There are five main symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized movements, and negative symptoms, which refers to a loss of ability you previously had, such as a new lack of emotional expression.
These symptoms fall into one of several broader categories, per the American Psychiatric Association (APA): positive symptoms (those which are abnormally present), negative symptoms (those which are abnormally absent), and disorganized symptoms.
These symptoms may vary in type and severity and can change over time. They usually first appear in a person’s late teens through early thirties, according to the National Institute of Mental Health (NIMH).
To be diagnosed with schizophrenia, a person must have at least two of the five main symptoms, according to Cleveland Clinic.
Positive Symptoms of Schizophrenia
People with schizophrenia may display psychotic symptoms, meaning they become detached from reality or experience the world in distorted ways.
These symptoms can be particularly troubling for friends and family.
These are what doctors call “positive” symptoms — characteristics or behaviors that are abnormally present. While schizophrenia is one potential cause of psychosis, there can be other causes, such as dementia, bipolar disorder, or substance use disorder, which is part of why diagnosing schizophrenia can be challenging.
Positive symptoms of schizophrenia include the following.
Hallucinations
This is when a person hears, sees, smells, or feels things that aren’t really there.
Auditory hallucinations — hearing sounds or “voices” that are not really there — are the most common type of hallucination in people with schizophrenia.
This could come in the form of hearing a clear voice or hearing many less-clear voices, like the noise on a busy subway. Other types of auditory hallucinations include music, nature calls, or animal calls, per Cleveland Clinic.
Visual hallucinations are less common in schizophrenia and occur more in neurological illnesses, such as certain forms of dementia, but they tend to be vivid and colorful, and may include scenes with family members, religious figures, or animals, past research has noted.
Delusions
These are beliefs that a person with schizophrenia is completely convinced are true, but that are very clearly illogical or untrue to those around them. For example, a person with schizophrenia may believe they’re being watched by another person, followed by the government, or that people on television are sending messages directly to them and require a certain response.
Many people with schizophrenia may have paranoid delusions, believing that others are trying to harm or plot against them. Paranoid delusions can make it difficult for a person with schizophrenia to cooperate with treatment, research shows.
Negative Symptoms of Schizophrenia
Other schizophrenia symptoms are sometimes referred to as “negative” symptoms. This means that the usual and expected ways for someone to interact with their surroundings are abnormally absent. Negative symptoms of schizophrenia can include:
- Becoming withdrawn and disinterested in daily social interactions
- Speaking little, even when forced to interact
- Lack of emotional expression when talking (the face may not move, and the voice may be dull and monotonous)
- Lack of pleasure in activities
- Difficulty focusing or paying attention
- Difficulty using information to make decisions
- Neglecting physical appearance or hygiene
- Severe lack of energy
Disorganized Symptoms of Schizophrenia
These symptoms involve confused and disordered thinking and speech, difficulty with thinking logically, and abnormal movements.
Disorganized Thinking and Speaking
People with schizophrenia may have trouble organizing their thoughts in a logical pattern. Disorganized thinking manifests as disorganized speech. As a result, people with schizophrenia may talk in a jumbled way that’s difficult to understand.
In rare cases, someone with schizophrenia may put together sentences containing random words with no decipherable meaning to those around them — sometimes known as “word salad,” according to Mayo Clinic.
Unusual Body Movements
People with schizophrenia may make unusual movements ranging from agitation to purposeless repetitive movements, states the APA.
When severe, these movements can interfere with the activities of daily living. Antipsychotic medications taken to treat schizophrenia can cause tardive dyskinesia, a neurological syndrome that causes involuntary movements.
Cognitive Symptoms of Schizophrenia
In addition to positive, negative, and disordered symptoms, cognitive symptoms of schizophrenia are very common. These symptoms include difficulties with memory, attention, concentration, and educational performance, per the APA.
Someone who’s experiencing cognitive symptoms of schizophrenia may struggle with:
- Working memory (short-term memory that allows someone to remember information while working on a task, such as instructions)
- Processing speed
- Planning
- Reasoning
- Problem-solving
Cognitive problems among people with schizophrenia are known to significantly affect their ability to stay employed, live independently, and function in social settings.
