Updated date:

Understanding the Signs and Symptoms of Schizophrenia

M. D. Jackson has studied psychology since 1989. While her specialty is family relations, she also loves neuroscience and behaviorism.

Echos From the Past

It was a strange conversation that I gave little thought to in the moment. My father was sitting at the dining room table in his home speaking about the people who had been following him. He had my mother convinced that this delusion was real.

I brushed it off as paranoia from smoking marijuana. He was an old man and even though he had a conspiracy theory radio talk show at a tiny radio station, no one was after my father. He was having delusions of grandeur.

It wasn’t the first time my father believed he had been followed or that he described a situation in which he was targeted by someone or something. He had an obsession with space and aliens, something I also believed to be a consequence of his marijuana use.

As I delved deeper into my psychology education, I found more and more symptoms of something more serious than my father’s career drug use. My father’s symptoms were consistent with schizophrenia. Looking back so many things made sense as I read case study after case study. My father passed away in 2011 never getting treatment for his mental illness.

Empty Inside the Illness

Empty Inside the Illness

Normalizing Mental Illness

According to the National Institute of Mental Health (NIMH) 2020, there are 11.2 million people in the United States with a Mental Illness diagnosis. One in five people has a mental illness of some type (NIMH, 2020). Normal is a very subjective term in our society.

Up until the 1980s people with severe mental illness were carted off and kept in mental institutions. Today people with mental illness are medicated and released into society. The care of these individuals is often neglected or under-addressed.

“I understand your pain. Trust me, I do. I’ve seen people go from the darkest moments in their lives to living a happy, fulfilling life. You can do it too. I believe in you. You are not a burden. You will NEVER BE a burden.”

— Sophie Turner

What Is Schizophrenia?

Of the mental illnesses, one of the most widely misinterpreted is schizophrenia. Schizophrenia is an illness of the brain that causes people to improperly view reality. Our reality fashions the way we function/behave in society.

Normal everyday tasks can become freighting for someone with schizophrenia as their minds tell them that average things are harmful. Schizophrenia diagnosis may include hallucinations, delusions, disorganized speech, or catatonic behavior, avolition, and affective flattening (American Psychological Association, 2000).

It is important to note that not all schizophrenics have all the symptoms. Mental illness works on a spectrum where a person may have two or more behaviors presenting but, not all the behaviors will be present.

The opportunity for misdiagnosis is great since almost all diagnosis is contingent upon a self-reporting system, such as an interview or survey. Likewise, there are mild to severe cases of schizophrenia. Before you look up the symptoms, let us discuss them in reverse order.

“Mental health problems don’t define who you are. They are something you experience. You walk in the rain and you feel the rain, but, importantly, YOU ARE NOT THE RAIN.”

— Matt Haig

Symptoms and Behaviors

Affective Flattening

This is when a person does not show emotions, expressions, or body language. Essentially it is the person at the party sitting quietly not speaking, usually in a stiff position not reacting to their environment. While there are people who have other disorders that may cause this behavior, those disorders do not usually include this level of lack of expression.

This is different than being a wallflower; this person appears checked out completely from his or her surroundings. Part of this is an effort to not draw attention to themselves.

Avolition

This is a lack of motivation to do things that have a goal. Schizophrenics will make plans and then not keep them, or neglect to do a mundane task such as paying a bill. They are known for not completing life goals such as college or high school. Some of this lack of follow-through can be traced back to delusions. An outing may mean they have to be around people which is always a source of anxiety for a schizophrenic. Any contact with other people is an opportunity to be judged or outed for their behavior.

Catatonia

This has many dimensions within the behavior. People always think of the extreme catatonic behavior seen in the movies. Just as schizophrenia is varied so are the states of catatonic behavior. Healthline (2020) reports that catatonic behavior can be categorized as:

  • stupor (a state close to unconsciousness)
  • catalepsy (trance seizure with a rigid body)
  • waxy flexibility (limbs stay in the position another person puts them in)
  • mutism (lack of verbal response)
  • negativism (lack of response stimuli or instruction)
  • posturing (holding a posture that fights gravity)
  • mannerism (odd and exaggerated movements)
  • stereotypy (repetitive movements for no reason)
  • agitation (not influenced by external stimuli)
  • grimacing (contorted facial movements)
  • echolalia(meaningless repetition of another person’s word)
  • echopraxia (meaningless repetition of another person’s movements) (sic, Healthline 2020).

