The symptoms of schizophrenia

There are a wide range of typical symptoms, from hearing voices to trouble concentrating. It is common for several of the following symptoms to occur together:

• Hallucinations: Most people with schizophrenia hear voices in their head. They may also see, taste or feel things that aren’t there, but that’s less common. The voices might be friendly or threatening, and they may “belong” to people who they know or to strangers. People often say that the voices comment on their behavior, talk about them, or tell them to do certain things.
• Delusions (false beliefs): It is common for people with schizophrenia to think that they’re being followed, or to firmly believe that they have been chosen to carry out a special task. Normal things suddenly seem strange. They often believe that everything that happens is related to them, and see “signs” everywhere, confirming their views and beliefs. Or they may think that others are out to get them.
• Depersonalization: People who experience depersonalization find it hard to tell the difference between themselves and the outside world. For instance, they may feel like someone else is controlling their experiences and thoughts – or that others can read their mind.
• Disorganized speech and thinking: Thoughts become jumbled and confused, spoken sentences are grammatically incorrect and don’t make sense. People keep having the same thoughts over and over again.
• Changes in feelings: This may include feeling empty inside, having dampened emotions, becoming socially withdrawn or sometimes depressed. People may also experience sudden mood swings or behave very inappropriately – for instance, they may laugh in sad situations.
• Abnormal movements: Some people have an urge to move about with no particular purpose. Others copy movements, make faces or freeze in unusual positions or while making unusual gestures.
• Limited ability to think: People may have a reduced attention span or find it hard to concentrate and remember things. Complex tasks become very difficult (for instance, applying for a job).

During acute psychotic episodes, the main symptoms are hallucinations, delusions, depersonalization and abnormal movements. Once the acute episode is over, people are more likely to have symptoms such as concentration and memory problems, social withdrawal and listlessness.

The way in which schizophrenia develops over time can vary. These are the most common ways:

• The person has only one single acute psychotic episode, or only a few. No other symptoms occur after that. About 25% of people who experience acute psychosis only have one episode in their life.
• The person has repeated episodes of psychosis over a period of a few years, and no more after that. But they still have a few lasting milder symptoms.
• The person regularly has acute psychotic episodes. Between those episodes, they have hardly any – or only mild – symptoms at first, but those symptoms slowly get worse.
• The symptoms gradually increase over time, don’t go away and are sometimes very severe.

It is often assumed that people may harm others during acute psychotic episodes. But that rarely happens. Although there is a chance that they may become more aggressive or want to hurt someone, most people who are going through acute psychosis aren’t violent towards others.

They are more likely to become victims of violence or accidents themselves – for instance, if they lose control of themselves and do risky things as a result of their delusions.

Although the above-mentioned symptoms are typical for schizophrenia, different people experience the illness very differently. This will depend on things like how severe the symptoms are, how well the treatment works, and how much the support of others helps.

This symptom is less of a problem for some than for others. Some find the voices threatening and extremely exhausting after a while, and they can make delusions much worse. Hearing voices can make you feel scared, confused and doubt yourself. Other people find a way to deal with the voices in their head, and aren't too bothered by them.

Some don’t consider themselves to be ill. They accept “their” voices as part of who they are. Some don’t tell others that they hear voices in their head, for fear of being labeled as “sick” or being forced to have treatment.

Even if different people with schizophrenia have similar symptoms, they may feel differently about them and believe that they have different causes. This affects how they deal with the symptoms. The answers to the following questions often vary greatly from person to person:

• Do you consider the voices to be threatening, just a little bothersome, or do you even think they have enriched your life?
• Do they help you to understand yourself better?
• Why do you hear certain voices?

Many of those affected would like people to show interest in their experiences, and listen to them before judging them.

Some people believe that the hallucinations and voices in their head are part of a spiritual or transcendental experience, and proof that other realities exist (for instance, a world of the dead, or alien life forms). Or they might think that psychotic experiences are an expression of an existential crisis.

There are many different types of delusions, too. Some people think they’ve been “chosen” to carry out a special task – like saving or protecting the world from something evil. This may be expressed in absurd fantasies that often involve famous personalities, people who they work with, or people who they feel they have to take action against. Some people with schizophrenia are convinced that they’re a part of the world of movies or literature, or they believe that people on the radio or TV are trying to send them secret personal messages. Many of those affected have the feeling that they're being followed or that others are plotting against them – for instance, the government, the Secret Service or their own neighbors.

When people with schizophrenia are delusional, they’re often very restless and full of energy. They sometimes have extremely positive feelings, are very creative and euphoric. Or they may feel terrified or paranoid, and worry that they’re “going crazy.” Their feelings often go up and down, from positive to negative and back again.

Insomnia is a big problem for many people who have schizophrenia. They wake up at night, have nightmares or are scared of falling asleep in the first place. Many believe that they will never be able to get a proper night's sleep again. But they really want to sleep because they think the lack of sleep is causing a lot of their problems, such as exhaustion and difficulties concentrating.

Sleep problems are sometimes a sign of psychosis, but they might also be related to stress in everyday life and substance abuse.

People who are diagnosed with schizophrenia often feel stigmatized. They worry that others will look down on them and discriminate against them. For fear of being labeled as “crazy,” many become withdrawn and don’t tell anyone about their diagnosis. They often know very little about the causes and effects of their illness, or about the treatment options. Many say they aren't given the opportunity to talk to specialists about how they experience the illness.

On the other hand, some people say that the diagnosis helped them to understand their situation better, take their symptoms seriously and get the help they need.