Schizophrenia is more than hallucinations and delusions. Its symptoms often occur in phases.

When you live with schizophrenia, psychotic symptoms — those moments of reality detachment — are a part of your diagnosis.

Not every day is filled with these symptoms, though. In fact, schizophrenia consists of three stages that tend to cycle in order.

So, living with schizophrenia does not mean constant hallucinations. Instead, it can mean living through a phase of behavioral changes or through a phase of clarity marred by depression.

The prodromal phase, aka the beginning stage, is the first phase of schizophrenia.

During this time, the symptoms of schizophrenia start to emerge subtly. Changes in social activity and ideology may just be seen as natural personality shifts.

Symptoms of the prodromal phase may include:

  • social withdrawal
  • increase in suspicious thinking
  • changes in previous ideologies
  • trouble concentrating
  • memory lapses
  • decline in work or school performance
  • irritability
  • anxiety or paranoia
  • change of social circle
  • difficulty sleeping
  • inappropriate affect (reactions without a proper stimulus, like laughing for no reason)
  • changes in diet
  • skewed interpretation of events

During this beginning phase of schizophrenia, those closest to you may notice minor changes in your thinking and behavior.

Because schizophrenia onset is often during the late teen years, some of these symptoms may be dismissed as a part of “growing up.”

Even if you visit a mental healthcare professional, symptoms of the prodromal phase can mimic those of many other mental health conditions.

Schizophrenia may also fly under the radar because the prodromal phase can last months or years before advancing to the second phase of schizophrenia.

Many people living with schizophrenia experience a slow, gradual development of symptoms during this phase.

However, for some, the more impairing symptoms of schizophrenia — those that interfere with your day-to-day functioning — can start suddenly.

This doesn’t necessarily mean the prodromal phase has been skipped. It may mean it was subtle enough to go unnoticed or had a very short duration.

During the active phase of schizophrenia, aka the acute stage, you may start to experience more impairing symptoms of schizophrenia.

The active phase is when schizophrenia tends to be diagnosed.

Your behaviors may change drastically enough to alert those around you. This is the phase of schizophrenia where symptoms of psychosis may appear.

During this phase, there are three primary types of symptoms you may experience:

  • Positive symptoms: symptoms that are added to existing function, such as hallucinations and delusions
  • Negative symptoms: symptoms that cause a loss of function, such as cognitive decline, social withdrawal, or loss of emotional expression
  • Disorganized symptoms: symptoms that are seen by others as nonsensical, including disorganized speech, thoughts, or unpredictable movements

This phase of schizophrenia can last weeks or years. Duration is often dependent on how quickly you seek treatment.

In a 2018 systematic review of cognitive behavioral combination therapy, more than 52% of people experienced a reduction in positive symptoms with treatment.

Also known as the recovery phase, the residual phase of schizophrenia symbolizes a quieting of symptoms seen during the active phase.

As symptoms of the active phase diminish, you may find you have a new sense of clarity toward behaviors and thoughts that occurred in the other phases.

This may mean you experience a return of depressive symptoms, as you realize the impact of schizophrenia on your life.

In some cases, symptoms that remain during this time may progressively worsen each time you go through an active stage.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), negative symptoms tend to be the most persistent during this time.

Residual phase symptoms may include:

  • social withdrawal
  • fatigue
  • disorganized thoughts and behavior
  • cognitive disturbance
  • lack of emotion or expression

Like the active stage, the duration of the residual stage of schizophrenia can be heavily influenced by treatment.

Nothing suggests living with schizophrenia means you will experience more than one major episode cycle. Successful treatment can keep you in the residual phase indefinitely.

A cross-sectional study from 2021 notes that high schizophrenia relapse rates are significantly associated with:

  • short treatment duration
  • nonadherence to medication
  • the presence of an additional mental health condition

The stages of schizophrenia are a part of the condition’s progression. There’s no known individual cause for when one phase shifts to another.

What experts do know is that the progression of schizophrenia can be held off through prompt and ongoing treatment.

Overall, schizophrenia is thought to be influenced by many causes. Each person may have a unique blend of traits and exposures that may contribute to the condition.

Some of these factors may include:

Remember that having any of these influencing factors doesn’t necessarily mean that you’ll develop schizophrenia.

Schizophrenia can be difficult to diagnose during the prodromal phase, due to the vague nature of symptoms.

It’s typically assessed during the active phase, when what you’re experiencing starts to significantly impact your life.

To achieve a schizophrenia diagnosis, the DSM-5 states the following guidelines must be met:

  • Significant presence of at least 2 of the following symptoms during a 1-month period (or less with successful treatment):
    • delusions
    • hallucinations
    • disorganized speech
    • disorganized or catatonic behavior
    • negative symptoms
  • One of the present symptoms for diagnosis must be delusions, hallucinations, or disorganized speech.
  • Since the onset of symptoms, major functioning impairment has been seen for the majority of the experience.
  • Symptoms persist for at least 6 months, continuously, and include at least 1 month of active phase symptoms.
  • Other mental health disorders, such as schizoaffective disorder or bipolar disorder with psychotic features, have been ruled out.
  • Symptoms aren’t linked to substance use.
  • Delusions or hallucinations must be present for 1 month in children with autism spectrum disorder or a communication disorder for a schizophrenia diagnosis to be considered.

If, after 1 year, symptoms persist, you may be given a specifier on your diagnosis to indicate the severity and recurrence of your symptoms.

These specifiers include:

  • first episode, currently in acute episode
  • first episode, currently in partial remission
  • first episode, currently in full remission
  • multiple episodes, currently in acute episode
  • multiple episodes, currently in partial remission
  • multiple episodes, currently in full remission
  • continuous
  • unspecified
  • with catatonia

The symptoms of schizophrenia may feel intimidating, especially if you’ve experienced a loss of touch with reality.

Despite how overwhelming it might be in the moment, this mental health condition is considered highly treatable, with many people seeing long-term success with treatment.

While you can’t completely cure schizophrenia, you can manage symptoms effectively through:

For many people, a combination of antipsychotic medications and therapy is the best option for managing symptoms.

Schizophrenia isn’t a one-dimensional condition. It consists of three phases, with each phase having its own unique set of symptoms.

Seeking treatment is one of the best ways to manage symptoms of schizophrenia. With treatment, you may experience longer periods between active phases — or rarely experience an active phase again.

If you or a person you know may be experiencing this condition, you can speak to someone immediately by calling the SAMHSA National Helpline at 800-662-4357 (HELP).

If this is an emergency, you can receive immediate assistance by calling 911.

You can also receive immediate help if you: