What is schizophrenia?

Schizophrenia¹ is a brain disorder that affects how a person interprets and responds to reality.

People with schizophrenia may experience hallucinations, delusions, disordered thinking, and an inability to focus and stay still. These symptoms are usually severe, and in some cases, can be debilitating. Many people affected by schizophrenia find that their symptoms impair their daily functioning at a significant level.

People diagnosed with schizophrenia require ongoing treatment throughout the course of their lives. However, they are not usually dangerous or violent². Many successfully live with family members, on their own, or in group homes. They can often hold jobs and contribute to society as long as they continue their treatment.

While it is a chronic disorder, many people with schizophrenia who pursue and follow through with treatment find their symptoms greatly improved. Treatment for schizophrenia is consistently becoming safer and more effective. Studies are also being conducted to examine differences in brain structure and tissues in people with schizophrenia in hopes of determining its underlying causes and developing even more effective treatments.

Paranoid schizophrenia

Paranoid schizophrenia³ is the most common subtype of schizophrenia. The term “paranoid schizophrenia” is no longer referred to as a specific condition in the United States, however. Patients can be diagnosed with schizophrenia and told that they have paranoid characteristics, but this is no longer a separate diagnosis.

This form of schizophrenia is characterized by hallucinations and delusions. These symptoms may cause a person with the disorder to fear entities that have real or perceived control in their lives, such as governments, medical professionals, mental health experts, and more.

Paranoid schizophrenia may be diagnosed later in life than some other types of schizophrenia. It does not seem to affect speech, movement, or emotions in the same ways that other types do.

Catatonic schizophrenia

Catatonic schizophrenia⁴ is the rarest type of schizophrenia diagnosed. Like paranoid schizophrenia, catatonic schizophrenia is no longer diagnosed as a specific condition in the United States.

People with catanoic symptoms often move very little, and when they do move, it is often sudden and unusual. They may alternate between extreme activity and extreme stillness. Some do not talk at all, while others may mimic both speech and movement.

How common is schizophrenia?

Schizophrenia is believed to affect less than 1%⁵ of the population. However, that number may be artificially low. Because it can be difficult for people with schizophrenia to trust medical practitioners, some may never receive a diagnosis or pursue treatment.

Schizophrenia affects men and women at about the same rates, though the onset of the condition may happen earlier in males. Schizophrenia seems to occur at consistent rates around the world, though it is hard to determine the exact rates of the condition in some cultures in which mental health disorders are considered taboo.

Schizophrenia causes

No one knows exactly what causes schizophrenia. However, research is ongoing, and scientists learn more every year about why people develop this condition. Most researchers believe that a combination of factors contribute⁶ to the development of schizophrenia, including genetics, environmental factors, and brain chemistry.

People with schizophrenia show differences in the structures of their brains and central nervous systems from those who are not affected by the disease. The neurotransmitters dopamine and glutamate also occur in different concentrations in people who have schizophrenia. While no one knows if these differences are caused by or result from the condition, they clearly indicate that schizophrenia is a brain-related disease.

Risk factors for schizophrenia

Scientists believe that having certain genes puts a person at a higher risk of developing schizophrenia. However, they aren’t sure which genes those are or the exact mechanisms by which the genes produce the condition.

While schizophrenia does seem to run in families, there are many individuals diagnosed with the condition who do not have it in their family. Conversely, there are also people who have multiple relatives with schizophrenia that do not develop it themselves.

Scientists propose, then, that schizophrenia involves an interaction between certain genetic predispositions and environmental factors. It is thought that environmental factors may act to turn certain genes on or off, resulting in schizophrenia.

Possible environmental risk factors⁷ for schizophrenia include:

• Problems during the birth process
• Malnutrition after birth
• Exposure to certain toxins and viruses (or to certain viruses at certain times) during development
• Other psychosocial factors

Schizophrenia symptoms

Schizophrenia involves a range of symptoms. The disorder can be difficult to diagnose because most patients do not show symptoms in every category. When diagnosing schizophrenia, healthcare providers will look at a person’s overall functioning for at least six months, taking into account the presence of some of the following symptoms and their effects on the individual’s ability to function over that time.

Signs and symptoms⁸ of schizophrenia include:

• Hallucinations: A person may see, hear, touch, taste, or smell things that other people do not perceive and that are not actually there. Hallucinations appear just like normal experiences for the person having the sensation.

The most common type of hallucination involves hearing voices. These voices may be threatening, violent, or critical. They may ask the person to take certain actions or try to convince them of something, and can seem to come from either known or unknown sources.

