Symptoms of schizophrenia

Schizophrenia symptoms are sometimes described as ‘positive’ symptoms and ‘negative’ symptoms, but this doesn’t mean they are good or bad. Positive schizophrenia symptoms are experienced in addition to reality, whereas negative schizophrenia symptoms affect your ability to function.

Positive symptoms of schizophrenia

Positive schizophrenia symptoms include unusual changes or additions to a person’s typical thoughts and feelings, and include:

• Hallucinations: Seeing, hearing, or feeling things that others don’t
• Delusions: Believing things that others don’t
• Disorganised thinking: The things you say might not make sense to other people. You may switch topics without any obvious link.

What are hallucinations?

Hallucinations are a type of psychosis and involve seeing, feeling, and hearing things that aren’t there. Hearing voices is the most common type of hallucination, and can be distressing, especially if the voices are derogatory, aggressive, or commanding. Types of hallucination include:

• Auditory hallucinations: Hearing voices or sounds that other people can’t hear
• Visual hallucinations: Seeing objects, people, shapes, and lights that other people can’t see
• Tactile hallucinations: Feeling sensations that aren’t real, such as touch or insects on your skin, or like your internal organs are moving around
• Presence hallucinations: Feeling like somebody is in the room with you
• Olfactory hallucinations: Smelling things that aren’t there. These can be foul or pleasant, such as burnt toast or perfume
• Gustatory hallucinations: Tasting things that aren’t real
• Proprioceptive hallucinations: Feeling like you’re moving when you are not, such as flying or floating

What are delusions?

Delusions are a type of psychosis and involve false, sometimes unusual beliefs about the world, which are difficult to change despite evidence that they aren’t true. The most common type of delusion is persecution, where the person believes others are working against them or mean them harm. Someone living with schizophrenia can experience types of delusion which could include:

• Delusion of persecution: Believing others are out to get you, or somehow mean you harm
• Delusion of grandeur: Believing you are an important or famous person, or that you have special powers or abilities
• Delusion of control: Believing outside forces are controlling your thoughts or actions, including planting thoughts in your mind or removing thoughts
• Delusion of reference: Believing objects or events have a personal message, such as a sign or billboard having personal meaning, or someone’s unrelated actions having personal significance
• Erotomania: Believing that a person is in love with you when they aren’t. This can be a person that you know, or a celebrity you have never met

What is disorganised thinking?

Disorganised thinking, also known as thought process abnormalities, involves symptoms affecting speech and thinking. The types of disorganised thinking include:

• Tangential thinking: You might move from one thought to another related thought without getting to the point. Thoughts might be connected in a tangential, superficial way.
• Circumstantial thinking: You might talk in circles, providing unnecessary detail before reaching your intended point.
• Derailment: In severe disorganised thinking, your thoughts and speech might become jumbled and disjointed, having almost no connection with each other. This is known as derailment, or loose associations.
• Clang associations: With clang associations, you choose words based on their sound in relation to each other, often rhyming or based on puns rather than meaning.
• Incoherence: In severe cases, words may have no connection or association to each other, and it becomes impossible for others to understand the intended meaning. This is sometimes known as ‘word salad’.

Negative symptoms of schizophrenia

Negative schizophrenia symptoms affect typical functioning, such as cognitive impairment, and often appear slowly, months or years before a person’s first acute episode of schizophrenia involving hallucinations or delusions. They may be difficult to notice, especially if they start during teenage years, as they can look like other mental health conditions and typical experiences. This is known as the prodromal period of schizophrenia and may get worse over time. Somebody living with schizophrenia can experience a range of negative symptoms which could include:

• Lack of motivation (avolition)
• Slow movement
• Change in sleep patterns
• Poor grooming or hygiene
• Difficulty planning or setting goals
• Becoming withdrawn: Not saying much (alogia), change in body language, lack of eye contact, less interested in usual hobbies and activities
• Affective flattening: Reduced range of emotions and emotional expression
• Low sex drive and inability to experience pleasure of all kinds (anhedonia)
• Cognitive experiences: Low attention span, memory problems, unable to absorb information, poor decision making

A diagnosis of schizophrenia doesn’t mean you have all of these symptoms. The way your illness affects you will depend on the type of schizophrenia that you have. The negative symptoms can vary in length of time you experience them and the severity.

When do schizophrenia symptoms begin?

Schizophrenia symptoms usually begin after puberty, but as with many mental health conditions, they can occur at any age. It’s most common to start experiencing symptoms in your late teens, but the age can differ between men and women.

On average, those assigned male at birth are diagnosed in their late teens to early 20s. Those assigned female at birth are more commonly diagnosed in their late 20s to early 30s. It’s rare to develop the disorder before age 12 or after age 40.

What are the phases of schizophrenia?

Schizophrenia tends to occur in phases and repeating episodes or cycles. The first phase of schizophrenia, the prodromal phase, can be difficult to diagnose as it can be similar to other mental disorders. It usually involves symptoms such as becoming withdrawn, difficulty concentrating, and memory problems. These might be the first signs of schizophrenia that someone experiences.

The second phase of schizophrenia, called the active phase (also called the acute phase), is the more severe phase of schizophrenia and includes hallucinations, delusions, and disorganised thinking. This phase can appear suddenly without the predromal phase.

The residual phase of schizophrenia (also known as the “recovery phase”) somewhat mirrors the prodromal phase, with symptoms such as poor concentration, low energy, and low motivation. Symptoms such as hallucinations, delusions, and disorganised thinking are usually mild or entirely absent during this phase.

This phase isn’t considered as a diagnosis, but it can help to explain the progression of symptoms in schizophrenia.

Can you have schizophrenia without hallucinations/delusions?

It’s possible to have schizophrenia and not experience delusions or hallucinations. As with any mental illness, having schizophrenia does not mean you will experience all the symptoms. However, hallucinations and delusions are some of the most common symptoms of schizophrenia.