I have been diagnosed with schizoaffective disorder and complex PTSD. 

I experience typical dissociative symptoms like depersonalisation and derealisation but recently on my psychiatrist report to my GP she mentioned that my symptoms of ‘delusion of thought control’ maybe a sign of dissociation other than an actual delusion. I don’t know what her thought process was about that. I met another psychiatrist previously who said all my psychotic symptoms were dissociative and that I don’t have a psychotic disorder just complex PTSD. However most other psychiatrists disagreed and said I definitely have a psychotic disorder (schizoaffective disorder). This includes the psychiatrist I just mentioned who said one of my ‘delusions’ was dissociative. 

I remember in the appointment she asked me whether I feel like my thoughts are my own and I said to her sometimes it doesn’t. She quoted me in her report that I said sometimes my thought feels ‘foreign’ and that I was convinced someone was tempering my memory. She concluded that she didn’t have the impression that I experienced ‘delusion of thought control’ but ‘the symptoms maybe dissociation’. I’m confused as she didn’t mention that my other symptoms were dissociative too just this one.

At the end of her report she said I had ‘second person, auditory command hallucinations with a running commentary’, she also said I had ‘delusions of persecution and reference’. She made the diagnosis of schizoaffective disorder. She explained during the appointment that it is because when I was manic I was also very psychotic at the time. She thinks my presentation lines up with a psychotic illness rather than bipolar disorder alone which I was previously diagnosed with.

She also made a separate diagnosis of complex PTSD which she didn’t made me aware during the appointment but I found out from her report.

It is interesting how she thinks some symptoms are dissociative we seems to link with PTSD but some are psychotic in nature. She seems to still believe that I’m psychotic and I need antipsychotic medication despite her also making the diagnosis of complex PTSD.

I’m just confused. Can dissociation be confused with psychosis?

I worked with a trauma specialist for a short period of time before dropping out because I couldn’t afford to see her privately. She is not a specialist in psychosis so she believed due to my family history of psychotic illnesses it is very possible that I have a psychotic illness but at the same time my symptoms can be a representation of the extensive trauma I went through as a child.

I don’t know. The consensus most psychiatrists currently have towards my case is that I have schizoaffective disorder. But what if it’s all trauma and a dissociative experience?