Science suggests people with high functioning schizophrenia can develop coping skills to thrive at work, school, and in their communities.

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Current science spotlights the positive coping tools, attitudes, and stories of people with schizophrenia, a chronic and serious mental health condition. Of particular interest are those who engage meaningfully with their work, studies, and communities.

People with schizophrenia who socialize and work while managing their symptoms are sometimes referred to as having “high functioning schizophrenia.”

While specific strengths may prepare people with high functioning schizophrenia for success, their clinical diagnosis remains the same as others with schizophrenia. People with high functioning schizophrenia often report that symptoms like distorted thinking and hallucinations never entirely disappear.

Still, those with high functioning schizophrenia can lead successful lives.

If you are among the estimated 24 million people worldwide living with schizophrenia, learning about the science behind your condition can be helpful, especially when considering treatment. Studies and stories highlighting the experiences of high functioning individuals with schizophrenia might offer guidance and hope.

“High functioning schizophrenia” isn’t a clinical diagnosis. People with schizophrenia who function at a high level typically still have to manage the condition’s hallmark symptoms, including distorted thinking and occasional breaks with reality.

High functioning schizophrenia typically refers to an individual’s ability to manage symptoms to engage in meaningful work, education, and socializing.

In a 2010 presentation, researchers examined the characteristics of 21 highly functional people with schizophrenia. “High functioning” was defined as someone with schizophrenia maintaining one of the following roles for at least 6 months:

  • professional, technical, or managerial employment
  • a significant, responsible position as a full-time caretaker
  • responsibilities as a full-time student

Schizophrenia stigma

People with schizophrenia have been stigmatized as “mad” or mischaracterized as having bipolar disorder or multiple personality disorder, now known as dissociative personality disorder (DID).

Today, the mental health community is increasingly sensitive to how the surrounding environment and education can hinder and help those with schizophrenia.

Though symptoms can vary from person to person, those with high functioning schizophrenia often have the same or similar symptoms as others with this condition, including negative and positive symptoms.

  • Positive symptoms: psychosis, delusions, hallucinations, changes in movement or motor behavior
  • Negative symptoms: withdrawing socially, displaying flat affect or appearing emotionless, low motivation for routine activities, speaking and communicating less
  • Cognitive symptoms: challenges with focus, disorganized speech, decision making, memory, and learning

Diagnosis

To be diagnosed with schizophrenia, you must experience 2 or more of the following symptoms for at least a month, with persistent symptoms for 6 months:

  • delusions
  • hallucinations
  • disorganized speech
  • grossly disorganized or catatonic behavior
  • negative symptoms with delusions, hallucinations, or disorganized speech

These symptoms must also impact your self-care, work, or relationships for an official diagnosis.

Onset

The onset of schizophrenia typically occurs in the late teen years to early 20s for men. Onset often occurs in the late 20s to about 30 years for women.

This condition often gets diagnosed after an episode of psychosis makes it obvious. Still, someone may show negative symptoms first, along with changes in thinking, behavior, and social interactions before this episode.

Other high functioning characteristics

High functioning individuals with schizophrenia may have some influencing characteristics, such as:

  • a sense of self that incorporates but is not defined by their illness
  • persistence and resilience
  • an understanding of when they are symptomatic
  • the ability to engage in coping strategies and self-regulation efforts when symptoms arise

Subsequent studies have continued to investigate the behaviors and underlying characteristics of those with high functioning schizophrenia to better target treatments, behavioral management, and future areas of study.

Ability to understand others

A 2016 study of 36 individuals with high functioning schizophrenia and 24 people with schizophrenia who were not high functioning indicated that the high functioning participants demonstrated:

  • the ability to observe and understand others’ facial expressions
  • no greater ability to reflect on the feelings of others
  • impaired ability to empathize

Researchers suggest future studies might examine the influence of brain activity on these findings to develop treatments for social cognition and difficulties people with schizophrenia may have with understanding what others might be feeling or thinking.

Creativity

A 2021 study of 96 people with schizophrenia examined the role creativity might play in clinical symptoms, neurocognition, and social functioning.

Researchers measured domains of creativity, including:

  • originality
  • flexibility
  • expressiveness
  • colorful imagery

Along with social cognition skills, creative ability seemed to correspond to participants’ self-reported functioning in:

  • socializing
  • living independently
  • engagement during free time
  • maintaining employment

Researchers speculate that creativity might help individuals with schizophrenia:

  • find new ways to manage symptoms
  • problem solve
  • cope with life challenges flexibly and inventively

Future research might explore humor and resilience as factors that influence the severity of schizophrenia symptoms, along with multidisciplinary treatments of schizophrenia, such as art therapy.

