What is schizophrenia?

When a doctor describes schizophrenia as a psychotic disorder, they mean that, in their view, you can’t tell your own intense thoughts, ideas, perceptions and imaginings from reality.

Views on schizophrenia have changed over the years. Questions have been asked about whether schizophrenia is one condition or more than one syndrome with related features. These questions drive both debate and research. Although there may be some discussion over the true nature of schizophrenia, most psychiatrists will diagnose and treat in the same way.

Many people argue that when considering a diagnosis of schizophrenia it is important to think about individual experience. In this way, each symptom of schizophrenia might then be seen as a logical or natural reaction to difficult life events or life experience.

Some people argue that because psychiatric experts can’t agree about the definitions, causes, and suitable treatments for schizophrenia, it shouldn’t be used as a diagnostic category at all.

How is schizophrenia diagnosed?

When you become unwell, you are likely to show significant changes in your behaviour. For some people this can happen quite suddenly, but for others these changes may occur more gradually. You may become upset, anxious, confused and suspicious of other people, particularly anyone who doesn’t agree with your perceptions. You may be unaware, or reluctant to believe, that you need help.

In making a diagnosis, doctors will want to rule out other physical or mental health problems. They will look for various ‘positive’ symptoms and ‘negative’ symptoms, and make a diagnosis based on the presence and duration of some or all of these symptoms.

Positive symptoms

‘Positive’ symptoms are symptoms that most people do not normally experience. They include: strange thinking (‘thought disorder’), hallucinations and delusions.

Strange thinking (‘thought disorder’)
Your thoughts and ideas may seem jumbled and make little sense to others. Conversation may be very difficult and this may contribute to a sense of loneliness and isolation.

Hallucinations can affect any of your senses. You might:

  • see things that others don’t
  • smell things that others don’t
  • hear voices or sounds that others don’t.

Voices can be familiar or strange, friendly or critical and might discuss your thoughts or behaviour. The voices you hear might tell you to do things. People who are diagnosed with schizophrenia seem to hear mostly critical or unfriendly voices. You may have heard voices all your life, but a stressful life event might have made the voices harsher and more difficult to deal with.

“I can ignore the voices most of the time but some days it’s insistent and frightening.”

According to some research, up to four per cent of the population hear voices. For most people, the voices they hear present no problem and are not associated with schizophrenia.

Delusions are usually strongly held beliefs or experiences that are not in line with a generally accepted reality. Delusions associated with schizophrenia are probably distressing for you, or those around you, as they may be unusual or extreme. For instance, you might believe secret agents are following you or that outside forces are controlling you or putting thoughts into your mind. For more information, see paranoia and psychotic experiences.

Negative symptoms

‘Negative’ symptoms are a lack of some emotional responses or thought processes. ‘Negative’ symptoms include: lack of interest, emotional flatness, inability to concentrate, wanting to avoid people or to be protected.

“I was finding it difficult to talk, the words in my mind just would not come out.”

Being withdrawn, being apathetic, and being unable to concentrate are all described as ‘negative’ rather than ‘positive’, because they show a reduction in thought or function. It can be very difficult to tell whether negative symptoms are part of the schizophrenia, or whether they are present because you are reacting to other frightening or distressing symptoms. For example, a person with a mental health problem may be discriminated against or ignored which may cause them to feel isolated and depressed and so withdraw.

Different diagnoses

There are different types of schizophrenia. The most common one is paranoid schizophrenia. If you don’t have all the symptoms used to diagnose schizophrenia, you may be given a diagnosis of ‘borderline schizophrenia’.

If you have any doubts about the diagnosis you have been given, you can ask for a second opinion.


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