When we think of schizophrenia, we often picture a person seeing or hearing things that are not actually there. In popular culture, characters like Psycho’s Norma Bates depict a crazed individual who does not fit into the society around them.
Yet the truth of schizophrenia is that it is a real mental illness suffered by millions of americans.
At its core schizophrenia is about losing touch with reality. While untreated schizophrenia can impact a person’s quality of life and ability to function, there are several ways to attain support and receive helpful treatment.
What is Schizophrenia?
The National Institute of Mental Health defines schizophrenia as “a serious mental illness that affects how a person thinks, feels, and behaves” (Schizophrenia, n.d.) This mental disorder affects 20 million people around the world with men tending to show symptoms earlier in life.
The typical age of onset schizophrenia is late adolescence, which researchers believe may be due to the vulnerability of the brain during this essential development period (Gogtay et al., 2011). The earlier the age of onset, the worse the outcomes are for a person with schizophrenia. A meta-analysis found that those who develop schizophrenia earlier in life end up in the hospital more often and experience more negative symptoms, more relapses, and poorer social/ occupational functioning (Immonen & Jääskeläinen, 2017).
Some symptoms of schizophrenia may include:
- Distorted thinking
- Altered perception
- Disorganized emotions
- Changes in sense of self and behavior
- Hallucinations: Seeing or hearing things that are not present
- Delusions: fixed false beliefs unshared by others
How schizophrenia impacts a person’s ability to perceive the world makes it a very difficult mental illness to live with. It can affect a person’s ability to perform necessary daily functions, and often impacts occupational performance (Schizophrenia, n.d.).
A Brief History of Schizophrenia
In the past, schizophrenia was often misunderstood as a “spiritual affliction” or a sign of evil (Lieberman & Dishy, 2021). While schizophrenia is neither new nor rare, it has been predominantly studied throughout the past two centuries.
The word “schizophrenia” comes from Greek roots of “schizein”, meaning to split, and “phrē”, which means mind (Miller, n.d.). When first used by Eugen Bleuler in 1908, the term was adopted to describe the disruption and separation of thoughts, emotions, functioning, and perception that people with the disorder experience.
Previously, the concept of schizophrenia was associated with the notion of split personality in the general public. Later, “split personality” was recognized as a distinct mental health illness, and it was later renamed “multiple identity disorder.” (lumen learning, n.d.).
In the 1930s, psychosurgical techniques to remove brain tissue or pathways were the earliest forms of attempted treatment. Shock therapies were also introduced to induce seizures which were thought to cure the disorder. The development of the first atypical antipsychotic medication in the 1950s drastically altered the course of treatment.
Since then, technology has advanced tremendously. Thanks to neuroimaging and computational methodology, we’ve been able to make substantial advances in understanding schizophrenia (Lieberman & Dishy, 2021). The definition and criteria for schizophrenia remained the same between the DSM-IV and DSM-V because of its validity and reliability.
OCD vs Schizophrenia
Obsessive-compulsive disorder and schizophrenia are two separate mental health disorders. When a person has OCD, they generally have unwanted thoughts, ideas, or sensations, which they may attempt to alleviate by performing certain behaviors or “compulsions” (Psychiatry.org, n.d.). A person can be diagnosed with either one without having the other. Even so, schizophrenia and OCD may co-occur.
It is estimated that 1% of the US population has OCD (NIMH, n.d). However, when examining people with schizophrenia, 25% present OC symptoms, and 12% have OCD (Scotti-Muzzi and Saide 2017). For those who obtain a diagnosis for both, OCD symptoms tended to be the first sign of a mental health issue (Schirmbeck & Zink, 2013).
The major difference between schizophrenia and OCD is delusions vs obsessions. Delusions are false beliefs that often make a person feel as though they are extraordinary in some way (APA Dictionary of Psychology, n.d.). On the other hand, obsessions are often related to things like cleanliness or asymmetry (APA Dictionary of Psychology, n.d.). Those with obsessions tend to be aware of their irrational thinking but unable to control their impulses.
The high co-occurrence rate has lead to a proposal of “schizo-obsessive disorder”, where a patient has symptoms of both disorders. Both disorders present in late adolescence, and both are associated with imbalances of the neurotransmitters dopamine and serotonin (Afshari et al., 2015). This diagnosis has not been added to the DSM.
