Reviewed by Whitney White, MS CMHC, NCC., LPC
Schizophrenia is often thought of as a rare and sometimes scary mental disorder associated with delusion, but as schizophrenia is becoming more widely diagnosed, the disorder in tandem is becoming more normalized. In fact, schizophrenia affects 20 million people around the world.
What Is Schizophrenia?
To understand why a person with schizophrenia thinks, feels, or behaves a certain way, let’s review what may be happening neurologically.
Scientists believe that a person with schizophrenia may have issues within the brain’s messaging system. Neurotransmitters are chemicals that transmit information in the brain. The two neurotransmitters linked with schizophrenia most often are serotonin and dopamine.
Serotonin and dopamine are probably the most commonly known neurotransmitters, as they are responsible for the pleasure center, among other things. In a brain with schizophrenia, these neurotransmitters display abnormalities.
To be clear, there is still a lot of uncertainty about the knowledge of a schizophrenic brain structure. In addition to imbalances and abnormalities, researchers have noticed the absence or enlargement of cells in certain brain areas.
What Are the Causes?
Considering that schizophrenia is not normally noticeable early on, and the disorder is not normally diagnosed until early adulthood, the causes can be difficult to pinpoint.
Generally, there is a strong consensus that schizophrenia is a genetic condition but can also be caused or instigated by brain development and environmental factors.
Predisposition to schizophrenia genetically does not mean a person will inherit it, but the risk is much higher. Research suggests that a parent with schizophrenia has a 40% chance of passing the genetic marker to their child.
Likewise, the significance of early childhood brain development is extremely important to the brain’s neurotransmitters’ access and function and this is often where environmental influence can make a difference.
What Are the Types of Schizophrenia?
The Diagnosis and Statistical Manual of Mental Health (DSM) is the leader for updating mental health research and responsible for the proper classification of most disorders.
The DSM-IV (published in 1994) separated schizophrenia into these distinct types:
- Paranoid Type
- Undifferentiated Type
- Catatonic type
- Residual Type
- Disorganized Type
The most familiar of the five types are likely the “paranoid type.” Paranoid schizophrenia is associated with the symptoms of feeling like you’re being watched, targeted, or potentially in harm’s way.
Paranoid schizophrenia can often present itself as fear, or a more self-centered delusion. Someone with this condition might feel like they are the recipient of an important message via external “signs”, or perhaps they have a serious, personal fear of strangers, the internet, the government, or the television.
Each type of schizophrenia classified by the DSM-IV is considered now more so in the line of symptoms, rather than distinct types.
Symptoms of Schizophrenia
According to the latest version of the DSM published in 2013 (the DSM-V), schizophrenia is diagnosed by the presentation of at least two of the following symptoms (in no particular order):
- Delusions: Delusions can be considered similar to paranoia. A person who experiences the unrealistic, abnormal, or strongly self-absorbed perception of the surrounding world might be experiencing delusions. These delusions are frequently easy to disprove, but schizophrenic delusions make it difficult to reason with the person suffering. They can be further categorized into the following:
- Persecutory: Delusion of being stalked or tracked – often the most difficult to disprove.
- Referential: Delusion of public knowledge being somehow personal – i.e., a special message delivered via a TV broadcast or song on the radio.
- Grandiose: Delusion of self-importance.
- Erotomatic: Delusions regarding the person’s love life.
- Somatic: Delusion regarding health or the body.
- Religious: Delusion regarding a higher power or demon.
- Disorganized Speech: The literal disorganization of words, or sentences, in a way that does not make logical sense to another person.
- Extreme Catatonic Behavior: In short, catatonic symptoms associated with schizophrenia can be described as the lack of movement, acknowledgement, or speech in response to stimuli. Catatonic schizophrenia can also insinuate randomly flipping from under-activity to hyperactivity.
- Hallucinations: This affects the senses. A person with hallucinations might see, smell, hear, or feel things that are not present. Frequently, a person with schizophrenia can be thought of as “hearing voices” in their head. That symptom would fall under this category, specifically, as an auditory hallucination. Therefore, hallucinations are often explained as the following:
- Negative Symptoms: Rather than the presence of symptoms, negative symptoms is the absence thereof. Moreover, negative symptoms can be described as a significant lack or absence of certain neurotypical functions. For example:
- Lack of pleasure
- Flattened emotional response
- Infrequent speech (alogia)
- Social withdrawal
- Absence of personal hygiene
- Lack of motivation or ability to follow-through (avolition)
What Are the First Signs of Schizophrenia?