• Delusions: Delusions are powerful beliefs that are not based in reality. Even when confronted with concrete evidence that a delusional belief is not true, people diagnosed with schizophrenia will often not be able to let go of the belief. They are not open to new ideas and are unable to process facts that go counter to these beliefs.

Many people have delusions that center on someone being after them or “out to get” them. Others may believe that they are famous (or so exceptional that they should be). Some may believe that a very specific catastrophe is about to happen and that they either need to prepare for it or do something to prevent it.

Delusions may be accompanied by difficulty concentrating, the feeling that certain thoughts are “blocked,” or confused thinking.

• Disorganized thinking and speech: Many people diagnosed with schizophrenia struggle to communicate verbally. Their speech may be garbled, or they may seem to speak words at random, imitate others’ speech (rather than speaking for themselves or in their innate voice), or give answers that do not have anything to do with the question asked.

Practitioners infer disorganized thinking from this disorganized speech. Some people with schizophrenia seem unable to organize their thoughts. They may also fail to complete tasks because they cannot remember things or keep their minds in order. This can lead a person to be unaware that they have schizophrenia or to fail to remember their diagnosis, which can make treating the condition a challenge.

• Unusual motor behavior: People with schizophrenia can demonstrate childlike movement patterns, extremely agitated behavior, or behavior that appears “silly” or out of place. They often struggle to focus their behaviors, making it difficult to complete tasks. Some might use their motor behavior to resist following instructions or may take bizarre postures. Some may demonstrate excessive movement, while others may not move their bodies at all unless it becomes absolutely necessary.
• Negative symptoms: These lower a person’s ability to function the way they need to in everyday life. People may fail to start activities, or start them but find themselves unable to complete the task. They may appear to be completely “flat” or unmotivated: devoid of visible emotion, unable to maintain basic personal hygiene, avoiding eye contact, not changing their facial expressions, or not expressing themselves in any tone other than a monotone.

The collection of negative symptoms together may look like clinical depression, especially when they are experienced without symptoms in other categories. People experiencing these symptoms may be unable to develop and sustain relationships or enjoy activities like hobbies, outings, social gatherings, and more.

Early signs of schizophrenia

The symptoms⁹ of schizophrenia in teenagers and young adults may differ from those seen in adults. Schizophrenia can seem to come on slowly, with abnormal thinking and social withdrawal gradually worsening into hallucinations and disordered thinking.

In teens, schizophrenia may look like:

• Withdrawal from normal social groups, like friends and family
• Difficulty falling asleep or staying asleep
• Significant irritability or depression
• A sudden drop in performance at school
• An unusual lack of motivation

Since these symptoms may overlap with normal teenage moodiness, as well as other conditions, it can be hard for a practitioner to diagnose schizophrenia in particular. This is known as the prodromal¹⁰ phase of the disease, in which it is developing but is not yet fully expressed. It may not be possible to diagnose the condition until it develops beyond this initial stage.

Complications from schizophrenia

When receiving the right treatment, the symptoms of schizophrenia can be managed well. However, when left untreated, the disorder can interfere with every area of life. Complications associated with schizophrenia include:

• Suicidal tendencies: This can include suicide attempts but may only involve elaborate thoughts of suicide. If you or a loved one is experiencing suicidal thoughts or tendencies, call the Nation Suicide Prevention Lifeline at 1-800-273-8255.
• Anxiety disorders and obsessive-compulsive disorder: Some people with schizophrenia believe that they need to act a certain way to stave off catastrophe.
• Abuse of alcohol, nicotine, or other drugs: It may feel easier for some people to self-medicate with these substances rather than pursue treatment.
• Depression: The symptoms of schizophrenia can both mimic and cause depression.
• Inability to go to work or to school: People affected by schizophrenia may not have the motivation to do these activities (or, if they do, their symptoms may make it impossible).
• Financial difficulties and homelessness: If a person diagnosed with schizophrenia cannot hold down a job, they may find themselves in financial trouble, which can lead to homelessness.
• Health and medical problems: Some people affected by schizophrenia don’t trust medical practitioners, so they may not get the help they need for both schizophrenia and for other medical issues.
• Social withdrawal or isolation: People diagnosed with schizophrenia often act in unusual ways, which can drive others away. They may also seem uninterested in social relationships or be unable to follow through enough to maintain the relationships they want and need.
• Victimization: It can be easy for unscrupulous people to take advantage of someone diagnosed with schizophrenia. They may also see themselves as victims when they actually are not.
• Aggressive or violent behavior: While uncommon, some people with schizophrenia can become violent when they are agitated or when someone challenges their delusions.