The Symptoms of Schizophrenia

The symptoms of schizophrenia can be really confusing and challenging to understand. The symptoms are listed below, but first, it’s really important to understand that schizophrenia must be diagnosed by a trained mental health professional through diagnostic interviews and medical evaluations.

There are currently no physical or lab tests that can diagnose schizophrenia, but they can help rule out other conditions that sometimes have similar symptoms, like seizure disorders, metabolic disorders, thyroid dysfunction, brain tumor, and drug use.

The symptoms of schizophrenia fall into three broad categories: positive symptoms, negative symptoms, and cognitive symptoms.

Positive Symptoms

Positive symptoms refer to thoughts, perceptions, and behaviors that are present in people with schizophrenia, but not in other people. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable.

Hallucinations – Hallucinations are false perceptions. The person may hear, see, feel, smell, or taste things that are not actually there. The most common type of hallucination is auditory hallucinations.

• Auditory: Hearing things that other people cannot hear. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other.
• Visual: Seeing things that are not there or that other people cannot see.
• Tactile: Feeling things that other people don’t feel or feeling something is touching their skin that isn’t there.
• Olfactory: Smelling things that other people cannot smell, or not smelling the same thing that other people do smell.
• Gustatory: Tasting things that are not there.

Delusions – Delusions are false beliefs that are held in spite of invalidating evidence. People hold these beliefs strongly and usually cannot be “talked out” of them. The content of the delusions may include a variety of themes. Some examples include:

• Delusions of persecution: The belief that they (or someone close to them) are being plotted or discriminated against, spied on, threatened, attacked or deliberately victimized.
• Delusions of reference: When an individual attaches special personal meaning to actions of others or to various objects and events when there is no information to confirm this. The person may believe that certain gestures, comments, or other environmental cues are specifically directed at him or her. For example, it may seem as if special personal messages are being communicated to them through the TV, radio, or other media.
• Somatic delusions: False beliefs about their body. For example, that a terrible  physical illness exists or that something foreign is inside or passing through their body.
• Delusions of grandeur: The belief that they are very special or have special powers or abilities.
• Delusions of control: The belief that their feelings, thoughts, and actions are being controlled by other people.

Thought disorders: Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called “disorganized thinking.” This is when a person has trouble organizing his or her thoughts or connecting them logically. They may string words together in an incoherent way that is hard to understand, often referred to as a “word salad.”

The person may make “loose associations,” where they rapidly shift from one topic to an unrelated topic, making it very difficult to follow their conversation.

“Thought blocking” may occur in which the person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head.

A person with a thought disorder might make up meaningless words, or “neologisms,” or perseverate which means to persistently repeat words or ideas.

Negative Symptoms

Negative symptoms are the absence of thoughts, perceptions, or behaviors that are ordinarily present in other people. These symptoms are often stable throughout much of the person’s life.

Affective flattening – Affective flattening is characterized by a reduced range of emotional expressiveness, including limited or unresponsive facial expression, poor eye contact, and reduced body language.

The expressiveness of the person’s face, voice tone, and gestures may be reduced or restricted. However, this does not mean that the person is not reacting to his or her environment or having feelings.

Alogia – Alogia, or poverty of speech, is the lessening of speech fluency and productivity. The person may have difficulty or be unable to speak and may give short, empty replies to questions.

Avolition – Avolition is the difficulty or inability to begin and persist in goal-directed behavior. It is often mistaken for apparent disinterest. The person may not feel motivated to pursue goals and activities. They may have little sense of purpose in their lives and have few interests.  They may feel lethargic or sleepy, and have trouble following through on even simple plans.

Anhedonia – Anhedonia is defined as the inability to experience pleasure from activities one used to find enjoyable. For example, the person may not enjoy watching a sunset, going to the movies, or close relationships with other people.

Cognitive Symptoms

Cognition refers to mental processes that allow us to perform day-to-day functions, such as the ability to pay attention, to remember, and solve problems. Cognitive impairments are considered a core feature of schizophrenia and contribute to difficulties in work, social relationships, and independent living.

Some examples of cognitive symptoms in schizophrenia include:

• Trouble concentrating or paying attention
• Poor memory
• Slow thinking
• Poor executive functioning. (Executive functions include the ability to plan, solve problems, and grasp abstract concepts.)

Similar Psychiatric Disorders

Schizophrenia shares symptoms with some other psychiatric disorders. Prominent psychotic symptoms seen in schizophrenia are similar to those seen in other psychotic disorders, such as Schizoaffective Disorder, Schizophreniform Disorder, and Brief Psychotic Disorder.

Bipolar Disorder – Symptoms of schizophrenia may also overlap with symptoms of Bipolar Disorder. Individuals with schizophrenia may experience mood disturbances seen in Bipolar Disorder, including mania and depression.

Medical Conditions, Substance Abuse & Toxins – Schizophrenia must be distinguished from a Psychotic Disorder due to a General Medical Condition, where psychotic symptoms are judged to be the direct consequence of a general medical condition. Schizophrenia must also be distinguished from a Substance-Induced Psychotic Disorder, in which psychotic symptoms are judged to be the direct consequence of drug abuse, medication, or toxin exposure.

Keep Learning and Find Support

The most important thing is to keep learning about schizophrenia and find a safe place to ask questions and feel supported. We offer a free private Facebook group for families with schizophrenia and bipolar disorder. You can also subscribe to receive our newsletter so that you can receive our latest blog posts.

Here are some additional articles you might find helpful:

• Schizophrenia: Overview and Course of the Disorder
• What Causes Schizophrenia and How Common Is It?
• Antipsychotic Medication: What You Should Know
• Evidence-Based Treatment for Schizophrenia
• Family Support for Schizophrenia: How Family Members Can Help