Schizophrenia is typically recognized as a disintegration of thinking processes and emotional responsiveness. It’s often associated with psychoses such as hallucinations and delusions. Schizophrenia may affect how a person functions in one or many aspects of life, depending on which symptoms are present and how severe they are.
Working with a therapist or counselor can help people with schizophrenia improve their social skills, develop higher self-esteem, and learn more about mental health issues that may accompany the condition.
Schizophrenia most commonly manifests through delusions, hallucinations, disorganized thinking and speech, and paranoid delusions. The term schizophrenia has Greek roots: It combines the word schizo, meaning “to split,” and phrene, meaning “the mind.” This term references a disruption of the balance between thinking, perception, memory, and personality.
Studies have shown that schizophrenia may result in brain tissue loss, especially within the first 2 years of an episode. One study also found that people with schizophrenia often had brains that were slightly smaller than average. In the same study, antipsychotic medications were linked to greater brain tissue loss. Recent research has uncovered evidence that schizophrenia may impact the whole body and could be connected with health issues including an overactive immune system and diabetes.
Due to some misconceptions about the condition, people with schizophrenia may face stigma. Prejudiced views about how people with schizophrenia may act or behave often make it more difficult for those affected to receive treatment or even acknowledge they need help.
Schizophrenia can manifest as a broad range of symptoms which vary in severity and type from person to person. The symptoms of this condition can also change over time. Symptoms of schizophrenia are commonly divided into two categories: positive and negative.
Positive symptoms represent changes in thoughts and behavior that are not part of usual functioning. They include:
- Delusion of reference: interpreting that an ordinary object has a special relationship with oneself
- Delusion of persecution: thinking oneself is being or in danger of being persecuted
- Delusion of control: believing someone or something is trying to exercise control over oneself
- Delusion of grandeur: believing oneself to be superior to others in areas such as intelligence, morality, omnipotence, or others
- Disorganized speech
- Disorganized behavior or movements
Negative symptoms refer to a lack of common behaviors and emotions. Sometimes they are hard to recognize because they can be similar to other mental health conditions, such as depression. Negative symptoms of schizophrenia include:
- Lack of emotional expression characterized by a flat or monotonous voice, lack of eye contact, and lack of facial expression
- Lack of interest in everyday life and difficulties with motivation
- Difficulty feeling pleasure
- Social withdrawal
Schizophrenia often begins to develop from ages 15 to 25. Many early signs of the condition are subtle, and most of these signs could indicate many other mental health issues besides schizophrenia. However, some of the earliest signs of schizophrenia may include:
- Sensitivity to stimuli such as noise and light
- Suicidal ideation
- Mood swings
- Slowed or quickened movement
- Easily triggered anger or suspicion
- Depression and/or anxiety
- Involuntary movements
- Clumsy or awkward gait
- Emotional numbness or sense of being detached
- Increased sensitivity to criticism or hurt
Those who may have or develop schizophrenia may be prone to isolating themselves socially and have difficulty keeping up with self-care. Becoming lost in thought, difficulty handling any amount of stress, lack of goal-setting behavior, and unusually intense interest in religion or politics may also be signs of schizophrenia.
The Diagnostic and Statistical Manual (DSM-5) lists schizophrenia under Schizophrenia Spectrum and Other Psychotic Disorders, where it is defined as a mental disorder characterized by disintegrating emotional responsiveness and thought processes. Schizophrenia is currently listed in the DSM alongside other psychotic disorders, including:
- Schizotypal personality disorder
- Delusional disorder
- Brief psychotic disorder
- Schizophreniform disorder
- Schizoaffective disorder
In the previous version of the DSM, schizophrenia was categorized into the following five types:
The DSM-5 no longer separates schizophrenia into types because they were found not to help with diagnosing or treating schizophrenia. Instead of being a type of schizophrenia, catatonia is now used to help diagnose schizophrenia on a broader level.
The criteria for schizophrenia as listed in the DSM-5 are:
- Disorganized speech, or frequent topic-changing or incoherence
- Disorganized or catatonic behavior
- Negative symptoms, such as lack of expression or speech
For a person to be diagnosed with schizophrenia, at least one of the first three symptoms must be present, and they must be present for at least one month. For example, a person who experiences delusions or hallucinations, disrupted relationships, difficulty functioning in everyday life, and disorganized speech or thinking may be diagnosed with schizophrenia.
Symptoms generally occur in young adulthood, and the condition may be diagnosed based on a person's self-reported experiences and observed behaviors. The reliability of a schizophrenia diagnosis is generally high, although some symptoms do overlap with those of major depression and bipolar.
Schizophrenia is believed to be a brain-based condition, but there is currently no test or brain scan that can diagnose it. Some people with schizophrenia see several doctors before they are properly diagnosed, and a diagnosis typically relies partially on self-reports as well as the doctor's own observations of the person and the behavior. Some people may also provide insight from friends and family.
The exact cause of schizophrenia is unknown, but researchers believe it is influenced by a combination of factors including genetics and environment. Schizophrenia is significantly affected by heredity, and its onset is often exacerbated by environmental stressors. According to research, a child who has one parent with schizophrenia has a 10% likelihood of developing the condition. And twin studies show that one identical twin has a 50% chance of developing schizophrenia if their other twin has it, while a non-identical twin has a about a 14% chance.
Schizophrenia has been linked to neurotransmitters, and particularly to dopamine imbalance, but this imbalance may be caused by schizophrenia rather than vice versa. Schizophrenia may increase a person’s sensitivity to neurotransmitters. Complications during pregnancy and childbirth, including premature birth and lack of oxygen for the infant during birth, have also been connected to schizophrenia.
In some cases, the use of substances such as marijuana and amphetamines may trigger symptoms of schizophrenia, although people with schizophrenia have also been shown to use alcohol and drugs at a higher than average rate. Another potential trigger for schizophrenia symptoms is stress, which may take many forms.
It is rare for children under age 13 to develop or show signs of schizophrenia, although warning signs of schizophrenia may begin to appear during adolescence. When schizophrenia does appear in children, it’s called childhood-onset schizophrenia.
Warning signs of schizophrenia in children may include:
- Delayed speech and language development
- Poor motor skills
- Disruptiveness or aggression
- Suicidal thoughts
- Confused or confusing thoughts
Children may show some of these warning signs before schizophrenia is diagnosed. Because of these symptoms, children may have more difficulty with emotional regulation, controlling their own behavior, and normal daily functioning.
Children may also experience hallucinations and meet other key criteria for schizophrenia, but these may occur later than the earlier signs. To some clinicians, the diagnosis of childhood-onset schizophrenia is controversial, as it can be difficult to diagnose properly.
Those with schizophrenia sometimes find that it affects their intimate relationships. As one of the hallmarks of the condition is loss of pleasure and decrease in or lack of sex drive, a person with schizophrenia may experience difficulty navigating intimacy with their partner.
One study, which interviewed five people with schizophrenia who were in relationships, found that many were frustrated that their treatment did not involve their partner. Both the person with schizophrenia and their partner reported feeling that their sexuality was overlooked during psychiatric treatment.
In some cases, people with schizophrenia and their partners may find couples therapy helpful for working through the unique relationship challenges associated with schizophrenia.
Schizophrenia can greatly impact a person’s life or ability to function, but there is hope. Many resources are available to help people manage schizophrenia. Learn more about treatment for schizophrenia.
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