Can Trauma Cause Schizophrenia?
Trauma is often associated with mental illness, and many people suggested it played a role in schizophrenia even before studying the relationship. Childhood trauma is a risk factor for schizophrenia (Schäfer & Fisher, 2011).
Population-based studies found a clear relationship between childhood trauma and psychosis, even when adjusting for other variables. Some forms of childhood trauma that have been studied include sexual abuse, physical abuse, emotional abuse, and neglect.
However, the mechanism underlying the relationship is still poorly understood. There are several potential pathways including:
- Negative self-perceptions
- Negative affect
- Biological mechanism
- Increased sensitivity to stress
- Irregulated cortisol
Can PTSD Cause Schizophrenia?
People with schizophrenia have a higher frequency of PTSD than the average population (OConghaile & DeLisi, 2015). PTSD, or post-traumatic stress disorder, occurs after exposure to an “actual or threatened death, serious injury, or sexual violence.” After the traumatic event, the person may experience recurring, intrusive distressing memories, dreams related to the event, dissociative reactions (like flashbacks), psychological distress, and/ or physiological reactions. They also actively avoid stimuli associated with the event and experience negative changes in cognition or mood (DSM-5 Diagnostic Criteria for PTSD – Trauma-Informed Care in Behavioral Health Services – NCBI Bookshelf, n.d.).
While both schizophrenia and PTSD have a variety of genetic and environmental risk factors, the genes associated with PTSD overlap with those associated with an increased risk of developing schizophrenia. PTSD does not cause schizophrenia, but it can co-occur due to similar risk factors (OConghaile & DeLisi, 2015).
Coping Strategies for Auditory Hallucinations
70% of people with schizophrenia experience auditory hallucinations (Turkington et al., 2016). For many, hearing voices may be distressing. Auditory hallucinations may lead to feelings of anxiety, anger, and/or shame. They can also make social functioning more difficult, which may lead to social avoidance. Unfortunately, this can lead to unhealthy coping strategies, which are distraction-based techniques. Some coping strategies that may lead to more distress include (Turkington et al., 2016):
- Drawing out the auditory hallucinations
- Shouting back to the voices
- Focusing on the voices through mindfulness
An assessment of the person’s current coping strategies can help determine a more effective course of action. Some examples of effective distraction strategies include:
- Listening to music at a low volume (ideally lyrical and slowly paced)
- Playing a musical instrument, because this engages the brain creatively
- Animal therapy, like playing with a pet
- Watching non-distressing TV
- Deep breathing exercises to mitigate anxiety
Being Woken Up By a Whisper
Hallucinations that occur when waking up are called “hypnopompic hallucinations” These hallucinations can occur in people without psychosis during a sleep paralysis episode (Teeple et al., 2009).
Hypnopompic hallucinations only occur when waking up, whereas hallucinations associated with schizophrenia can occur at any time. Furthermore, those who have hypnopompic hallucinations tend to know that their experience is not real, but those with schizophrenia struggle to distinguish between reality and their hallucinations.
What is the Relationship Between Schizophrenia & Serotonin?
Serotonin is a neurotransmitter. Along with dopamine, it is linked to some symptoms of schizophrenia. However, the understanding of the relationship between schizophrenia and serotonin has changed drastically over time.
While the research so far about how serotonin affects schizophrenia is inconclusive, “it appears that 5HT findings may be related to certain features of Type II schizophrenia such as negative symptoms” (Bleich et al., 1988).
Patients with chronic schizophrenia presented elevated serotonin levels, suggesting that serotonin dysfunction may be related to the “negative symptoms” of schizophrenia such as social withdrawal, blunt affect, and cognitive function.
What is Residual Schizophrenia?
In Residual schizophrenia, a person had an episode but no longer experienced disorganized speech/behavior, delusions, or hallucinations. Instead, the residual symptoms are the negative symptoms which include avolition or flat affect. People with residual schizophrenia may also experience reduced positive symptoms, including odd beliefs (Residual Schizophrenia (Concept Id: C0036351) – MedGen – NCBI, n.d.).
Losing Touch with Reality – When to Be Concerned
Psychosis is defined by losing touch with reality, which is why it can be so frightening for both the person experiencing it and their loved ones (NIMH » Understanding Psychosis, n.d.). Over time, losing touch with reality can become disruptive, affecting your ability to work, foster positive relationships, and enjoy life.