In her “Diary of a High-Functioning Person with Schizophrenia,” law professor and author Elyn Saks describes her challenges, successes, and coping mechanisms.

Saks experienced her first episode of psychosis at 16 years old, which she describes as “a waking nightmare” characterized by nonsensical beliefs, including the idea that she’d killed people with her thoughts.

Still, Saks has always been able to write and study, graduating from Yale University and earning wide acclaim for her work and writing in the field of the mental health law.

Hardly ‘symptom-free’

Saks stresses that to be high functioning with schizophrenia is hardly the same as being “symptom-free.”

Although Saks doesn’t have negative symptoms, the positive symptoms she lives with include:

  • unrealistic thoughts several times a day
  • occasional hallucinations
  • episodes of extreme psychosis that last for several days, approximately three to four times a year, in response to stress

Strategies for thriving

Here are some strategies that have allowed Saks to thrive when her schizophrenia is symptomatic:

  • seeking accommodations at work to avoid symptom-triggering stress
  • continuing to research and write about topics she finds meaningful
  • structuring her days
  • enjoying advocacy work and her marriage

A 2016 study summarizes the strategies participants with high functioning schizophrenia have used to manage symptoms:

  • avoiding destabilizing behaviors and situations, such as drinking or watching horror films
  • relying on support from others for objective and kind feedback
  • taking their prescribed medications consistently
  • using reasoning techniques to examine symptoms
  • seeking out accommodating environments
  • pursuing supportive spiritual practices
  • maintaining healthy lifestyles
  • finding purpose in work or educational goals

All participants were employed, and many held or worked on academic degrees.

Scientists haven’t yet pinpointed the exact causes of schizophrenia, and there is no known way to prevent or cure this condition.

But researchers do know that schizophrenia is generally caused by many factors working together, such as:

  • Genetics: schizophrenia can be hereditary
  • Brain differences: including structural differences in the frontal region of the brain and chemical imbalances involving the brain’s neurotransmitters
  • Birth complications: such as low birth weight and premature delivery
  • Adverse childhood experiences (ACEs): including loss, neglect, trauma, or abuse early in life
  • Substance use: certain substances may trigger schizophrenia to develop in people who have a genetic predisposition

Regardless of functionality, schizophrenia can commonly co-occur with other mental health disorders. According to a 2009 review, other conditions that may be present alongside schizophrenia include:

However, symptoms of other mental health disorders must be distinguished from schizophrenia before a clinical diagnosis can be made, such as:

A doctor or mental health professional can differentiate schizophrenia from these somewhat similar conditions by examining:

  • duration of symptoms
  • timing associated with delusions or hallucinations
  • severity of depressive or manic symptoms
  • whether symptoms are a result of substance use or other conditions

If you think you or a loved one may have high functioning schizophrenia, consider speaking with your doctor or therapist as a first step. Schizophrenia can be diagnosed only by a doctor or mental health professional.

Schizophrenia is a lifelong condition, but symptoms can be managed through many approaches. Your doctor and therapist can work with you to find the best treatment plan for you.

Finding the right treatment can take time and effort, and you may have to try multiple things before finding what works.

Typically, treatment plans for schizophrenia include a combination of:

  • Medication. Antipsychotic drugs are often prescribed for people with schizophrenia to manage episodes of psychosis.
  • Therapy. Cognitive behavioral therapy (CBT) can be helpful for schizophrenia, especially in learning to examine the validity of psychosis episodes, avoiding triggers, and managing your responses.
  • Self-care and lifestyle changes. Reducing stress, building a strong social support network, eating well, getting enough sleep consistently, and doing what you love can help manage symptoms of schizophrenia.
  • Education and community programs. Education and community programs can build your strengths, improving everyday functioning, independence, outlook, and quality of life. A 2016 study suggests vocational, CBT-based intervention programs can help reverse learned defeatist beliefs in people with mental health conditions like schizophrenia.
  • Make a plan. Schizophrenia self-advocate Katherine Ponte suggests having a treatment plan and team in place for symptomatic crisis situations.

Schizophrenia is a lifelong condition that can sometimes present with severe symptoms, even for people who are “high functioning.”

High functioning schizophrenia means you still experience symptoms but you’re able to participate at work, school, and in your personal life to a higher degree than others with the condition. There is no particular diagnosis.

With the right treatment plan, schizophrenia symptoms can be managed. If you or a loved one think you may have high functioning schizophrenia, consider speaking with your doctor or therapist about a treatment plan tailored to your symptoms.

Psych Central’s guide to finding mental health care can help you find support.

Living with schizophrenia doesn’t have to stop you from pursuing goals, interests, and meaningful relationships.