What Is Schizophrenia?
Schizophrenia is a chronic psychological disorder that affects a person’s thoughts, feelings, and behavior. A person suffering from schizophrenia has difficulty distinguishing between what is real and what is not real. Major symptoms that include delusions and hallucinations are distressing and make it difficult for one to carry out day-to-day activities and maintain relationships.
The illness is diagnosed in about 1.1 percent of the population.1 Onset is around age 16 to 30, although onset for males is typically earlier than females.2
Symptoms of schizophrenia are categorized as “positive” or “negative.” A positive symptom, such as delusions or hallucinations, adds a feeling or behavior that isn’t typically experienced by most people without schizophrenia. A negative symptom takes away a feeling or ability that is normally present in most people, but is now missing—such as a lack of motivation. Most people with schizophrenia experience both positive and negative symptoms. Positive symptoms are typically easier to treat than negative symptoms and tend to persist longer.
The experience of positive symptoms in schizophrenia designates a break with reality and is referred to as psychosis.3 Patients can experience either hallucinations or delusions, or both simultaneously.
Hallucinations are the experience of visual, auditory, or olfactory sensations that others cannot see, hear, or smell. Auditory hallucinations can include hearing a voice or voices in one’s head, which the person does not identify as their own internal voice or thoughts. These voices can be disparaging and threatening.4
Delusions are firmly held irrational beliefs that the patient upholds despite evidence to the contrary. Common forms of delusions in schizophrenia include:
- Delusions of persecution. This is a strongly held belief that someone or something means to do you physical or emotional harm. An example of a delusion of persecution is believing that your next-door neighbor is entering your home while you are sleeping in order to poison your food or to spy on you.
- Delusions of grandeur. This is a belief that you are an important, powerful, or famous person. That could mean that you are royalty, a historical figure, or even a deity. You may believe you also have special powers, such as an ability to know the future.
- Delusions of reference. You feel that something or someone is referring to you when it is not. These delusions can take on many forms. For instance, you may believe something you read in the newspaper refers to you or your thoughts. An actor talking in a movie may seem like they’re sending a message to you personally. Neutral or innocuous stimuli seem to take on personal and possibly harmful significance.
- Thought insertion. This is the belief that your thoughts are not your own, rather they were placed there by an outside source. This is similar to auditory hallucinations; someone with schizophrenia can attribute internal stimuli—like their thoughts—as coming from an external source.
- Thought broadcasting. One may feel as though their thoughts are not being privately contained inside their own mind. Instead their thoughts are being broadcast so that someone or something can observe or collect them. This could be literal broadcasting, such as the belief that aliens are projecting your thoughts into outer space via radio waves. It could also mean a general feeling that people around you know your thoughts without you having to speak or share them.
A psychotic person is not aware of the bizarre nature of his or her delusions or hallucinations. They cannot simply be “talked out” of these beliefs, or be made to shown how they are untrue. That’s because their mental condition causes what’s called anosognosia, which means a “lack of insight” into a mental health condition.5 It may seem plainly untrue to someone not suffering from schizophrenia that the mail carrier would be sending hidden messages to you via weekly circulars, but a person with schizophrenia cannot see why this is illogical.
Someone with schizophrenia may also experience disorganized speech, such as incoherence, perseveration (the repetition of words), frequent derailment (touching on unrelated or loosely associated ideas), or word salad (an unintelligible mixture of nonsense or made-up words). They may display grossly disorganized or catatonic behavior, including stupor or extreme rigidity or flexibility of the limbs.6
Negative symptoms 7 of schizophrenia include:
- Avolition. Lack of motivation, inability to follow goal-oriented action.
- Anhedonia. Inability to experience pleasure.
- Social withdrawal. No interest in being with other people.
- Difficulty paying attention.
- Apathy. This can show up as lack of personal hygiene or a lack of concern for others or self.
- Affective flattening. An absence of emotional expression facially, vocally, even a lack of body language.
- Alogia. Reduction in speech, little detail used when communicating.
Someone suffering from schizophrenia could experience any combination of positive or negative symptoms. Patients also often experience impaired executive function, including working memory. This means they may be unable to process, interpret, and retain new information or recall this information in order to perform a task later. Deficits in attention and short-term memory are common.8
A psychiatrist or psychologist can diagnose schizophrenia. There is no laboratory or medical test for schizophrenia. Instead, a mental health professional will evaluate the patient and rule out other physical and psychological conditions. Once diagnosed, a treatment plan including medication and psychotherapy is typical.9
While proper administration of antipsychotic medication can eliminate positive symptoms of the illness, negative symptoms often persist and are harder to treat with medication.
Seeking help as soon as symptoms arise is particularly important. The earlier the intervention the more likely the patient is to make a socio-occupational recovery, possibly even reversing the effects of psychosis.10