Understanding Schizophrenia In Women: Symptoms, Challenges, And Treatment

Schizophrenia is considered a serious mental illness—Individuals living with the condition often experience severe symptoms that significantly impact their ability to function. 

Men and women with schizophrenia are prone to many of the same symptoms, such as hallucinations, delusions, and cognitive challenges. However, schizophrenia is known to manifest differently between sexes—biological differences and societal factors can play a significant role in shaping the symptoms, treatment options, and life experiences that influence how the disorder is managed. 

It may be helpful to understand these differences, as they may shed light on the benefits of personalized treatment approaches and address both the biological and social challenges faced by women with schizophrenia. 

Schizophrenia in women: Insights and differences

Women with schizophrenia often experience the condition differently than men due to biological and social differences that govern the realities of their lives. These differences can be seen in symptom onset, symptomatology, and diagnosis and treatment, as well as the lived experiences of women with the disorder.

Prevalence and onset

Schizophrenia exhibits no significant gender differences in its incidence or prevalence, meaning men and women are diagnosed with schizophrenia at similar rates. However, some gender-specific patterns may warrant closer attention.

Research from the World Health Organization suggests that symptom onset tends to be later in women than in men. While males tend to be diagnosed with schizophrenia in their early to mid-20s, females are more frequently diagnosed later in life, often between 45 and 54 years. This finding has been consistently observed and validated through various studies over the years. 

However, the time from the onset of symptoms to the first hospitalization remains the same across genders, underscoring that the later onset in women is not a result of delayed diagnosis or hospitalization but an inherent difference in the disease's emergence.

Symptoms and diagnosis

Symptomatology may also differ between men and women. Women are observed to exhibit more affective symptoms, such as anxiety, mood swings, and mania. Some research has found that women tend to display more overt hostility, physicality, and dominance alongside unique manifestations like sexual delusions and heightened emotional expressions. However, symptoms can vary considerably between individuals and may be informed by their unique backgrounds, experiences, and personal health history.

The way that clinicians interpret symptoms can vary between genders. Whereas specific symptoms may be described as negative symptoms in men, women are more likely to be diagnosed with a co-occurring mood disorder (a condition known as schizoaffective disorder. 

Treatment and management

Research indicates some differences in the way women and men respond to schizophrenia medications, as well as disparities in long-term treatment outcomes. However, treatment effectiveness can vary significantly between individuals, and regardless of biological sex, treatment often requires ongoing medication management, psychotherapy, and a robust support network to help ensure the safety and stability of an individual. 

Studies have found that women often have better outcomes than men in schizophrenia treatment, though the exact reasons for this result are unclear and may require further research. The later age of onset may mean that women can achieve improved life outcomes before their diagnosis, while males often develop symptoms in the years of early adulthood. However, men with schizophrenia can also achieve positive outcomes with this condition. 

Some studies have suggested that female sex hormones may facilitate a better drug response. In addition, women are known to have better rates of medication compared to their male counterparts. They may be less likely to experience substance use disorders that can complicate outcomes for men. 

Medication dosages and responses also differ between genders. An extensive study spanning ten European countries, for example, revealed that gender significantly affects how clients respond to antipsychotic treatments and quality of life improvements. 

Clinical trials have revealed that women often experience more distressing medication side effects. Additionally, some antipsychotics can lead to increased prolactin levels, occasionally causing amenorrhea (missed periods), galactorrhea (unintended milk flow), reduced sexual desire, and changes in bone density. Although some medications may not increase prolactin levels, they can cause weight gain, presenting another set of challenges.

Managing schizophrenia in women often benefits from a nuanced approach. This approach might include choosing the right medication and providing comprehensive support focused on women-centered research. Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

The estrogen hypothesis

There has been considerable interest in the role that sex hormones might play in the development and treatment of psychotic disorders. Some researchers have hypothesized that estrogen may play a protective role, regulating neurotransmitter systems and neuroinflammatory processes. 

This finding could explain why symptom onset tends to occur later in life for women—As estrogen levels drop, symptoms may begin to appear. In addition, estrogen therapy has been found efficacious across several clinical trials. While some studies have supported this idea, others have failed to establish support for the estrogen hypothesis. For this reason, further studies may be beneficial to support this theory. 

Impact on women’s health

In addition to the significant mental and emotional struggles that accompany schizophrenia, the condition can also uniquely affect women’s physical health. For instance, obesity is more common among women with schizophrenia, which may affect the effectiveness of antipsychotic medications and be a risk factor for other health complications like heart disease and diabetes. Note that BMI is not the only way to measure health, and having a larger body is not necessarily linked to health complications. 

