Asperger's and negative symptoms of schizophrenia

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I have both Asperger's and paranoid schizophrenia.

NB: if you don't know what "negative" and "positive" symptoms of schizophrenia are, I advise you to look online because I really do not feel like explaining it here.

When I am very ill I have terrible positive symptoms to the point that I have to be sectioned and put on a secure unit just to protect myself and others from death or severe damage. I get extremely delusional and the hallucinations are almost constant.

I don't tend to experience much in terms of negative symptoms (hence paranoid schizophrenia - look it up), but see below:

But now, although I am definitely not in remission (I've been some level of "ill" for 8 years), I don't experience such strong positive symptoms (although I do still hear voices, see things and get very scared in certain benign situations), but I do experience one main negative symptom which is "flattened affect". I speak in monotone most, if not all, the time, and I don't show much expression on my face and I have zero body language.

HOWEVER.....what I am wondering is, is how much of this single negative symptom is schizophrenia and how much is it Asperger's?

I have had other negative symptoms, but only mild-moderate.

This "flattened affect" is even confusing my psychiatrist, because she can't come to a conclusion as to whether it is a negative symptom of schizophrenia or if it is AS.

Can you enlighten me?

I honestly am not sure. It could be an area where the two overlap. Are you able to contact anyone who has known you since you were a child and ask them if you had a flat or monotone voice?

From what I've read, the flat affect of schizophrenia usually comes into play later in life, just as the symptoms for schizophrenia usually get worse and more noticeable as a person gets older. In other words, it is a clear change. You go from having a voice with lots of expression to having one that is flat. If your voice never changed, and was always flat and monotone, then it is probably due to AS and not schizophrenia.

The idea about asking how you acted as a child is a good one, because childhood-onset schizophrenia is quite rare. So, if you had issues with a monotone voice, lack of body language and lack of facial expression as a child and you have a dx of Asperger's, then it's most likely the Asperger's and not the schizophrenia.

That is a very good point. I will have to ask my dad if I spoke in a monotone all my life. Although I do remember I was extremely hyper and disruptive/aggressive (diagnosed ADHD) as a kid. I'm the complete opposite now, but I do think it might have affected my tone of voice.

I'll get back to you when I find out.

Apparently I showed more expression as a kid, but it was "weird" expression in that my voice didn't sound right and I struggled to make intonations at the right time.

So AS has always caused me to have trouble with intonation. But schizophrenia has made me monotonous.

You could have both but the Aspie symptoms make it look more severe than what it is. At this point having been diagnosed with both I don't think it really matters. I think depression that can be amplified by a flat effect or AS should be more concerning. Having difficultly expressing yourself can bring on depressing thoughts whether or not it's the AS causing it or flat effect. I think the more you explore how it affects you with your doctor the more you'll understand the dynamics of which one is more active it and how it's affecting you.

I'm not sure you can be diagnosed for both conditions on an equal footing in the UK. I think one condition has to be primary and the other a secondary co-morbid. For example, you could be diagnosed with Asperger's but due to various reasons such as troubling personal circumstances, negative influences and strong medications, you could develop symptoms on the schizophrenia spectrum. Though there is an area were the autistic and schizophrenia spectrums overlap and the traits become similar, I think one or the other condition would need to be primary.

I know at least three people who were initially diagnosed with conditions on the schizophrenia spectrum but the diagnosis was updated, super-ceded and replaced by Asperger's. I personally don't know any cases where the reverse has happened.

I don't think it's the schizophrenia. But if so, you may be diagnosed with the wrong subtype. I have undiferentiated type schizophrenia, and one time my therapist thought she had narrowed down a specific subtype (paranoid), but then had to scrap the idea because the major disqualifying factor was that you couldn't have a flat affect with paranoid schizophrenia, and I often have a flat affect.