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Which is it - schizoaffective or schizophrenia - and is it linked to compulsive sex?
Jul 3, 2011

Hello Dr.Fawcett,

One doctor said I had paranoid schizophrenia in 1994. Two years later, I stopped my meds and bounced around at different jobs and got addicted to porn and sex. Then, in 2002, I found out I was positive. The next two doctors said I had schizoaffective disorder, followed by another doctor who said I had paranoid schizophrenia again. I'm asking if sexual compulsive behavior is linked to schizoaffective mania type or to schizophrenia? And did my mental illness lead to HIV or did HIV lead to mental illness (in your professional opinion)?

Thank you very much sir for your feedback and help on the site.

Response from Dr. Fawcett

First let me give some brief definitions. Schizophrenia is a complex mental disorder that can make it difficult to differentiate real and unreal experiences and can impair one's thinking. Symptoms can include hallucinations, delusions (beliefs not based on reality), loose associations (thoughts jumping between unrelated topics), and social isolation. The paranoid type of schizophrenia can include more argumentative behavior and delusions that others want to harm you. There are numerous medications that, while having many side effects, can control these symptoms.

Schizoaffective disorder is on the "schizophrenic spectrum" and includes the cognitive features of schizophrenia (for example, hallucinations and delusions) as well as a mood disorder (depressive and/or bipolar/manic varieties). Making an accurate diagnosis of schizoaffective disorder is difficult (as your history indicates) and occurs when the patient has features of both disorders but doesn't meet criteria for either illness alone.

All that said, about 30% of men with either disorder experience compulsive behaviors, which can include sexual acting out, so it is very possible that those years off your meds (during which your were addicted to porn and sex) contributed to the mania. It is likely that this mania contributed to risky, compulsive behavior which put you at higher risk for HIV.

The important concern at this point is that you consistently take any psychiatric medications that are prescribed (and HIV meds, of course). These will control your psychiatric symptoms and stabilize your moods so that you are better able to do the things you need to do to remain healthy while living with HIV. Disorganized thinking and mood fluctuations due to mental illness are significant factors contributing to non-adherence of HIV medications, so remaining stable is very important.

Finally there are support groups for sexually compulsive behavior which are very effective - here are few links: SAA and SLAA. Your local mental health association can help you locate support groups for schizophrenia or schizoaffective disorder.

Thanks for writing.

-David



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