Split personality. Violent behavior. Never being able to hold onto a job or have a career. Myths abound about schizophrenia, a serious and complex mental disorder currently affecting about 1 percent of American adults.

Patients diagnosed with schizophrenia do not present with a split personality, nor is it common for someone with the disorder to be violent, says Simon Rego, PsyD, chief psychologist at Montefiore Medical Center and Associate Professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City. And many individuals with schizophrenia are able to work.

Here, experts dispel some of the more common myths about schizophrenia.

#1 Myth: Schizophrenia means you have a split personality.

Reality: “This is a classic myth,” Dr. Rego says. A split personality, also called a Dissociative Identity Disorder or a Multiple Personality Disorder, is extraordinarily rare, he explains. It is quite distinct from schizophrenia, he says.  “Schizophrenia is a thought disorder,” he explains, “The myth likely stems from the fact that in schizophrenia there is a breakdown, or split, between thoughts, emotions, and behavior.”

This split results in the person confusing reality and fantasy, Dr. Rego explains. “The person may experience delusions and hallucinations, and emotions may become blunted or inappropriate,” he explains. When most people think of schizophrenia, they think of someone who is seeing things and hearing voices, Dr. Rego points out. “These are what are called positive symptoms, but people with schizophrenia have negative symptoms, too,” he says. Among the common negative symptoms are low motivation, difficulty forming social connections, and a flat, blunted affect, Dr. Rego says. A lack of pleasure in everyday activities, rarely speaking, and difficulty paying attention are also symptoms, according to the American Psychological Association.

#2 Myth: Violence is common among individuals with schizophrenia.

Reality: It’s actually rare for someone with schizophrenia to be violent, says Dr. Rego. An individual with schizophrenia is much more likely to be the victim of violence rather than the perpetrator, he says. “They tend to struggle more to have the social benefits that most of us have,” Dr. Rego explains. “They may be homeless or staying in a shelter, where they may be singled out and assaulted.”

Some individuals with psychiatric disorders like schizophrenia do become aggressive, says Scott Ira Krakower, DO, assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, New York. “However, it is a myth that this is always the case,” he says. “A person can be aggressive and have an anger problem and not have schizophrenia,” he explains. Both medication and counseling can help with any signs of violent behavior, he says.

#3 Myth: People with schizophrenia can’t ever hold down a job.

Reality: Actually, some individuals, when stable, are able to function quite well, Dr. Rego says. “When they are being compliant with their medication and are engaged in some sort of psychosocial treatment, they are often quite functional,” he says. The National Alliance on Mental Illness estimates that as many as half of the two million Americans with schizophrenia can improve significantly or even recover completely if they get treatment. Dr. Rego refers to the “recovery model” of treatment for schizophrenia, and an article in the Current Opinion in Psychiatry.

“Working appears to help people recover from schizophrenia, and recent advances in vocational rehabilitation have been shown to be effective in countries with differing economies and labor markets. A growing body of research supports the concept that empowerment is an important component of the recovery process,” the authors write.

About a quarter of young people with the disorder recover when treated within six months to two years, reports the American Psychological Association, and another 35 to 40% percent are improved enough after longer-term treatment to live fairly normal lives with only minor symptoms. What makes this possible is psychosocial support—psychotherapy, family education, and self-help groups that can help people with schizophrenia cope and regain their lives. Job training and vocational counseling also can be useful.

Still, cautions Dr. Krakower, some patients have difficulty holding down a job. “And it’s okay for them to get additional treatment,” he says. “Sometimes they may need to be on disability, and that’s okay, too.”

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#4 Myth: A person with schizophrenia can seem perfectly normal one moment and change into a different person the next.

Reality: A sudden dramatic change of character in individuals with schizophrenia is not the usual scenario, Dr. Rego says. In fact, it’s common for the signs and symptoms of this mental disorder to surface over time. “There are often soft signs that the illness is going to take root,” Dr. Rego says. In the typical progression of the illness, a person may first become flat, isolate more frequently, and decrease their participation in activities. Then a psychotic break could occur—from a stressor such as starting college, Dr. Rego says. “So it is more of a slow progression, with a waxing and waning course that occurs over months and years,” he explains.

#5. Myth: People with schizophrenia usually require long-term hospitalization.

Reality: Appropriate treatment today may include a combination of out-patient care, acute hospitalization, and longer-term hospitalization when needed, Dr. Krakower says. And, even when family support and financial resources are available, many patients still need inpatient treatment, he adds.

“But the treatment model for schizophrenia is moving away from longer-term hospitalization and toward outpatient treatment,” he says. “At times, individuals may benefit from going to a day program or a partial day hospital, where they can receive daily treatment. Therapy may vary from individual to group therapy and the medication of choice is usually second-generation antipsychotic agents (i.e. aripiprazole, clozapine, and risperidone).”

In a longer-care setting, the time can vary from weeks to months and depends on how the patient is progressing, Dr. Krakower says.

Long-term hospitalization may also be an indication that the person isn’t getting enough support. “In some cases, society has failed them,” says Stephen Ferrando, MD, Director of Psychiatry at Westchester Medical Center Health Network (WMCHealth). “We are not providing enough services for them to succeed.”

#6. Myth: Bad parenting is what causes schizophrenia.

Years ago, it was believed that the mother or both parents were responsible if the child developed schizophrenia, Dr. Rego explains. While there is a genetic susceptibility—the disorder tends to run in families—there is absolutely no evidence that it is caused by how a person is parented, he says.

“Plus, even if your parent has schizophrenia your chances of getting it are less than 25 percent,” Dr. Ferrando explains.

So what does cause it? Rather than a single gene for schizophrenia, it’s likely that various genes, as well as environmental factors, are responsible, according to the American Psychological Association.

Environmental factors that may trigger the onset of schizophrenia can range from extreme academic stress to substance abuse. Dr. Ferrando says. “We know that extreme environmental stress like these situations can trigger the onset of schizophrenia,” he says.

If you or a loved one has been diagnosed with schizophrenia, it may feel scary. Understanding the reality of the disorder not only helps to erase the stigma surrounding the condition but also frees you up to focus on an effective treatment plan.

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Last Updated: Oct 2, 2020