misdiagnosed with schizophrenia in the past and autism used to be considered a form of schizophrenia with infantile onset. However, the reverse can also be true: Schizophrenic people can be misdiagnosed with Asperger's syndrome! There are many areas of overlap, but onset of frank mental illness is usually in adolescence or young adulthood in schizophrenia; symptoms become worse with age, not better. Contrary to popular belief, schizophrenia isn't necessarily about hearing voices, seeing strange things, and believing the government is secretly spying on you through devices implanted inside your toaster. Schizophrenia is a spectrum disorder like autism and manifests itself in many different ways.

Different theories abound explaining the development of schizophrenia. Some researchers posit a personality dimension of schizotypy, psychoticism, cognitive disinhibition, etc. that is a factor both in creativity and in psychosis. They theorize that creative people have higher intelligence and more intact personality structures to begin with so that their more disinhibited mode of thinking stays under their control instead of controlling them. Schizophrenic people may have a weaker personality to begin with (meaning higher reactivity to psychic stressors and a more introverted personality with few friends), and many also show signs of neurodevelopmental abnormality at a young age (e.g., poor fine and gross motor coordination). In relatively well-adapted people, large psychological stress could bump them over their boundary for psychotic decompensation (in the best case, a brief psychotic episode rather than chronic schizophrenia). Severe mood episodes, for example, can create the psychic stress to induce psychotic symptoms.

In many cases, the personality first slowly decays before frank psychosis is obvious; these signs resemble Asperger's syndrome. This is called the negative syndrome of schizophrenia: apathy, autism (withdrawal from others), flat affect, little to say, few thoughts, and sometimes a preoccupation with a single idea (monmania). A person who develops these negative symptoms without distorted thinking has schizoid personality disorder. If the negative symptoms become extreme, the person will become a shell of a person, more robotic than human. In this case, simple schizophrenia or undifferentiated schizophrenia is diagnosed even if there is no evidence of outright psychosis (psychiatrists take care to distinguish the negative syndrome of schizophrenia from depression and pervasive developmental disorders).

In many cases, the schizoid person will attempt to maintain some semblance of normality, which clincal psychologists call an "as-if personality" because it seems so stilted and artificial. Their thinking becomes concrete, and their social intuition vanishes. These are also the residual symptoms that last even after active psychosis is treated. In many cases, though, the negative symptoms aren't the end of the story. They sense themselves becoming increasingly dissociated from what might be called variously their subconscious, their sense of self, their intuition, or their feelings. Instead of becoming aware of intuitions like "I am hot," or "I like this," they become consciously aware of more basic bodily sensations without the higher thoughts associated with them. They will try to analyze these to figure out what the source of the odd sensations are, and this is where psychotic thinking begins. On the other hand, the intuitions they do pick up are often of danger, one they cannot recognize. So their mental processes start creating delusions to make sense of these odd things happening in their mind. The downward spiral continues as they increasingly turn inward and analyze and analyze, and their thinking collapses: Thoughts jump in and out, break before they're finished, odd sensations reoccur. They will begin to believe internal thought processes are external to them. Internal negative self-appraisals become conscious as external voices or visual hallucinations of demons and such things. The undifferentiated fear is analyzed as some outside persecutor; a paranoid system of delusions may develop. They may become so trapped in their psychosis that they will become catatonic. The brain rewires itself constantly, and their distorted thinking is a vicious cycle, which breaks the brain down.

The schizophrenic spectrum:

