July 16, 2023/Mental Health

Schizophrenia vs. Schizoaffective Disorder: What’s the Difference?

People with schizoaffective disorder have additional mood symptoms

Professionals examine pieces of troubled patient's mind.

If you or a loved one has been diagnosed with — or is showing signs of — a mental illness like schizophrenia or schizoaffective disorder, you know the rollercoaster ride well.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

The right diagnosis can be hard to reach. And when a diagnosis does come, you may be wondering what it even means.

What is schizoaffective disorder anyway? What is schizophrenia? And what does that all mean in your life?

The dividing lines between a diagnosis of schizophrenia vs. schizoaffective disorder are clearly laid out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text RevisionDSM-5-TR, the current gold standard for the diagnosis of mental illness.

But as you probably already know, real life isn’t always as clear-cut as a reference book. The signs and symptoms of schizophrenia and schizoaffective disorder can be hard to interpret.

So, we talked with psychiatrist Travis Krew, MD, to better understand these illnesses — their similarities, their differences and, most importantly, how you can manage them to live your best life.

Symptoms of schizophrenia vs. schizoaffective disorder

The difference between schizophrenia and schizoaffective disorder is this: Schizophrenia is a condition characterized by hallucinations, delusions and/or disordered thinking. People with schizoaffective disorder also have those symptoms — and, additionally, they have symptoms consistent with episodes of depression, mania or both.

That’s a lot to take in. So, let’s break it down.

Schizophrenia

Schizophrenia is a kind of psychosis. That means it impacts a person’s perception of reality and ability to participate in logical conversations with others. Dr. Krew explains that to be diagnosed with schizophrenia, you need to have at least one of these three main symptoms of schizophrenia and show signs of illness for six months or longer:

  • Hallucinations: Seeing or hearing things that aren’t there.
  • Delusions: An unshakable belief in something that isn’t true.
  • Significant disorganization of your speech.

Additionally, people with schizophrenia may have other symptoms that can help a healthcare provider recognize the disorder. That may include things like making slow or unusual movements, isolating oneself or appearing emotionless. Those symptoms may be typical of some people with schizophrenia, but they aren’t definitive enough for a schizophrenia diagnosis on their own.

Schizophrenia symptoms often happen in stages. That means symptoms may be more severe at times and less apparent at others.

Schizoaffective disorder

Schizoaffective disorder is one of the six types of schizophrenia.

It’s a thought disorder layered with a mood disorder. That means that in addition to having at least one of the three major symptoms of schizophrenia above, people with schizoaffective disorder also experience extreme bouts of emotional turmoil.

“I describe schizoaffective disorder as having schizophrenia, but also meeting some other criteria that modify that disorder,” Dr. Krew explains. “People with schizoaffective disorder have symptoms of depression — or depression and mania — that coincide with their symptoms of schizophrenia.”

In other words, people with schizophrenia can experience depression separately from their schizophrenia symptoms. But that’s not schizoaffective disorder.

Schizoaffective disorder is diagnosed when depression or mania are present for the majority of the time when they also experience symptoms like hallucinations, delusions and disordered thinking.

Advertisement

Symptoms of depression include symptoms like:

  • Prolonged sadness.
  • Having low energy or fatigue.
  • Feelings of hopelessness, helplessness and/or worthlessness.
  • Thoughts or actions of self-harm.

Mania is characterized by symptoms like:

Advertisement

Chart: Schizophrenia vs. schizoaffective disorder

Condition
Schizophrenia
Critical symptoms
Hallucinations, delusions and/or disordered speech.
Depression symptoms
No.
Mania symptoms
No.
Depressive type schizoaffective disorder
Critical symptoms
Hallucinations, delusions and/or disordered speech.
Depression symptoms
Yes.
Mania symptoms
No.
Bipolar type schizoaffective disorder
Critical symptoms
Hallucinations, delusions and/or disordered speech.
Depression symptoms
Maybe.
Mania symptoms
Yes.


Challenges with diagnosis

Schizophrenia affects about 22 in every 1,000 people. Schizoaffective disorder is estimated to affect about 3 in every 1,000 people. But that estimate is harder to know for sure because diagnosing the disorder can be so challenging.

“It can be tricky to do the longitudinal work necessary to get the diagnosis right, particularly with schizoaffective disorder. You really need to have a good picture of the patient,” Dr. Krew explains. “There can be a haste to diagnose a person who has mood symptoms with schizoaffective disorder. Or, on the other hand, you can easily miss symptoms that would have led you to that diagnosis.”

