Unlike virtually every other mental illness, schizophrenia is fairly unique in that its first onset is nearly always in young adulthood — not childhood or as a teen, and rarely after one’s 30s. Most people who are diagnosed with schizophrenia have their first symptoms and episode in their 20s — early to mid-20s for men, a little later (late-20s) for women.
This is, in part, what makes it such a devastating disorder. Just as a person is finding their way in the world, exploring their personality and relationships with others, schizophrenia strikes.
Unlike other disorders, too, its symptoms can be especially scary and troubling to the person’s loved ones.
So what is schizophrenia? It’s a constellation of symptoms and behaviors that revolve primarily around delusions, hallucinations, incoherent speech, diminished expression of emotions, and disorganized or catatonic behavior. Its basic symptoms haven’t changed over the years, even with the release of the DSM-5. ((The only significant changes from the DSM-IV definition are that delusions no longer need to be “bizarre” and one of the primary symptoms must be either delusions, hallucinations or disorganized speech — a requirement not in the DSM-IV.))
A hallucination is a sensation or sensory perception that a person experiences in the absence of a relevant external stimulus. That is, a person experiences something that doesn’t really exist (except in their mind). A hallucination can occur in any sensory modality — visual, auditory, olfactory, gustatory, tactile, etc.
A delusion is a persistent false belief someone holds about themselves or the reality around them. The person holds it despite what almost everyone else believes or other evidence. Delusions can be bizarre or not, and might involve any of a number of things, such as: that another person is in love with them; their sexual partner is unfaithful; being persecuted, harassed or conspired against; of being controlled by someone or something else; something isn’t right with their body; they can broadcast their thoughts to others or that others can insert their thoughts into their own mind; or they may have an inflated sense of worth, knowledge or power.
According to the DSM-5, “The peak age at onset for the first psychotic episode is in the early- to mid-20s for males and in the late-20s for females. The onset may be abrupt or insidious, but the majority of individuals manifest a slow and gradual development of a variety of clinically significant signs and symptoms.”
Worse, “earlier age at onset has traditionally been seen as a predictor of worse prognosis,” but the DSM-5 attributes this more to the gender differences — males get the symptoms earlier, so have had less time to gain maturity in their normal development (cognition, emotional adjustment, etc.)
I’ll never forget one of my friends calling me in a panic one day:
“My friend, he’s just gotten stranger and stranger. It started over the summer, where he started saying that people were talking to him inside his head. Then the other week, he left home and didn’t come home for days — nobody knew where he was! He thinks others are out to get him, and when you talk to him, it seems like he’s not all there. The easy-going person I knew is gone. He’s just not all there, like he’s got no emotions. He doesn’t think he needs help, and doesn’t think anything’s changed… But his family and friends clearly see it. What can we do to help him?”
Unfortunately, some people with schizophrenia lack insight or awareness of their illness. This isn’t a coping strategy they’re using (e.g., they’re just “in denial”) — this is a part of the constellation of symptoms of schizophrenia itself. And that makes helping the person get treatment all the more difficult.
Eventually he agreed to go see a doctor, was diagnosed with schizophrenia, and was prescribed a medication that helped control his symptoms. But it was a process that involved a lot of patience on the part of his family and friends, who had to gently suggest that seeing a doctor might help him feel more like himself again.
Some believe those with schizophrenia have a hard life ahead of them, and that’s usually true. The DSM-5 suggests that the course of the disorder “appears to be favorable in about 20 percent of those with schizophrenia” — not an optimistic number.
However, schizophrenia is not a sentence — it’s simply a diagnosis. But a diagnosis that can help inform a person’s choices for treatment and support.
While there’s no test for schizophrenia, you can take our short experimental screening test for schizophrenia. It can’t tell you if you have schizophrenia, but it can tell you if whether you have symptoms that may be consistent with schizophrenia. (Only a mental health professional can make an accurate diagnosis of schizophrenia.)