Disorganized Speech

This would be a loose or inappropriate correlation of topics, rapid shifting from one topic to another, repetition of statements, or use of words that only have meaning to the person. In a social setting, this looks a lot like social anxiety however, it’s more intense and uncomfortable. The conversation itself does not have a logical progression.

Delusions

In a schizophrenic brain, this usually involves people or items within their reality, however; the belief about what those items or people are doing is imagined. These false assumptions about reality often lead to adverse reactions. These delusions are often delusions of persecution or paranoia.

Paranoid delusions are the belief that something or someone is out to harm or inflict emotional damage. In my experience, schizophrenics almost always create a scenario in which someone is out to get them or dislikes them.

It’s interesting to note that schizophrenics often pick people who are close to them as their villains. For many schizophrenics, there is always a villain.

Pieces of the Puzzle

Pieces of the Puzzle

"The advice I’d give to somebody that’s silently struggling is, you don’t have to live that way. You don’t have to struggle in silence. You can be un-silent. You can live well with a mental health condition, as long as you open up to somebody about it, because it’s really important you share your experience with people so that you can get the help that you need.”

— Demi Lovato

Delusions, Hallucinations, and Paranoia

Delusions of Reference

This involves correlating casual information or events to give it unreasonable meaning. Famous mathematician John Nash suffered from Schizophrenia and one of his symptoms was delusions of reference. He correlated stories in magazines and newspapers to mean a secret code that he was working out. In reality, these were just random stories without hidden meaning.

Schizophrenics tend to build stories from varied information. They are big believers that casual conversations are an attempt to gaslight them. The mere mention of random words can cause a correlation between the word and current events in the person’s life. These correlations are coincidental and meaningless to everyone but, the schizophrenic.

Delusions of Grandeur

Delusions of grandeur are often explained using the “He thought he was Jesus” point of reference. More commonly people inflate their own importance and delude themselves into believing they have a power or skill that others cannot possess. Delusions of grandeur may include beliefs that someone is stalking the person or intentionally harassing the person.

The premise for the delusion is always that the person is greater than others thus these grand schemes are working against them. This works in their brain as a thought that “I’m so important to the world that people want to be like me, follow me, and try to harm me”. In reality, these people are relatively unknown and do not have a strong presence in the world.

Delusions of Control

Delusions of control are when a person insists someone or something outside of themselves is trying to control them. This may be a belief that their thoughts are being hacked, or they are being gaslighted by another person or entity. Either way, they believe control is being attempted or happening.

“Common delusions of control include thought broadcasting (“My private thoughts are being transmitted to others”), thought insertion (“Someone is planting thoughts in my head”), and thought withdrawal (“The CIA is robbing me of my thoughts”)(sic, Grohol, J. 2019)

Hallucinations

Hallucinations are the manifestations of events that do not exist in reality. A common Schizophrenia hallucination is hearing voices. It is interesting to note that every Schizophrenic attributes the voices differently.

Some Schizophrenics believe the voices are God, Satan, ghosts, the thoughts of others, demons, or aliens. The voices are often directive or destructive telling the schizophrenic horrible things about themselves, others, or telling the schizophrenic to complete a task that is irrational to protect themselves. The voices are actually internal dialogue being misjudged as external stimuli.

In my experience, the voices are a reflection of the person’s beliefs about themselves.

General Paranoia

Grohol (2019), outlines some basic behaviors seen in Schizophrenics such as; purchasing extra door locks, checking behind themselves as they walk, or refusal to use a telephone.

I have also seen this in combination with delusions where a person may believe they are being followed while they travel, possibly followed by someone out to get them. When their behaviors are singled out they do not amount to much.

Schizophrenics avoid close contact with most people because the biggest problem they face is keeping their mental illness a secret so that they do not end up in an institution. They know what happens to people who are paranoid or hear voices.

