Polyamory, Schizophrenia, and other psychotic disorders (Part 1)

This post and others discussing specific mental disorders will reference the Diagnostic and Statistical Manuel of Psychiatry and Psychology, Edition Five (DSM-V). Apologies to my international readers, I’m just not familiar enough with the ICD to use it as a reference.

Please note: everyone’s experience of mental illness is different. This is general information meant to give you an idea of what to expect. Nothing in this blog is intended to diagnose or treat. Please see a psych professional if you or someone you love may be suffering from a mental illness.

The Psychotic Disorders

  1. Delusional disorder
  2. Brief psychotic disorder
  3. Schizophreniform disorder
  4. Schizophrenia
  5. Schizoaffective disorder
  6. Other

Delusional disorder, as the name says, involves delusions specifically. Brief psychotic disorder is for what seems to be an episode of schizophrenia that lasts less than a month. Schizophreniform is if it lasts less than 6 months. Schizoaffective disorder is when the primary diagnosis is mood related (primarily depression or bipolar) but there are psychotic symptoms. And of course schizophrenia a long term disorder manifesting multiple symptoms of psychosis.

Symptoms of Schizophrenia and Psychotic disorders

There are five features that define psychotic disorders in DSM-5. Delusions are fixed beliefs that cannot be changed by evidence that contradicts them. Hallucinations are sensing something (usually seeing and/or hearing, but sometimes tactile or taste/smell) that isn’t there. Disorganized thinking (speech) means not being able to follow a conversational topic, lack of coherence in speech, or loose associations. Grossly disorganized or abnormal motor behavior (including catatonia) is when the body doesn’t move right and/or doesn’t move at all, when there is no physical illness to explain the problem. Finally what are called negative symptoms–lack of emotional expression, lack of speech, inability to motivate or direct oneself in completing tasks, not being able to feel pleasure from normally pleasurable experiences, and lack of motivation to socialize/interact with other people.

Interestingly, the way symptoms manifest can change depending on the culture a person is living in. In the US today, hallucinations from psychotic disorders are often terrifying experiences. Voices telling you to kill someone else or kill yourself, threats, personal attacks, and other really nasty things are common. However, 100 years ago most hallucinations where benign. The voice of your dead relative, or a saint, or an angel were common. And in other parts of the world, hallucinations often continue to be benign, usually harmless but sometimes actually supportive.

Society has a long history of demonizing people with schizophrenia and psychotic disorders. We need to remember that, like all mental illness, schizophrenia and other psychotic disorders grow out of healthy (or at least normal) mental processes. Most people have had that time walking home at night when they would swear someone was following them–but if you turned around you were alone, many of us got home and locked the door “just to be safe” (delusion). Almost everyone, at one time or another, has heard their name called when no one was calling them (hallucination). Everyone I’ve ever met has had days where their thoughts are disorganized and they can’t follow a conversation. For most of us, these things pass in a few moments or a few hours and laugh at ourselves and go on with our lives. We all have days when we just don’t want to deal with other people or have trouble motivating ourselves to get shit done (I know I’m not the other person who procrastinated my entire way through Freshman year.)

People with psychotic disorders can be scary. Not gonna lie about that. But the world they are living in is far more frightening for them than they are for you. So if you do meet or know someone who has a psychotic disorder, please start with compassion.



Medication is the primary treatment for psychotic disorders. Antipsychotic medications are divided “conventional” and “atypical.” Conventional antipsychotics are older medications with a higher rate of severe side effects. Atypical antipsychotics are newer medications with significantly reduce side effects. Unfortunately, conventional antipsycotics are much cheaper. When dealing with a medication which will likely be lifelong, price can be a significant concern.


So far, no therapy has been found that helps the symptoms of psychotic disorders. However, therapy has been very effective in helping people manage their symptoms. It is especially important for people with schizophrenia to recognize when stress in their life might trigger an acute phase. Preventing the occurrence of an acute phase by managing stress and recognizing early warning signs can be key to successfully managing schizophrenia.

Social skills training and vocational rehabilitation can be important treatments as well, especially for people with long term psychotic disorders.

Other treatments

I don’t know enough about alternative treatments (either alternative therapies such as art and music therapy or alternative medicine such as meditation, herbs, and massage) for psychotic disorders. If you or a loved one wants to explore alternative treatments, start by talking with your psychiatrist and psychologist.

