Key Takeaways
- Schizophrenia symptoms include delusions, hallucinations, disorganized speech, and behavior.
- It’s essential to consult a doctor if social or work functioning is impaired.
- Negative symptoms like lack of emotion and reduced speech can make schizophrenia challenging to identify.
The symptoms of schizophrenia can seem peculiar to people who observe them. Some common symptoms of schizophrenia include delusions, hallucinations, disorganized behavior, lack of emotion, reduced and disorganized speech, and memory problems.
However, when people are experiencing symptoms, they may have little or no insight that their thoughts or behaviors are strange. The lack of insight can make schizophrenia very frustrating and frightening for loved ones.
Verywell / Cindy Chung
Schizophrenia: A Psychotic Disorder
Schizophrenia is classified as a psychotic disorder, meaning a person becomes disconnected from reality. This disconnect will affect some combination of a person’s perceptions, thought processes, beliefs, and emotions. These symptoms may come and go episodically.
Three Phases of Schizophrenia
Schizophrenia usually develops in three phases:
1) A prodromal phase when changes in thoughts, feelings, and perceptions begin
2) An acute phase when psychotic symptoms appear
3) A recovery phase where support, medication, and therapy aid in improving the condition
Clinical Symptoms
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) is a clinical resource practitioners use to diagnose mental health conditions. As with other conditions, there are specific clinical criteria involving symptoms and course of illness, that need to be met for someone to be diagnosed with schizophrenia.
Positive Symptoms
Symptoms of schizophrenia are referred to as positive or negative. That doesn’t mean that some are good and some are bad. Positive symptoms are those that are present in someone with schizophrenia that someone without schizophrenia or another mental health condition would not experience. Examples of these symptoms include:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized behavior
Delusions
Delusions are fixed, false beliefs that don’t make sense in the context of a person’s culture. Although everyone has distorted beliefs from time to time, people with psychotic delusions can’t be convinced that their beliefs aren’t real.
Hallucinations
Hallucinations are false sensory experiences that have no basis in the external world. Psychotic hallucinations occur when the person is fully awake and not under the influence of alcohol or drugs.
Auditory hallucinations (hearing voices) and visual hallucinations (seeing things) are the most common, but a person can hallucinate a touch (for example, bugs crawling on the skin), taste, or smell.
Disorganized Speech
Disorganized speech is also known as “loose association.” In psychotically disorganized speech, words are not linked together based on the normal rules of language but may be strung together based on sounds, rhyme, puns, or free associations.
Although everyone makes speech errors, especially when they’re tired or stressed, disorganized speech during a schizophrenic episode is severely abnormal. It can be difficult or impossible to understand.
Disorganized Behavior
Disorganized behaviors for someone with schizophrenia are not goal-directed and don’t make sense in context. For example, while taking one’s clothes off to take a bath is sensible, taking one’s clothes off on a public bus is an example of disorganized behavior.
Laughing at inappropriate times or for no reason is a disorganized behavior. Adopting strange postures or freezing can be examples of catatonic behaviors.
Negative Symptoms
In addition to the positive symptoms that become present in someone with schizophrenia, others are referred to as negative symptoms. This means that the person is experiencing an absence or reduction of certain traits typically present in healthier individuals.
The term negative suggests that something feels as if it is being taken away or disappearing from the person’s daily experience. Examples of negative symptoms can include things like:
- Flattened affect
- Anhedonia
- Reduced speech
- Lack of initiative
Flattened Affect
People with flattened affect appear emotionless or have a very limited range of emotions. They show little response to emotional or disturbing situations or images. This restricted expression of emotion can be alarming to others, as it can feel like the person with schizophrenia is disappearing from them.
Anhedonia
Someone with the condition of schizophrenia can experience a lack of joy in things that used to bring them pleasure. This change tends to be quite noticeable by others around them and is not simply a change in interests.
Reduced Speech
A negative symptom of schizophrenia can involve someone speaking noticeably less than they used to. This particular symptom could also be observed as someone speaking less fluently than before.
Lack of Initiative
The loss of will to do things is a negative symptom of schizophrenia. Remember that a negative symptom refers to a characteristic that seems to be lessening or disappearing from the person. Loss of motivation and initiative, also known as avolition, is a common negative symptom.
Positive Symptoms
-
Delusions
-
Hallucinations
-
Disorganized speech
-
Disorganized behavior
Negative Symptoms
-
Flattened affect
-
Anhedonia
-
Reduced speech
-
Lack of initiative
Other Symptoms of Schizophrenia
In addition to the formal diagnostic criteria, there are a variety of other symptoms or comorbidities that can often be found in people with schizophrenia. These symptoms include things like:
- Agitation, anger
- Anxiety
- Cognitive Impairment
- Depression
- Sleep disturbances
- Substance use (especially tobacco use)
Myths About Schizophrenia Symptoms
One common misconception is that violence or aggression are common symptoms of the condition. It is important to recognize that this is not the case. Having schizophrenia does not mean that a person is violent or dangerous. While the condition is chronic, it can be managed effectively with medications, therapy, and support.
More About Cognitive Symptoms
Cognitive symptoms of schizophrenia have to do with the way a person thinks. Although cognitive symptoms are not used to diagnose schizophrenia, some are pretty common with the condition, such as:
- Difficulty maintaining attention: The inability to sustain focused attention makes people with schizophrenia seem spacey or “out of it.”