Schizophrenics know they are always at risk of being found out and locked up. They tend to lie to mental health professionals, and for this reason, they are often misdiagnosed as bipolar, depressed, or as having social anxiety. Only someone living with a schizophrenic will start to see patterns and behaviors that are irrational.

Causes of Schizophrenia

Over the last 20 years research has been conducted to determine the origin of schizophrenia. Some recent data shows a connection between schizophrenia and genetics.

In a 1999 Princeton study, genetics was found to play a strong role in the generational passing down of the disorder. In a 2013 study by Tsuang on the genetics of schizophrenia patients, 10% of the patients had a single parent with schizophrenia and 40% of the patients had both parents who were schizophrenic.

Identical twins are often used in genetic research since they are genetically identical. In identical twins, the connection goes up to a 60% chance that if one twin has schizophrenia, the other one twin has schizophrenia as well (Tsuang, D. 2013).

Additionally, there is a 15% chance of a parent passing schizophrenia down to a child. As genome projects progress science will continue to advance the understanding of how genes play a role in schizophrenia.

Another connection to the onset of schizophrenia is child abuse. More specifically loose connections have been made between childhood sexual abuse and schizophrenia. Even Freud did work in linking sexual abuse to hysteria and trauma (Janssen, 2019). Many people with schizophrenia were subjected to sexual abuse as children although, the direct connection has not been made with any clarity. Furthermore, cases of multiple personality disorder (not schizophrenia) have shown a direct connection to childhood abuse.

According to Casserella, 2020, “Mind-altering drugs called psychoactive or psychotropic drugs, such as methamphetamines or LSD, can make schizophrenia more likely” (sic).

Additionally, Marijuana research has shown that it increases the risks of schizophrenia. Combination drug and alcohol use has also been linked to the onset of schizophrenia. This creates a “what came first, the chicken or the egg” scenario in which science is currently unsure if the drug use was a self-medicating factor or if the drugs were the cause of the schizophrenia.

Schizophrenia Diagnosis

Grohol 2019 stated the following symptoms of Schizophrenia:

  • Social isolation and withdrawal
  • Irrational, bizarre or odd statements or beliefs
  • Increased paranoia or questioning others’ motivations
  • Becoming more emotionless
  • Hostility or acting with extreme suspicion for no reason
  • Increasing reliance on drugs or alcohol (in an attempt to self-medicate)
  • Lack of motivation
  • Speaking in a strange manner unlike themselves
  • Inappropriate laughter
  • Insomnia or oversleeping
  • Deterioration in their personal appearance and hygiene

As previously stated, you are unlikely to see the symptoms all presented in one person. Some of these symptoms are present in advanced cases. Many of these symptoms are present in other disorders making it difficult to diagnose.

There is a lot of cross-over in the pharmaceutical industry in terms of what is used to treat bipolar and schizophrenia. Therefore some people may show positive results even when they are misdiagnosed.

Functional Magnetic Resonance Imaging (FMRI) has made breakthroughs in the understanding and diagnosis of mental disorders. FMRI scans show brain activity using a visual representation of the brain in which activity is represented by color. Seeing how the brain is functioning shows medical professionals where deficits or over activity are present.

Gur, R. & Gur, R 2010, were able to “elucidate potential neural substrates of deficits in cognition and affect by providing measures of activation to neurobehavioral probes and connectivity among brain regions”. This ability to identify connectivity deficits may assist in both diagnosis and treatment.

According to the Mayo Clinic complications associated with Schizophrenia include:

  • Suicide, suicide attempts, and thoughts of suicide
  • Anxiety disorders and obsessive-compulsive disorder (OCD)
  • Depression
  • Abuse of alcohol or other drugs, including nicotine
  • Inability to work or attend school
  • Financial problems and homelessness
  • Social isolation
  • Health and medical problems
  • Being victimized
  • Aggressive behavior, although it's uncommon (sic, Mayo Clinic 2020)

Schizophrenia and Intelligence

General studies indicate low Intelligence Quotient (IQ) in patients with schizophrenia while they are having an episode. Cernis et al. 2015, found a sub-group of schizophrenics that have an unusually high IQ as well as evidence that per-episode there is a surge of higher IQ.