Like many disorders, schizophrenia exists on a spectrum, with some cases being more severe or mild than others. Recognizing schizophrenia can be challenging, especially early on. The onset of schizophrenia is, therefore broken up into three different phases:
- Prodromal Phase: This is the first phase and is difficult to recognize given that symptoms are still slow to develop, and behavior is not noticeably different quite yet.
- Acute Phase: This is the second or active phase. During the acute phase, symptoms are experienced by the afflicted and recognizable to others.
- Recovery Phase: This third phase occurs after a schizophrenic episode. Coming down from an acute phase can cause depressive feelings.
Schizophrenia is rarely diagnosed in children. It typically begins presenting itself after puberty. Therefore, the minor changes in behavior, or feeling, can be missed entirely due to the other hormonal changes an average person faces during that time of life.
Men are typically diagnosed earlier than women, but there is no particular discrepancy when it comes to which gender schizophrenia afflicts more frequently.
Overall, schizophrenia is diagnosed more often than the average person might expect. Globally, schizophrenia is actually one of the top 15 leading causes of disability.
Statistically, people with schizophrenia are more likely to be at risk for substance abuse and co-occurring mental/behavioral health disorders. Diagnosing schizophrenia is the first step towards addressing these risks. But even thereafter, it’s important to take a closer look at what these risks entail, and why they’re common.
Research suggests that those suffering from schizophrenia are 4.6 times more likely to be diagnosed with substance abuse, be it alcohol or drug misuse. Additionally, 70% of people diagnosed with schizophrenia also have nicotine dependence.
People genetically predisposed to schizophrenia can be triggered environmentally by certain drugs. For example, substances that distort reality can sometimes cause onset schizophrenia, in conjunction with other factors.
Otherwise, people who are already aware of their schizophrenic symptoms sometimes turn to drugs and alcohol in unhealthy ways in an attempt to manage or curb the symptoms of schizophrenia.
Substance abuse is a co-occurring condition that should be addressed by a medical professional.
Other Co-Occurring Conditions
Research suggests that while 47% of people with schizophrenia also experience substance abuse, other psychiatric comorbidities affect those with the disorder.
For example, those with schizophrenia statistically have shown a presence of:
- 50% Depression
- 29% Post Traumatic Stress Disorder (PTSD)
- 23% Obsessive-Compulsive Disorder (OCD)
- 15% Panic Disorder
Many of these comorbid conditions fall under the umbrella of anxiety disorders. The relationship between anxiety and schizophrenia is complicated, and often so deeply intertwined that it can be difficult to address, making it that much more important to diagnose.
Likewise, schizophrenia and depression can also be deeply intertwined. Depressive symptoms can often be at the heart of schizophrenia mismanagement.
The National Center for Biotechnology Information (NCBI) refers to a suggestion for understanding the combination of depression and schizophrenia categorically as following:
- Depressive symptoms secondary to natural factors
- “Nonorganic” depression related to the acute phase
- Depressive symptoms related to the prodromal phase and symptoms that resemble depression that may present instead as negative symptoms
Living independently, keeping relationships, staying employed, handling finances, and maintaining proper judgement can, in some cases, be very difficult for a person with schizophrenia.
Depending on the severity of the disorder, a person with schizophrenia may need a caretaker present 24/7. Caretakers can be a major expense for anyone, and it is not uncommon for medical bills to add up for those with severe schizophrenia and comorbid conditions.
However, caretakers can be essential to the success of daily life for a person living with schizophrenia. For all guidance regarding assistance or treatment, please consult a licensed mental health professional.
Living A “Normal” Life
When professionally addressed, schizophrenia can be managed, and the individual can go on to lead full and fulfilling lives. Once diagnosed, there are plenty of management options for a person with schizophrenia.
If you or somebody you care about seems to be experiencing or at risk for schizophrenia, take this short, free, and confidential quiz to provide some clarity. While this quiz may offer some insight into symptoms and commonalities, remember that a true diagnosis can only come from a licensed mental health or medical professional.