Schizophrenia Symptoms and Signs
Schizophrenia is a condition in which perception and belief separate from shared reality — most often hallucinations and fixed false beliefs — alongside a loss of drive, expression and the ability to organise thought.
Also called: Schizophrenia spectrum disorder, Psychosis.
ICD-10 F20 · ICD-11 6A20
Not a split personality. A mind that loses track of where signals come from.
Schizophrenia is not having two personalities. It is an illness that changes a person's experience of reality. They may hear voices nobody else can hear. They may become certain of things that are not true.
Quieter changes come alongside those, and they are often harder to live with. There is less motivation, less pleasure, and flatter emotion. Memory and focus get harder too.
It usually starts in the late teens or twenties. It is treatable, and many people live well with it. It is also one of the most misunderstood conditions there is.
FROM INSIDE
What it is actually like
It rarely starts with a voice. More often the world feels slightly wrong for months. Ordinary things start to seem like they carry a message. A song on the radio. A stranger's glance. The way a car is parked.
Then a voice starts commenting on what you do. It sounds as real as anyone else in the room. It knows things about you. Nobody else seems to hear it.
Explanations form to make sense of all this, and they feel certain. From the inside it does not feel like confusion. It feels like noticing something everyone else has missed.
A radio playing your own voice back
Imagine your own thoughts coming back through a speaker in another room. They are slightly changed, and nothing says they started with you. You would not think "that is me". You would think someone else was talking.
WHAT IT DOES
Three kinds of symptoms
Doctors group the symptoms like this. Most people have some from each group.
Positive symptoms
These are experiences added to normal life. Hearing voices. Seeing things. Fixed beliefs that are not true, such as being followed or controlled.
Negative symptoms
These are things taken away. Motivation, pleasure, speech, and showing emotion. People often mistake them for laziness.
Cognitive symptoms
These are problems with memory, attention and planning. They are often the biggest barrier to working or studying.
Disorganisation
This is speech or behaviour that is hard to follow. It happens because thoughts jump about, or connect in unusual ways.
23M — WORLDWIDE
80% — INHERITED
1 in 3 — RESISTANT
14.5 — YEARS
When it tends to begin
Peak age of onset: 20.
Median age of onset: 25.
Schizophrenia usually begins between the late teens and the early thirties. It starts a little earlier in men than in women. Months of small changes often come before the first clear episode. Doctors call that period the prodrome. Getting help early leads to better outcomes.
How it is actually diagnosed
A diagnosis needs at least two of these, present for a good part of one month. At least one of them must come from the first three.
- Delusions: fixed beliefs that are not true and do not change with evidence
- Hallucinations, most often hearing voices
- Disorganised speech
- Very disorganised behaviour, or catatonia
- Negative symptoms, such as reduced emotion or motivation
Three more things must be true. Signs of the illness must last at least six months in total. Work or relationships must be affected. And drugs, medical illness and mood disorders must all be ruled out first.
If it is worse than that right now
The risk of suicide is raised in schizophrenia. It is highest in the first few years, and just after leaving hospital. Voices telling a person to hurt themselves are an emergency. Early intervention teams exist for exactly this moment.
If you or someone you know is in danger, contact emergency services or a crisis line now.