Consider a person who arrives at the emergency room believing the CIA is watching them but doesn’t have proof. They also hear voices that no one else hears. Those can be clear indications of schizophrenia. So, that’s the diagnosis they’re given.

It may take a much deeper conversation to recognize that person also has a hard time getting out of bed most days (depression). Or that they recently stayed up for a few days straight repainting their entire house (mania).

Treating schizophrenia and schizoaffective disorder

Early and continuous treatment for schizophrenia and schizoaffective disorder is critical. The conditions can severely impact your physical, mental and social well-being if they aren’t properly treated.

A combination of therapy and medication is typical for people with schizophrenia or schizoaffective disorder.

Antipsychotic medication can help improve symptoms of schizophrenia. People with schizoaffective disorder will typically also take antidepressant medication or mood-stabilizing medication to even out the extreme highs and lows of depression and mania.

It’s critical that people with schizophrenia or schizoaffective disorder take their medication as directed and seek regular follow-up care to manage their condition. But some people with these conditions may have trouble adhering to a medication schedule. For some people, long-acting medication — like a shot you only get once every few weeks — can help, Dr. Krew says.

Advertisement

Seeking help

It’s a Catch-22 that can be difficult to overcome People with schizophrenia or schizoaffective disorder need medical treatment. But the conditions themselves can make people resistant to even considering that they have a condition. So, they often don’t seek treatment.

Hallucinations feel real. Delusions are incredibly hard to shake. And mania can make people feel incredibly happy, even euphoric — not a symptom people typically seek treatment for.

“For most people, treatment is initiated by some outside party like family or law enforcement,” Dr. Krew notes. “The patient themselves may not recognize that they’re experiencing any symptoms.”

If you’re concerned about a loved one and suspect they have a mental health condition, like schizophrenia or schizoaffective disorder, Dr. Krew advises that you help them seek support. But consider treading lightly.

“The goal is never to be confrontational with the person that you’re looking to help with,” he continues. “Challenging delusional beliefs or trying to argue and provide evidence to the contrary generally reinforces and perhaps worsens their perception of that delusion.”

The idea is to de-escalate the situation. So, instead of challenging the content of their ideas (“No, the FBI isn’t on your case.”), focus on the experience of what’s happening (“That does sound scary, and I can tell you’re losing a lot of sleep over this. I don’t want you to be afraid. Maybe it’s time to talk with someone about it.”).

Emergency situations — like a person who expresses suicidal or violent thoughts or is showing signs of instability and has access to weapons — should be handled immediately by professionals. Call 911 or the 988 suicide and crisis lifeline.

Advertisement

Learn more about our editorial process.

Related Articles

person on a swing between sun and rain
July 27, 2023/Mental Health
8 Early Signs of Schizophrenia

Emotional changes, isolation and unusual behavior could signal the onset of the condition

A person's head with two people talking inside of it.
July 27, 2022/Mental Health
What Are the 6 Types of Schizophrenia and How Do They Affect You?

The mental health disorder includes a spectrum of conditions

Sad person holding smaller version of themselves in their hands
May 22, 2024/Mental Health
How To Be More Confident and Improve Your Self-Esteem

Ignore the negative self-talk, practice positive affirmations and remember, you’re not perfect — and that’s OK!

Person at podium in front of crowd, nervous, sweating
May 20, 2024/Mental Health
Anxiety Has Its Benefits — But Only in Healthy Doses

A healthy amount of anxiety can keep you safe from harm and motivate you to take action

Person sitting with multiple arms trying to juggle multiple tasks, with same person with hand on head
May 17, 2024/Mental Health
What Is High-Functioning Depression? Signs and Symptoms

People with high-functioning depression may not seem depressed on the outside, but the condition can cause turmoil on the inside

Person observing a loving couple
May 15, 2024/Mental Health
Resentment: How It Can Creep In and Take Hold

The key to letting go of resentment is unpacking complex emotions and learning how to express them

Person reflecting on food and exercise
May 9, 2024/Mental Health
The Importance of Understanding Your Eating Habits

Learning about your relationship with food can help improve your eating behaviors and patterns

person looking at phone surrounded by whirlwind of bad news and negativity
May 6, 2024/Mental Health
How to Finally Stop Doomscrolling

Embrace mindfulness and practice checking your phone consciously, not compulsively

Trending Topics

Person in yellow tshirt and blue jeans relaxing on green couch in living room reading texts on their phone.
Here’s How Many Calories You Naturally Burn in a Day

Your metabolism may torch 1,300 to 2,000 calories daily with no activity

woman snacking on raisins and nuts
52 Foods High In Iron

Pump up your iron intake with foods like tuna, tofu and turkey

Ad