Hallucinations, delusions, disorganized thinking and behaviors… knowing these signs and what they look like can be a good step toward the right treatment plan.
Schizophrenia is a chronic mental health condition that affects a person’s behaviors, thoughts, and feelings.
The condition is one of the top 15 leading causes of disability in the world. It’s usually diagnosed between the ages of 16 and 30, after a person has experienced their first psychotic episode. It’s rare for a young child to have schizophrenia.
But symptoms of schizophrenia develop slowly over time. You may begin to see signs in early teen years, such as:
- experiencing a significant drop in grades or job performance
- suddenly having trouble thinking clearly or concentrating
- becoming suspicious of others or having paranoid thoughts
- spending more and more time alone
- having new passionate ideas that seem strange to others
- having strange feelings or seeming like they experience no feelings at all
- having less or no interest in how they look
- finding it difficult to tell the difference between what’s real and what’s not real
- being unable to speak clearly or struggling to communicate with others
Symptoms usually fall into one of three categories:
- Positive symptoms. They don’t see reality the same way other people do. They may also see, hear, smell, or taste things that others don’t.
- Negative symptoms. These are things that are unusually absent from their life. They have no interest and have lost the motivation to do most things, including everything from seeing friends to doing typical daily activities.
- Cognitive symptoms. They have trouble paying attention, concentrating, and remembering things.
People with schizophrenia have a variety of symptoms that can range in severity. The 10 most common ones are:
When a person with schizophrenia has hallucinations, they see, hear, smell, or taste things that don’t exist.
But to that person, what they see, hear, smell, or taste is very real. This can be pretty confusing or upsetting if you care about the person who’s having hallucinations.
Sometimes they might hear voices for a long time before anyone else notices.
These voices may be from people they know or people they don’t know. They might be judging or threatening them. They could also be a narration of what the person is doing or demanding them to do certain things.
Sometimes the voice isn’t a voice at all — instead it’s a sound like a whistle or hissing noise.
While often named together, delusions are different from hallucinations.
Delusions are false beliefs about things that may seem strange or illogical to others. Even if you present the person with facts that prove their idea isn’t based on reality, they’re unlikely to change their mind.
A person having delusions may believe that people on TV or radio are sending them secret messages that tell them to do something. Or they might believe they’re in danger or a specific person or group of people are trying to harm them.
People with delusions may find it difficult to concentrate. They may get confused or feel as though their thoughts have been blocked.
When thinking is “disorganized,” it means that it’s hard for someone with schizophrenia to keep their thoughts or speech in order.
They might have trouble remembering things or finishing tasks. They may start talking and then suddenly stop because they can’t remember what they were saying. Or, they may jump from topic to topic while having a conversation. Sometimes they’ll make up words.
If they’re experiencing severe symptoms, they may be impossible to understand. They might have “word salad” — a jumble of words thrown together in nonsensical order.
Or they might just choose to stop talking altogether.
Often, people with schizophrenia have anosognosia. This means they lack awareness of having an illness. This is different from being in denial. They aren’t capable of thinking clearly enough to choose to deny something. Anosognosia can make treating schizophrenia more difficult.
Cognitive difficulties are another common sign of schizophrenia, though admittedly, these can occur in various other conditions, too. The person may have trouble paying attention, concentrating, and remembering things.
Similar to disorganized thinking, this can make it hard for them to have a conversation.
These symptoms can also make it difficult for someone to learn new things or remember appointments. They might struggle to use information they just learned or make decisions that affect their life.
In general, people who are overly excited seem hyperactive and always moving around. It can be hard for them to sit still for long, and they’ll get very excited about things around them.
Everyone gets excited from time to time, but this overexcitement is different. Both their speech and movements may be fast, and sometimes they’ll have an “outburst” of energy that seems to come out of nowhere.
Their excitement can affect their ability to eat or sleep, and it can make it very difficult to talk to others. Or, they may move around so much and talk so quickly that they exhaust themselves.
In people with schizophrenia, the sudden movements and excitability are typically related to symptoms of psychosis, like hallucinations or delusions.
People who experience mania — a symptom of bipolar I disorder — may also appear overexcited with extra energy and little need for sleep. So if you’re noticing this in yourself or someone else, consider speaking with a mental health professional to receive the right diagnosis.
Some people with schizophrenia have an exaggerated opinion of themselves, sometimes called delusions of grandeur. They may think they’re superior to others or have extraordinary abilities. They may also incorrectly believe they’re very wealthy, smart, famous, or powerful.
Depending on the severity of the symptom, they may only believe these things about themselves but not do anything about it. Or it may impact their attitude about themselves.
In severe cases, they’ll believe they have multiple special qualities. Often, they’ll act on these beliefs in ways that may seem strange or even dangerous to themselves or others.
When a person with schizophrenia emotionally withdraws from things, they slowly stop caring about all aspects of daily life. They lack the desire to do things, and friends or family can’t encourage them to join activities.
When you talk to a person who’s emotionally withdrawing, they may seem distant and uninterested in having a conversation.
As they progress, they begin to lose all interest speaking with others and can end up completely withdrawn. They also stop having any emotional commitment to caring for themselves or their personal needs and may need help doing so.
A characteristic symptom of schizophrenia is a lack of emotional expression. People with this condition may show little or no reactions to good or bad news.
They also begin to show fewer facial expressions and gestures when they talk. Their voice may become “flat” when they speak.
Sometimes, they can have unexplained and seemingly inappropriate reactions to things, like overwhelming anger or inappropriate laughter.
Another classic sign of schizophrenia is the struggle to form generalizations or think beyond a solid idea or concept.
People with the condition may have a hard time understanding things that aren’t physical or real. They may also have difficulty understanding a proverb, simile, or metaphor because they can only interpret things literally.
They tend to get distracted by what’s real and literal, and may be unable to understand what a story means or the comparison that’s being made.
Disorganized behavior can include odd behaviors like smiling or laughing for no apparent reason, or talking to yourself. It can also include movements that seem to happen for no reason, or even being stressed or annoyed without a clear cause.
People with schizophrenia may have a childlike silliness about them. Or, they may be disheveled or oddly dressed. In some cases, they might also demonstrate inappropriate sexual behaviors, like public masturbation.
Catatonic behavior can include not moving much or at all, or refusing to do things or speak.
Someone might also do a lot of unusual movements that don’t seem to have a purpose. You may find them purposely in strange positions or notice their unusual gestures or grimacing.
People with schizophrenia may also have echolalia (repeating what others say) or echopraxia (repeating how others move).
There are many common signs of schizophrenia, and you don’t need to have all of them for a doctor to diagnose the condition.
If you recognize several of these symptoms and are concerned that you or a loved one may have schizophrenia, you can always reach out to a mental health professional for further support. They’ll be able to confirm a diagnosis and create a personalized treatment plan.
While schizophrenia may be a challenging condition, it’s manageable with the right tools and support. Early treatment will increase your chances of successful treatment.