Schizophrenia

Clinically Reviewed By: Corey Pitts, MA, LCMHCS, LPC, LCAS, CCS

What is schizophrenia?

Schizophrenia is a severe and persistent form of mental illness that affects how a person thinks, feels, and perceives reality. Individuals with schizophrenia often experience episodes of psychosis, which may involve psychotic symptoms such as hallucinations, delusions, and disorganized thinking. Note that it is not the same as dissociative identity disorder (DID), or split personalities.

Some people with schizophrenia may not recognize their symptoms as a mental illness, which can complicate getting treatment, though many individuals do have awareness of their condition. However, individuals who receive consistent treatment, especially early intervention, may have positive outcomes.

How common is schizophrenia?

Schizophrenia affects 23 million people around the world, which is less than 1% of the population. This means that it isn't as common as other mental health conditions. 

It's not a condition that presents right away. Earlier onset begins during adolescence or early adulthood, typically up until the mid-20s. Men often develop schizophrenia earlier than women, who may not show signs until their late 20s or 30s. It is not common for children to be diagnosed with schizophrenia.

The symptoms in teenagers are not always the same as those in adults. Some early symptoms, before delusions and hallucinations develop, are sometimes mistaken for teenage behavior, like not doing well in school, withdrawing socially, and feeling irritable or depressed. This may make the onset harder to detect. 

What are the symptoms of schizophrenia?

Schizophrenia symptoms may vary widely from person to person and may change over time. The disorder develops slowly, so symptoms may be less severe or noticeable in the beginning. These symptoms affect the way that people feel, behave, and think, which in turn impacts decision-making. People with schizophrenia may or may not notice changes in their own thoughts and mental abilities.

Common signs and symptoms

Schizophrenia symptoms may be divided into two groups: positive and negative symptoms. Positive symptoms are characterized by changes in thoughts and behavior, such as delusions and hallucinations. Negative symptoms are social, when a person withdraws, loses interest in everyday life, and may seem emotionless. 

Common schizophrenia symptoms, both positive and negative, may include:

• Hallucinations (hearing voices is most common, though visual hallucinations may also occur)
• Delusions, or holding firmly to beliefs that are not grounded in reality
• Disorganized thinking or disorganized speech that may be difficult for others to follow
• Unusual or unpredictable behavior
• Reduced emotional expression, motivation, or engagement in daily activities
• Social withdrawal or difficulty maintaining relationships

Negative symptoms may appear before someone has their first psychotic episode or exhibits positive symptoms.

Symptoms that may be harder to recognize

Some symptoms of schizophrenia may be more difficult to spot or recognize:

• Subtle changes in concentration, memory, or decision-making

• Declining performance at work or school

• Neglect of personal hygiene or self-care

These effects may appear gradually and be mistaken for depression or another mental health condition, which is why professional assessment is important.

What are the risk factors and causes of schizophrenia?

As of now, experts have not identified a single cause of schizophrenia. Instead, it's thought that a combination of genetic and environmental influences is more likely to cause someone to develop schizophrenia. Researchers also believe that changes in chemicals in the brain and body, such as dopamine and glutamate, may play a part in the development of this condition.

Schizophrenia has a genetic link and a family history of the condition may increase the likelihood of developing it. There may be subtle differences in brain development in people with schizophrenia, including different amounts of neurotransmitters. Complications during pregnancy and birth, such as lack of nutrition, low birth weight, or exposure to toxins, are other risk factors.

Environmental and outside factors may also play a role. Substance use, particularly the use of cannabis or stimulants, may place someone at an elevated risk of developing schizophrenia or other similar mental health conditions. Stress during difficult life events may trigger symptoms as well. This includes job loss, loss of a loved one, divorce, or abuse.

How is schizophrenia diagnosed and treated?

There is no single test for schizophrenia. Diagnosis requires assessment by a licensed mental health or medical professional using DSM-5 diagnostic criteria. During the assessment, a person must have at least two core symptoms that persist for at least a month, and the symptoms must affect their social and occupational functioning.

Treatment options

Generally, the earlier schizophrenia is treated, the better the outcome is, according to research. There’s no cure for the disorder, but symptoms may be managed with long-term medication and therapy. 

Treatment is tailored to the person and their needs, but antipsychotic medications are typically employed as a first-line treatment. Alongside medication, therapy is often a cornerstone of schizophrenia treatment. Psychotherapy, including cognitive behavioral therapy (CBT), may also help manage symptoms.

Family support and care coordinated by specialists such as psychiatrists, therapists, and social workers may be beneficial components to treatment plans for schizophrenia. 

 Can online therapy play a role?

Online therapy through platforms like BetterHelp may be appropriate for people with schizophrenia who are not in an active psychotic episode. BetterHelp connects people with licensed, accredited therapists who have experience in a number of fields. Together, therapists and individuals may communicate over convenient channels, including phone, video, live chat, and messenger.

Ongoing therapeutic care may be an important part of managing schizophrenia long-term, even between episodes of psychosis. Acute psychosis typically requires in-person or higher-level care, such as that of a psychiatrist or psychotherapist. While online therapy is not a replacement for emergency or psychiatric services, it may be a useful tool for providing consistent support. 

 FAQs

Is schizophrenia a type of personality disorder?

Schizophrenia is a psychotic disorder, distinct from personality disorders, though some symptoms may overlap.

Can a person with schizophrenia live independently?

With appropriate treatment and support, many people with schizophrenia may maintain independent living and meaningful daily routines.

Does schizophrenia always require medication?

Antipsychotic medication is a common and frequently recommended component of treatment, though individual treatment plans may vary based on a licensed professional's assessment.

Can early intervention make a difference in schizophrenia outcomes?

Research suggests that early intervention may help reduce symptom severity and improve long-term social or occupational functioning.

 Is online therapy an option for someone with schizophrenia?

Online therapy through a platform like BetterHelp may be appropriate for individuals with schizophrenia who are not in an active psychotic episode and are looking for ongoing mental health support.