Schizophrenia and Bipolar Disorder

I don’t know what the relationship is between schizophrenia and bipolar disorder. Officially, there isn’t one. But there has to be some reason they are so consistently misdiagnosed as each other. Again, culture seems to play a role–an American diagnosed as schizophenic who moved to Britain will usually be diagnosed by a British doctor as bipolar. The opposite often happens when a British person comes to America. With in America, it is very common for someone to go years thinking they have schizophrenia, make little or no progress in treatment, then have a new doctor diagnosis them with bipolar and the treatments for bipolar start working. Again, the opposite (someone diagnosed bipolar gets a new diagnosis of schizophrenia and stars seeing improvement) happens just as frequently.

If you look at the diagnostic criteria for schizophrenia and bipolar this makes no sense. There is nothing in bipolar about hallucinations or delusions or general motor problems. And nothing in schizophrenia’s criteria about mood swings. I don’t get it. But it’s something to be aware of.


Okay, usually I’d start talking about the impact of psychotic disorders on polyamory here, but that’s gonna be a very long discussion, so we’ll save it for next week.

Thanks to Richard Sprott for providing the diagnostic criteria for schizophrenia.

This post is part of the Polyamory and Mental Illness blog series.

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When Mental Illness and Polyamory Collide (Part 1)

The Complexity of Mental Illness and Polyamory

In some ways, mental illness and polyamory actually go very well together. The larger support network can be a huge benefit for someone dealing with mental illness, while the increase in available support also means that no one person gets overwhelmed trying to support the mentally ill partner all on their own.

But vague generalities almost always sound good. It’s when you get into the nitty-gritty that the problems develop.


This post can’t cover the entirety of the interactions of mental illness and polyamory. Both mental illness and polyamory are so varied that an entire book couldn’t cover all the interactions. My goal here is to introduce some of the ways they interact, so you can get a feel for the variety of interactions possible. More interactions will be covered when I  get into reviewing the various types of mental illness.

Manic NRE

Most of us are familiar with new relationship energy. The hormonal high that turns our brains to mush, pumps the libido up to “10” (whatever that may mean for each of us individually) and can strain existing relationships to the breaking point.

If you don’t have or know someone with bipolar disorder you may not be familiar with manic episodes. These bursts of energy, optimism, and irrationality can last anywhere from hours to months. During a manic phase it will seem perfectly reasonable to spend your life savings on shoes or to quit your job and start a new career throwing sex toy parties (when you have no savings, a family to support and have never even used a sex toy). It isn’t uncommon for people in manic phases to have so much energy they don’t sleep for weeks on end.

My own experiences watching someone go through manic NRE have been (relatively) mild. For which I can only be grateful. I don’t think it takes a quantum physicist to look at the brain-drain of NRE, the irrational exuberance of a manic phase, and see how these two combined can be a very bad thing.

OCD “Fairness”

Just like we all experience depressed days, we all have a few OCD tics. The difference between your obsessive need to always have the toilet paper hanging over the top of the roll and someone with OCD is that while it drives you crazy when the toilet paper is facing the wrong way, and you correct it whenever possible, someone with OCD will not be able to leave a public restroom until they have checked every stall to make sure the toilet paper is hanging properly. To not do so is to court a mental breakdown.

The romantic comedy “As Good As it Gets” with Jack Nicholson, while having all the many, many flaws of romantic comedies everywhere, was one of the few truly good representations of extreme mental illness in the media. Not everyone’s experience of OCD will be like that–if only because the movie simply could not give a good view of the obsessive thought side of the illness. But still, damn good portrayal.

Now, we’ve all run across the dangerous idea that poly relationships should be kept fair. That if you sleep with A one night, you have to sleep with B the next night. If 1 takes you out for an expensive night on the town, then 2 needs to take you out somewhere just as special. Most standard poly advice points out how ridiculous this is, and suggests that treating your partners as individuals with their one unique needs, wants and desires is healthier than obsessing about treating them both (or being treated by them both) “equally”

In general, I agree and have no quibble with this. However, I have known people with OCD whose compulsion was keeping everything balanced. If they stamped their left foot, they had to stamp their right foot. If they hang a picture on the right side of the wall, they have to hang a picture on the left. Do you see where this is going?

Someone with an OCD balance compulsion may need to keep a “balance” in their poly relationships. If they sleep with partner A one night, they have to sleep with partner B the next, if they buy a present for partner B, they need to buy an equally valuable present for partner A.

This post is part of the Polyamory and Mental Illness blog series.

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