What Is Schizoaffective Disorder?

Schizoaffective disorder is a serious mental health condition that exists at the intersection of schizophrenia and a mood disorder—most commonly bipolar disorder or major depressive disorder. In clinical terms, it's considered a “dual diagnosis” because it includes persistent symptoms from two distinct psychiatric categories.

The condition is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as involving:

  • Psychotic symptoms, such as hallucinations (hearing or seeing things that aren’t there), delusions (strongly held false beliefs), or disorganized thinking

  • Alongside mood episodes, which may include manic episodes, depressive episodes, or both

To receive a diagnosis of schizoaffective disorder, the psychotic symptoms must occur for at least two weeks in the absence of any major mood episode. This helps distinguish it from bipolar disorder or depression with psychotic features, where psychosis only happens during mood episodes.

There are two primary subtypes:

  • Schizoaffective disorder, bipolar type, which includes manic episodes with or without depressive episodes

  • Schizoaffective disorder, depressive type, which includes only major depressive episodes

Because it blends features of multiple disorders, schizoaffective can be difficult to diagnose accurately. People are often initially misdiagnosed with schizophrenia, bipolar disorder, or major depression, especially if symptoms develop gradually or change over time.

Wy TJP, Saadabadi A. Schizoaffective Disorder. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541012/

Self-Disorder and Schizophrenia:

Self-disorder refers to a disruption in the basic sense of self—the pre-reflective, automatic feeling of being a unified, embodied subject of experience. In simpler terms, it's the feeling that “I am me”—that my thoughts, perceptions, body, and sense of reality belong to me and are anchored in a stable, continuous identity.

In people with schizophrenia spectrum disorders, this foundational sense of self can become unstable or fragmented. This is often experienced as:

  • Depersonalization: Feeling detached from one’s own body or mind

  • Derealization: Feeling that the external world is strange or unreal

  • Thought insertion or withdrawal: Believing that thoughts are being put into or taken out of one’s mind

  • Hyper-reflexivity: Becoming excessively self-aware of thoughts, sensations, or actions that are usually automatic

  • Loss of ego boundaries: Blurring between self and others, or between internal thoughts and external reality

These disruptions are part of what researchers call disturbances of ipseity, from the Latin ipse, meaning "self." Ipseity refers to the core subjective presence of being a self. In schizophrenia, this ipseity can become unstable—leading to the kinds of psychotic experiences (like delusions or hallucinations) that characterize the disorder.

Relation to Diagnosis

While self-disorder is not yet included as a formal diagnostic criterion in the DSM-5 or ICD-11, it is increasingly recognized by researchers as a promising candidate for early detection, especially in people at clinical high risk (CHR) for psychosis.

Some clinicians believe that exploring self-experience in depth could help differentiate schizophrenia-spectrum conditions from bipolar disorder, borderline personality disorder, or dissociative disorders, which may present with overlapping symptoms but have different underlying dynamics

Resources:

  • Stanghellini, G., Ballerini, M., & Mancini, M. (2017). Other Persons: On the Phenomenology of Interpersonal Experience in Schizophrenia (Ancillary Article to EAWE Domain 3). Psychopathology, 50(1), 75–82. https://doi.org/10.1159/000456037

  • Sass, L., Pienkos, E., Skodlar, B., Stanghellini, G., Fuchs, T., Parnas, J., & Jones, N. (2017). EAWE: Examination of Anomalous World Experience. Psychopathology, 50(1), 10–54. https://doi.org/10.1159/000454928

  • Englebert, J., Monville, F., Valentiny, C., Mossay, F., Pienkos, E., & Sass, L. (2019). Anomalous Experience of Self and World: Administration of the EASE and EAWE Scales to Four Subjects with Schizophrenia. Psychopathology, 52(5), 294–303. https://doi.org/10.1159/000503117