Additionally, women with schizophrenia are more likely to experience unplanned and unwanted pregnancies. This finding could be due to various factors, such as misinterpreting bodily changes or not recognizing pregnancy early on, which are sometimes influenced by psychotic symptoms.

Pregnancy presents its own set of complications for women with schizophrenia, with research indicating that their babies may have a higher risk of low birth weight, slowed growth within the womb, and premature birth. Infant mortality is also higher compared to pregnancies in women without the disorder.

In addition to the health risks directly associated with schizophrenia, women with the condition are at a heightened risk of experiencing sexual coercion and assault, which can not only affect reproductive health but also compound mental health challenges.

If you are experiencing sexual abuse or have experienced assault, note that the Rape, Abuse, and Incest National Network (RAINN) has a hotline dedicated to supporting individuals experiencing sexual assault, harassment, or intimate partner violence. You can reach out to them anytime by calling 800-656-HOPE (4673) or using the online chat.

Societal and personal challenges for women

Women living with schizophrenia may face numerous societal and personal challenges that extend beyond their diagnosis. These issues are often intertwined with the broader context of women's status in society, which can significantly influence their mental health. While equality tends to enhance women's mental well-being, discrimination exacerbates their struggles. Below are a few societal challenges for women: 

• Homelessness: Schizophrenia increases the likelihood of homelessness. While more common among men, unhoused women are more vulnerable to exploitation, violence, and sexual assault, making their situation especially precarious. 
• Access to treatment: In some parts of the world, especially in low-income locales with limited mental health resources, women with severe mental illness often remain outside the reach of treatment facilities.
• Caregiving responsibilities: Supporting individuals with schizophrenia can be mentally and physically demanding, and these caregiving duties often fall disproportionately on women. 

Addressing the unique needs of women with schizophrenia and their caregivers can benefit from advancements in medical treatment and a concerted effort to eliminate stigma, improve access to care, and safeguard the rights and dignity of these individuals within society.

Schizophrenia treatment for women

Treating schizophrenia in women may benefit from a nuanced approach that considers both biological and societal factors unique to their experiences with the condition. Below are a few considerations treatment providers may keep in mind. 

Hormonal considerations

Treatment plans for women might account for hormonal differences that could affect symptom severity and medication effectiveness. Estradiol, a type of estrogen, may also be recommended by one’s doctor alongside antipsychotics.

Medication side effects

Women may experience unique side effects from antipsychotics, such as body changes and hormonal imbalances, requiring medication management. Several genetic tests are available that may gauge the likelihood of experiencing adverse effects of these drugs. Talk to your doctor about using these tests. 

Pregnancy and breastfeeding

Special attention may be beneficial to ensure medications are safe during pregnancy and breastfeeding, with adjustments made as necessary. Contraceptives may also be a consideration for women or people with gynecological reproductive systems who are not ready to become pregnant.

Social support

Community programs that support those with schizophrenia and their caregivers can be pivotal in ensuring ongoing care and treatment. These programs might include education, housing assistance, employment services, and affordable mental health care options. Support groups may also be helpful. 

Gender-sensitive mental health support

A comprehensive, gender-sensitive treatment approach might lead to improved outcomes by addressing both biological and societal factors unique to women. Seeking specialized support from a licensed mental health professional may be advisable for women learning to live with the illness.

Tailored interventions that address the unique biology and experiences of women can lead to better outcomes, ensuring women from all backgrounds with this condition receive the most effective and compassionate care possible.

Supportive psychotherapy for schizophrenia

While medication may be a frontline treatment for schizophrenia, supportive therapies can play a role in improving mental health, social functioning, and quality of life. Research indicates that modalities like cognitive-behavioral therapy (CBT), social skills training, family interventions, and cognitive remediation may be beneficial for those living with schizophrenia. 

For women, therapy can provide a safe and understanding environment to share the unique stressors that often accompany mental illness and womanhood. If you are living with schizophrenia and looking for such support, it can be challenging to find care in your area. In these cases, online platforms like BetterHelp may be more accessible. 

Research indicates that online therapy is as effective as in-person therapy, and many find it more cost-effective—with features like weekly group therapy sessions, interactive journaling, and daily messaging with a therapist, this therapy modality may help clients achieve considerable progress in a safe environment. 

Takeaway

For women with schizophrenia, treatment outcomes can be impacted by biology, life experiences, and level of support. With tailored treatment that accounts for and addresses these differences, women may learn to manage the illness and significantly improve their well-being. Consider contacting a licensed therapist online or in your area to receive personalized care.