• Schizoid Personality Disorder: negative syndrome of schizophrenia--apathy, introversion, etc.; remains in touch with reality
• Paranoid Personality Disorder: a personality disorder with interpersonal suspiciousness, ideas of reference, and hypervigilence, remains in touch with reality
• Schizotypal Personality Disorder: (also known as ambulant, latent, or borderline schizophrenia) Paranoid ideation, distorted thinking, unusual bodily perceptions, remains in touch with reality
• Simple Schizophrenia: mostly negative symptoms, no overt psychotic symptoms, bares resemblance to severe depression or Asperger's syndrome; some bizarre thoughts or preoccupations may exist along with comorbid anxiety, depression, and obsessive-compulsive behaviors
• Disorganized (Hebephrenic) Schizophrenia: transient positive psychotic symptoms (delusions and hallucinations), grossly disorganized thinking and behavior, often acts childish and silly, displays unusual emotions for situation (often to go with internal thoughts) or flat affect; rapidly develops strong negative symptoms
• Paranoid Schizophrenia: Patient develops paranoid delusions organized around a theme with accompanying hallucinations, distorted thinking present to a lesser extent than in disorganized type, negative symptoms less prominent than positive psychotic symptoms; usually has better prognosis than disorganized or simple schizophrenia
• Catatonic Schizophrenia: odd posturing of body, lack of movement or agitated and purposeless motion; mentally engrossed in psychosis; ability to move patient's body parts and they will waxily move back or stay there (I'm sure bored psychiatrists had fun doing this to figure this diagnostic sign out)
• Undifferentiated Schizophrenia: A mix of schizophrenic signs and symptoms that does not fit one of the other clinical types
• Residual Schizophrenia: After psychotic symptoms are treated, minimal psychotic and negative schizophrenic symptoms often persist; pecularities usually persist between schizophrenic episodes
  

This is an excellent post NeantHumain,

There were certainly times when I thought I might have some kind of borderline schizophrenia condition but Asperger's fits a lot more closely as far as I can see now.

Schizophrenia is such a bogeyman for most people. The whole thing needs de-mystifying. I've looked into it a lot and work in mental health so I've known lots of schizophrenics, although the ones we work with are very much at the severe end and mostly do have the more 'classic' symptoms, voices, delusions etc but flat affect and loss of personality are very common too.

Here's my experience of this:

I was convinced that I had discovered the meaning of life.

This wasn't enough though - I wanted to discover the purpose of life.

I become obsessed with what I was eating and drinking. To the point where I spent about an hour reading the food package before deciding not to eat it.

It became clear that I was the one to take on a mission to save the universe (ie, take it back to the first dimension). I knew what the first dimension was.

I actually had it planned out almost: Get a whoooooole lot of mercury and fill a very deep crater in the earth with it then shoot it with the most powerful jolt of radiation where it would be pointing (through the other side of the earth) at the sun. It would then take care of itself.

Everyone around me was an agent out to get me. Every car that passed me, every one around me. If I was near someone, I wouldn't be allowed to breathe, as they'd analyse my breath and pick up information about me.

I realised that I had a being from the 666th dimension inside me and he was the devil. Yet he was the good guy. Everyone was out to get him, and he was actually me.

I interpreted everything that was red as good and everything that was blue as bad / evil etc. The first dimension was deep red light vapour and that was all that was.

I saw a vampire and started panicking and feeling extreme anxiety, saying we've got to leave the lights on tonight and to not let any darkness into the house.

My mom called the doctor and they hospitalized me.

The first week that I was there is a total blank to me. I'm not sure what they did to my brain but I can't recall anything. I know they injected me with something and then that's all I remember.

The second week I felt very rejuvinated and fresh and happy.

I left and went on a three year course of antipsychotics pills.

(I'm running out the door now, so I couldn't read the whole thing yet, but...)

I've heard that a lot of people say that you cannot be diagnosed with both, and I've heard other people say that you can have Asperger's AND Schizophrenia.

HMMM

Also there is the fact that a lot of autistic people develop some pretty big changes in adolescence or early adulthood, and that catatonia itself is comparable to the way many autistic people move to begin with (and sometimes those movements become more prominent with time). (And yes -- some professionals do bend you around like that for fun, and no, it's not at all fun to be bent around like that.) Of course catatonia also appears in so many other situations that I suspect that's why the diagnosis of catatonic schizophrenia has gone down so much over time. It's only diagnosed now, I think, when some other cause for catatonia hasn't been found.

At any rate, if schizophrenia were diagnosable on "negative symptoms" alone in an autistic person (which it's not), then most autistic people would also have the diagnosis. However, any of those "negative symptoms only" diagnoses exclude autism; you have to have prominent hallucinations or delusions in order to be diagnosed with schizophrenia if you're autistic, pure and simple. I do think the reasons for that are solely political (to separate out autism from the diagnostic morass of schizophrenia), but that's how it is at the moment.