Schizophrenia is one of the most well-known mental health disorders despite not being common among the general population. Popular television shows and movies have often presented schizophrenia inaccurately, largely due to the complexity of the disorder.
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What is Schizophrenia?
When seeking to understand what schizophrenia is, it helps to first look at the main symptoms and then delve into various symptom categories and their unique features. The World Health Organization (WHO) provides the following definition of schizophrenia:
“Schizophrenia is a psychosis, a type of mental illness characterized by distortions in thinking, perception, emotions, language, sense of self, and behavior.”
Someone diagnosed with schizophrenia may lose their sense of reality and have bizarre and abnormal behaviors. The most commonly discussed symptoms include:
- Hallucinations which are perceptions of something being present that is not (for example, seeing an animal that is not truly present).
- Delusions which are held even when overwhelming evidence exists that contradicts the belief (for example, believing that you are the Queen of England)
Types of Schizophrenia
Prior to 2013, there were several subtypes of types of schizophrenia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, in the most recent revision, the DSM moved all symptoms under the sole category of schizophrenia, stating that differentiating subtypes did not seem to aid in providing better patient care. It is still helpful to review the former subtypes of schizophrenia in order to develop a clear understanding of the many presentations of this disorder. Some distinct categories of schizophrenia include:
Paranoid Schizophrenia describes a person who holds delusions that others, whether an individual person, a group of people or some other entity, are planning on causing harm to the patient or others they care for. A person with these types of delusions may actively work to protect themselves and others from outside harm.
Disorganized Schizophrenia presents as a person who may have illogical, bizarre, and incoherent, thoughts and patterns of speech. This may range from tangential speech to what is called a ‘word salad’—when speech patterns are so bizarre and incoherent that the individual words do not seem to have any connection to one another.
Catatonic Schizophrenia describes a person at either extreme end of the behavior spectrum. On one side, the person may have strange motor behaviors that occur at an equally strange rate. On the other end of the spectrum, all movements may become extremely reduced. In some cases of catatonic stupors, a person may stop all voluntary movements including speaking. Catatonia is a feature of other mental health disorders as well and has remained as a specifier for schizophrenia.
Childhood Schizophrenia is extremely rare. While schizophrenia itself has a very low prevalence rate, childhood schizophrenia cases are even less common. It is estimated that childhood schizophrenia occurs in approximately 1 in 40,000 children. Symptom patterns follow the same generalities as in adult cases of schizophrenia.
Schizoaffective Disorder is essentially the combination of schizophrenia and a mood disorder, such as depression or mania. Both sets of symptoms begin at the same general period rather than a mood disorder developing because of schizophrenia.
Schizophrenia and Agoraphobia
In some very rare cases, schizophrenia may be accompanied by other severely debilitating mental health disorders. One common anxiety disorder that is associated with schizophrenia is agoraphobia
Panic Disorder with Agoraphobia
It is thought that panic disorder with agoraphobia likely develops due to a person fearing embarrassment or other negative reactions if they go into public because of their schizophrenia symptoms. This fear may lead to panic attacks if one decides to venture into public. In this case, the added fear of having panic attacks in public can then begin to slowly limit the number of places where the person feels safe, often getting to the point where they will not leave their home.
Agoraphobia without a History of Panic Disorder
Agoraphobia also may co-occur with schizophrenia without the presence of a panic disorder or panic attacks. In these cases, it is strictly the fear of negative reactions that keeps the person from leaving their safety zone.
Symptoms of Schizophrenia
To develop a clear view of schizophrenia, the causes and symptoms must be examined. While learning about the former subcategories can help to organize symptom types, knowing the specifiers for the disorder is critical. Schizophrenia symptoms can be divided into two main categories: positive symptoms and negative symptoms.
Positive symptoms are those that are characterized by the addition of something, or the presence rather than the absence of symptoms. Positive symptoms include exaggerated ideas or perceptions such as the following:
- Delusions. Delusions are false beliefs held by the individual. No matter how much evidence is shown to the patient that their belief is incorrect, they will continue to steadfastly believe it. For example, if a person believes they are Tupac Shakur, nothing will convince them otherwise. You can show them their own reflection in a mirror, show them pictures and videos of Tupac, and even share articles about Tupac’s murder, but at the end of the day, they will still firmly believe that they are Tupac Shakur. Sometimes, these beliefs may not be about who they are but may also be about the world around them. For example, a person may believe that when a dog at the park looks at them, the dog wants to have a physical fight with them. This person then may act on this belief which could be highly dangerous for the person, the dog and others around.
- Hallucinations. Hallucinations can be either visual or auditory. It is also possible to have both. Visual hallucinations refer to seeing something that is not present like a unicorn in your driveway that follows your car to work every day. An auditory hallucination, on the other hand, refers to hearing something that is not truly there. Auditory hallucinations may vary significantly in the level of dangerousness. One person may experience auditory hallucinations that are simply conversational and pleasant; while another person may experience voices that command them to do something. Command hallucinations become extremely dangerous and even life-threatening if the commands are to harm oneself or other people.