- Memory problems: Schizophrenia often affects working memory, the kind of memory you use to keep things in your head for active processing, like the digits of a phone number you’re about to dial.
- Difficulty planning and structuring activities: This is caused by reduced executive function, a set of mental processes that allows us to identify the steps needed to complete a task and execute them in a proper order. Executive function also allows us to suppress our response to distractions in order to get something done.
- Lack of insight: People with schizophrenia have a specific cognitive blind spot that prevents them from understanding that they are ill. This means that loved ones and caregivers should remain as vigilant as possible to help the patient maintain their routines and treatment to control symptoms.
Symptoms in Children and Teens
When schizophrenia appears before the age of 18, it is referred to as early-onset schizophrenia. Childhood-onset schizophrenia, which occurs before age 13, is also possible, but it is considered very rare.
The earliest signs that may appear in childhood or adolescence include strange thoughts, problems differentiating between reality and imagination, difficulty concentrating, extreme moodiness, social withdrawal, and odd behaviors.
Symptoms in children are the same as in adults, but kids are more likely to have auditory hallucinations. Thought disorders and delusions do not emerge until adolescence or young adulthood.
Psychiatric Assessment
Because of the variety of symptoms that can be present, schizophrenia can be difficult to diagnose. In an effort to achieve greater precision in the process of diagnosing, the clinical criteria for schizophrenia within the DSM-5-TR have become more complex over time. There are reasons why it is important to diagnose schizophrenia accurately:
- It is a more common condition than people might think.
- People who develop schizophrenia can experience symptoms for the rest of their lives.
- Often, medication must be taken for the rest of their lives.
- Symptoms can significantly impact someone’s social abilities and work functioning.
DSM-5-TR Criteria
As outlined within the DSM-5-TR, the clinical features that must be present for the condition of schizophrenia to be diagnosed include the following:
1. Presence of at least two of the following symptom types (with at least one of the symptoms being in the top three listed here):
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized behavior
- Negative symptoms
2. The symptoms are to be experienced for at least six months, with the psychotic features (the top three listed above) being present for at least one month.
3. The person experiences significant problems with work and social functioning as a result of their symptoms.
4. The diagnosing clinician can determine that the symptoms the person has been experiencing are not caused by another medical or psychiatric condition or substance use.
Other Diagnostic Considerations
In addition to exploring and identifying whether or not someone meets the formal clinical criteria as listed in the DSM-5, there are additional things that a mental health provider will consider in the diagnostic process. These include:
- Family history of schizophrenia: A close relative with schizophrenia can increase someone’s chance of also being diagnosed with schizophrenia. This does not mean that people are born with the condition. Instead, having a combination of genes may cause people to be more vulnerable to developing schizophrenia. However, having these genes does not necessarily mean that people will develop the condition.
- Response to medication: People may have taken medication as part of mental health treatment in the past. Depending on someone’s responses to certain medications in the past, it may suggest certain diagnostic possibilities.
- Age at onset: Typically symptoms become present between the late teens and the mid-30s. If someone’s symptoms are presenting later in life it could suggest there is something else going on. It doesn’t necessarily rule out schizophrenia. It is simply something to consider in the diagnostic process.
- Situational factors: Experiences that can cause severe emotional distress can lead to brief periods of psychosis. As a clinician conducts their assessment, they will likely be considering any significant life changes or events to determine duration and severity of symptoms and whether or not there are other mental health conditions that should be considered.
Comprehensive exams are an important aspect of diagnosing schizophrenia. A clinician will not rely on limited pieces of information or only on self-reports from the client. They will be gathering information about the client’s family history, substance use and medications, sleep disturbances, appetite changes, and more.
In addition, a clinician needs to explore information related to the person’s values system, perspectives on the world, interests and talents, beliefs, and relationship dynamics. Family and close friends may also be interviewed to help provide helpful collateral information.
Closely Related Conditions
Schizophrenia is a complex diagnosis with a lot of symptoms and variables to consider. What makes things more complicated is that there are also several closely related conditions that involve psychosis. Some of the conditions that are to be ruled out can include:
When to Consult a Doctor
Because of the complexity and variety of symptoms associated with schizophrenia, it can be difficult for people to know if what their loved one is experiencing is concern enough to see a doctor.
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Onset and Duration of Symptoms
The onset of symptoms tends to be gradual, building in severity over time. This sometimes slow progression of symptoms can also make it difficult to know if what you, or someone you love, is experiencing is to be of concern.
Some of the most common early warning signs of schizophrenia include anxiety, depression, difficulty thinking clearly, reduced energy, restlessness, and social withdrawal. People may experience such symptoms for years before the condition becomes apparent.
Schizophrenia is a chronic, lifelong condition without a known cure at this time. The symptoms can worsen over time, or they can improve if the condition is well-managed with medication and therapy. Symptoms don’t always get better with age.
Functioning in Social and Professional Situations
When social and work (or school) functioning is impaired, it may be helpful to consult with a doctor. Because the symptoms tend to develop over time, it can be hard to realize that someone is experiencing difficulty in these areas. Noticing that a pattern has developed can be a signal to consult with a professional.
Challenges in Reaching Out
It can be challenging for people with schizophrenia to reach out to a doctor or other health professional about their concerns. This can be particularly tough for people experiencing symptoms that leave them feeling suspicious of others.
Reassurance from people they trust can help encourage and prompt someone to speak with a doctor or other mental health professional.