Many of the higher-IQ Schizophrenics are undetected as they are smart enough to mask the more severe symptoms. It should be noted that these people are often reclusive, having little contact with people who might notice their symptoms.

It is my current belief these patients are misdiagnosed due to their intelligence in not divulging the real scope of their symptoms. The schizophrenic is ever aware of being found out and institutionalized. In many cases, it is only after an extreme episode that a correct evaluation can be made.

Treatment

Current treatments for schizophrenia involve drugs that alter the function of neurotransmitters and receptors as well as their ability to move and accept serotonin and dopamine (Patel.K. etal. 2014).

There is a lack of consensus as to approach and treatments, most involve the use of drugs that alter the serotonin and dopamine exchange in the brain.

Unfortunately, Patel.K. etal. 2014, found that a meager 20% of patients report satisfactory treatment results. Newer studies suggest healthier lifestyle and diet are promising new in the managing of schizophrenia symptoms.

Preventative treatments are not available at this time. Hopefully, with the use of newer technology, the debilitating effects of schizophrenia will be manageable.

Dedication

Today, I called my mother who spent 38 years dealing with my father's mental illness. This article is dedicated to her for everything she did to try to maintain normalcy in our lives in the face of a storm without a name. I love you, Mom.

References

  • American Psychological Association, (2000). Schizophrenia. Diagnostic Criteria from DSM-IV-TR. P.153
  • Casserella,J. ( 2020). Are there drugs that can cause schizophrenia? Retrieved from https://www.webmd.com/schizophrenia/qa/what-drugs-can-cause-schizophren
  • Černis, E., Vassos, E., Brébion, G., McKenna, P J. Murray, R., David,A., MacCabe, J. , (2015). Schizophrenia patients with high intelligence: A clinically distinct sub-type of schizophrenia?. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25752725/
  • Grohol, J. (2019). Schizophrenia Basics: Delusions, Hallucinations & Onset. Retrieved on October 19, 2020 from https://psychcentral.com/lib/schizophrenia-basics-delusions-hallucinations-onset/
  • Gur, R. E., & Gur, R. C. (2010). Functional magnetic resonance imaging in schizophrenia. Dialogues in clinical neuroscience, 12(3), 333–343.
  • Healthline, (2020). Catatonic Schizophrenia. retrieved on November 19, 2020 from https://www.healthline.com/health/catatonic-schizophrenia
  • Janssen,D. (2019). Kränkung and Erkrankung: Sexual Trauma before 1895. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6733772
  • Mayo Clinic. (2020). Schizophrenia.Retrieved on October 20, 2020 from https://www.mayoclinic.org/diseases-conditions/schizophrenia/symptoms-causes/syc-20354443
  • National Institute of Mental Health. (2020). Mental Illness. Retrieved from https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
  • Psychiatr Clin North Am. 2010 Mar; 33(1): 35–66. doi: 10.1016/j.psc.2009.12.003
  • http://www.schizophrenia.com/research/hereditygen.htm
  • Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management, 39(9), 638–645.
  • Tsuang,D. (2013). New Schizophrenia Genes Discovered Through Innovative Genetic Sequencing Approach. Retrieved from https://www.bbrfoundation.org/content/new-schizophrenia-genes-discovered-through-innovative-genetic-sequencing-approach

This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2020 MD Jackson MSIOP

Comments

Pamela Oglesby from Sunny Florida on October 21, 2020:

This is an excellent article. It so thoroughly cover the signs and symptoms of schizophrenia. I am sorry to hear of the personal experience in your family, especially as he received not treatment.

It sounds like researchers are making good advances in understanding the cause of schizophrenia and how to treat it. That is good news.

Liz Westwood from UK on October 20, 2020:

I am sorry to hear about your very personal experience with schizophrenia in your family. You have done a good job at explaining this complex illness in your article.

Tammy Winters from Oregon on October 20, 2020:

Very informative. Thanks for sharing.