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So the only reason I don't have a schizoaffective dx is because I'm too high-functioning. I know I shouldn't let this bother me, but it does, since I almost never have affective issues and my psychotic features rarely occur within the context of mood. I don't relate to bipolar people and for whatever reason it bothers me I can't relate to people with my dx.

What is this high-functioning business? Do other people have issues with it?

I had a psychotic episode last year when my pdoc was away and the doctors thought it was fine b/c I'm high-functioning, even though I was wandering around hallucinating (visual/aural).

Why, when I meet every other criteria, would a pdoc hold back the schizoaffective dx? He's agreed I meet the criteria. What's the motivation? I don't like the idea of having 'schizo' in my dx, don't get me wrong, but I also don't like being dx'd with something I don't think I have.

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I think that's bs. You can be high-functioning and have schizoaffective or schizophrenia.

I've had a good prognosis when hospitalized even though I'm psychotic. I'm not sure what high-functioning means. I don' think I am because I'm on ssdi and can't work. My pdoc and tdoc seem to feel I'm capable of a lot, though.

I guess it doesn't matter too much if the treatment is the same, but I felt better when my dx was changed from bp to sza. It just felt like it fit.

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My uncle has schizoaffective and he is very high functioning. He was a professor for a while until his symptoms got worse, then he retired and just advises other professors and students. You would think that he was just super smart, which he is. He is my favorite relative for sure.

P.s. edited to add: my uncle wasn't treated for a really long time and just held it together, it got harder for him in his 40s.

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It seems like that happens a lot, pdocs not changing the diagnosis because the patient is "too high functioning". My pdoc actually said, after she changed my diagnosis to schizoaffective that I'm very high functioning. She mentioned holding down a full time job, paying my bills/taking care of myself, having a stable relationship. I think it's silly to not change to what seems to be the correct diagnosis just because of your level of functioning. Have you asked him straight up why he won't change your diagnosis if you do, in fact, meet the criteria? Maybe you need to just say "Look, we both agree that I fit the schizoaffective diagnosis. Why are you not changing my diagnosis? It bothers me to be diagnosed with bipolar if that isn't correct". Something like that.

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I don't think a diagnosis matters too much. You are on all the meds that a person with SZA would take. It's really a good thing that your pdoc says you are high functioning. Would you rather be low-functioning? Not able to work? Symptom ridden nearly constantly? Not able to drive? Unable to finish your college degree? etc. etc. I could go on and on. I would really take that as a good sign and go with it. Consider it a treasure!

But if you really want to push the issue then I would bring it up again to your pdoc and see what he/she has to say about it. It couldn't hurt. But I wouldn't many if any changes (to things like your meds, etc.).

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Obviously I prefer to be high-functioning - I don't think I've said or implied otherwise.

It really is that I feel my dx is incorrect. I know it won't change my treatment, but I don't think it's right, and that sort of thing really bothers me. I like to have things settled and neat, I find it agitating sort of for it to be left in flux.

I will talk to him again. The one thing I'm not sure of is since he heads a mood disorders unit if I'd still get to see him - I think so?

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I know what you mean about just wanting to know and have the correct diagnosis. It doesn't mean that your treatment would change at all, but you just want to have things all laid out and correct. I was the same way. I wanted the correct diagnosis (be it bipolar or schizoaffective) for my peace of mind because it bothered me to have things sort of up in the air. I think you should just ask your pdoc.

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This makes me wonder if the dimmer prognosis of schiz disorders are at least partially inflated by pdocs refusing to use those dx's unless someone is non-functional. It's been my experience that doctors never hesitated to apply the schiz label, and I went backwards from schiz to BP after more years of observation to see wtf my brain does over the long term.

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Guest Vapourware

I have never quite understood why the level of functioning of someone should be a prime factor in diagnosing someone. I mean, I can understand it being one factor, but I also think it can be inflated. It seems a bit demeaning to presume that people with schizo<x> cannot function 'highly'. People with any dx can be highly functional.

I was in a similar position with my old pdoc who put me down as bipolar partly because of my functioning. My current pdoc changed my dx after my last episode.

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I completely agree that somone's level of functioning, not their actual sx, should not be the diagnosic criteria. If it were me, i think i would be asking my pdoc some serious questions.

You do want to ask yourself if the 'stigma' in any way would impact you however, as that does play a role in some professions. For example, my licensure requires me to disclose my dx and if I were dx schizophrenic the board here in my state made no bones about the fact that they would be highly more hesitant and in need of a TON more further information than if I were 'simply" bipolar (which is still one of the stigmatized dx, as compared to say, anxiety or depression).

The whole thing is crazee, in a non mh kind of way.

Anna

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Anna, I don't need to disclose anything for work or otherwise (though I have disclosed to my immediate department and HR that I'm bipolar) - I just wouldn't disclose the new dx, at least not to my immediate department. I think I'd be a lot more careful about who and how I disclose to - right now I'm pretty open - or continue to say that I'm bipolar.

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In some ways, I can understand your frustration. I am also described as high-functioning with a dx of schizoaffective. For a long time, I kept going back and forth about whether or not I truly have this condition. Because it's an issue of our mind, it's so much more difficult to interpret it from an objective point of view.

I'm not saying you're denying anything- but for myself, rather than looking at now I looked at the past ten years and how much this has affected my life, and how ungracefully I have coped at times. I'm currently starting med trials again, because of a recent crisis, and simply to get rid of the voices.

How do I function at this level? I ask myself the same question. What I do know is that this diagnosis only points the way to certain medications that may help me. I believe many high-functioning people have this diagnosis. Every pdoc I've met has said that they have clients like this.

I can understand wanting things settled and neat, but such a complex issue is not even fully understood by any type of doctor or healer. I say whatever makes you feel the best, whether it be meds and/or a certain diagnosis- go with it. I wish you well.

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