- Disorganized Thinking or Speech. Disorganized thinking in schizophrenia refers to the illogical, strange and incoherent thoughts and accompanying behaviors of schizophrenia. For example, a person’s thoughts and speech may quickly derail off topic and change to a dramatically different topic. In other cases, a person may jumble their words together and fail to get their thoughts “organized” in a way that makes sense to them or anyone else.
- Abnormal Motor Behavior. Abnormal motor behaviors can include extreme reactions to the environment as with certain forms of catatonia or it may present as greatly slowed or in some cases odd movements. A person may move in a strangely rigid manner, have involuntary movements, or have a strange posture.
Negative symptoms are those that are characterized by the lessening of something, such as a catatonic stupor.
- Avolition. Avolition is a lack of motivation or initiative to accomplish purposeful tasks. Individuals with avolition may avoid answering the phone, skip paying bills, neglect personal hygiene and sit at home for most of the day.
- Apathy. Apathy is characterized by a lack of interest or enthusiasm. Unlike avolition, individuals with apathy will likely alter their behaviors to complete tasks if there is a real threat of negative consequences. People with avolition will not.
- Anhedonia. Anhedonia is the inability to feel pleasure. Anhedonia causes individuals to avoid activities they once enjoyed and makes forming meaningful relationships challenging.
- Alogia. Alogia is the inability or difficulty speaking resulting in reduced verbal fluency. Also referred to as poverty of speech, alogia manifests as reduced speech output and communication with little detail.
- Affective flattening. Affective flattening is distinguished by a limited range of facial expressions and emotion. Individuals with affective flatttening have poor eye contact and lack of body language.
- Social Withdrawal. Individuals with social withdrawal have no interest in being around other people. People with schizophrenia often isolate themselves and avoid making plans or taking calls.
Causes of Schizophrenia
The exact causes of schizophrenia remain unknown; however, researchers have been able to identify factors that may make a person more susceptible to developing this disorder. It appears that schizophrenia has a genetic component as it tends to run in families. However, it has not possible yet to identify a single responsible gene. At this time, it is believed that a pattern of genes predisposes a person to schizophrenia rather than any single gene.
Studying the brain structures of people with schizophrenia have revealed that there are some very small differences. While this does not hold true in every case, it does support the theory that schizophrenia happens due to a structural difference in the brain. It also appears that there is an imbalance and possibly a sensitivity to certain neurotransmitters in the brains of people with schizophrenia.
How is Schizophrenia Diagnosed?
Schizophrenia is usually diagnosed through observation. One of the first tasks when diagnosing schizophrenia is to eliminate other mental health disorders or physical ailments that may mimic schizophrenia. Tests can be run, including brain imaging, to determine if there are other causes for the symptoms; however, there is no test to determine that it is schizophrenia.
Who is at Risk for Schizophrenia?
Schizophrenia tends to run in families. However, there are usually some additional risk factors that can determine whether a person will develop schizophrenia.
For a person predisposed to schizophrenia, a clear psychological trigger usually occurs prior to the initial psychotic break. These are usually extremely stressful or traumatic life events. These types of events are the most common schizophrenia risk factors. While experiencing trauma does not cause schizophrenia, it may be the trigger to develop the disorder in someone who is already predisposed and, therefore, vulnerable.
Illicit drug use is a potential cause of schizophrenia, especially with concern to hallucinogens. Stories of people “tripping” on LSD or another drug and then developing schizophrenia are commonly shared. However, this is not necessarily a valid concern. Drug use has not been able to be determined as a direct cause of schizophrenia. Like stressful life events, drug use may be the deciding factor in whether a person predisposed to schizophrenia develops the disorder.
Schizophrenia does not appear to have a strong cultural influence since its prevalence seems to be stable across various cultures and countries. This severe mental health disorder affects more than 23 million people worldwide, according to the WHO. The disorder is slightly more common in males. Males also often have an earlier onset.
There is a significant stigma toward people with schizophrenia, which may lead to further ostracism and depression. One of the most disheartening schizophrenia statistics is that people with this disorder have a life expectancy as many as 20 years shorter than other people. People with schizophrenia are more likely to commit suicide and often have additional physical ailments because they don’t trust healthcare providers as a symptom of their disorder. It is extremely important to seek help if you believe you may have schizophrenia since treatment is available and effective. If you or a loved one are displaying symptoms of schizophrenia, you should schedule an assessment by a mental health professional to obtain an accurate diagnosis.
If you or someone you love is struggling with a substance use disorder and schizophrenia, treatment is available. At The Recovery Village, a team of professionals offers a number of treatment programs for substance use and co-occurring disorders. Call and speak with a representative to learn about which treatment program could work for you.
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