Changes in behavior often precede the development of psychosis or schizophrenia. Some of the top warning signs for psychosis include:
- Difficulty communicating
- A sudden decrease in the job or school performance
- Inability to separate fantasy from reality
- Reduced hygiene or personal care
- Social withdrawal, spending more time alone
- Suspiciousness of others
- Strange feeling
- Overly-intense new ideas
What to Do if You are Experiencing Abnormal Sensations or Thoughts
Abnormal thoughts and experiences may be difficult to share with others. While psychosis is not always connected with a mental health condition, it may be a symptom of schizophrenia or another condition.
According to Stephan Taylor, M.D., the team lead at Michigan Medicine who specializes in early care for psychosis, “ since these symptoms most often start in the teen and young adult years, when the brain is changing and maturing, early action can make a major difference” (Gavin, n.d.)
Seeking out early care can help those experiencing psychosis get the treatment they need. 75% of those who get effective help early on can relieve their symptoms. Many people go over a year without receiving the treatment they need for psychosis. Seeking out professional help ensures you get a treatment plan that’s right for you as soon as possible (NIMH » Understanding Psychosis, n.d.).
Seeking out treatment early is important for reducing the negative impact and improving quality of life. Earlier treatment often leads to better recovery.
Schizophrenia is a serious mental illness that involves a separation from reality. People with schizophrenia experience psychosis, including delusions and/or hallucinations, but they may also experience a variety of negative symptoms like flat affect.
Hallucinations can be upsetting and disturbing for those with schizophrenia. Understanding the most effective coping techniques can help a person to remain calm and move past their hallucinations.
Warning signs present before psychosis, and early intervention is critical for the best possible outcome. If you or someone you know presents any of the early warning signs, it’s important to seek out help as soon as possible.
The information above is intended for information purposes only. The information is not medical or professional advice. For diagnosis or treatment of any mental illness, consult a professional.
Afshari, P., Myles-Worsley, M., Cohen, O. S., Tiobech, J., Faraone, S. V., Byerley, W., & Middleton, F. A. (2015). Characterization of a Novel Mutation in SLC1A1 Associated with Schizophrenia. Molecular Neuropsychiatry, 3, 125–144. https://doi.org/10.1159/000433599
APA Dictionary of Psychology. (n.d.-a). APA Dictionary of Psychology. Retrieved August 8, 2021, from https://dictionary.apa.org/delusion
APA Dictionary of Psychology. (n.d.-b). APA Dictionary of Psychology. Retrieved August 8, 2021, from https://dictionary.apa.org/obsession
Bleich, A., Brown, S.-L., Kahn, R., & van Praag, H. M. (1988). The Role of Serotonin in Schizophrenia. Schizophrenia Bulletin, 2, 297–315. https://doi.org/10.1093/schbul/14.2.297
Causes – Schizophrenia – NHS. (12 C.E.). Nhs.Uk. https://www.nhs.uk/mental-health/conditions/schizophrenia/causes/
Exhibit 1.3-4, DSM-5 Diagnostic Criteria for PTSD – Trauma-Informed Care in Behavioral Health Services – NCBI Bookshelf. (n.d.). National Center for Biotechnology Information. Retrieved August 8, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK207191/box/part1_ch3.box16/
Gavin, K. (n.d.). Distorted Reality: What to Do About Early Signs of Psychosis. Health & Wellness Topics, Health Tips & Disease Prevention. Retrieved August 8, 2021, from https://healthblog.uofmhealth.org/brain-health/distorted-reality-what-to-do-about-early-signs-of-psychosis
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet; 2018 (https://doi.org/10.1016/S0140-6736(18)32279-7).
Gogtay, N., Vyas, N. S., Testa, R., Wood, S. J., & Pantelis, C. (2011). Age of Onset of Schizophrenia: Perspectives From Structural Neuroimaging Studies. Schizophrenia Bulletin, 3, 504–513. https://doi.org/10.1093/schbul/sbr030
Gururajan, A., Manning, E. E., Klug, M., & van den Buuse, M. (2012). Drugs of abuse and increased risk of psychosis development. Australian & New Zealand Journal of Psychiatry, 12, 1120–1135. https://doi.org/10.1177/0004867412455232
Immonen, J., & Jääskeläinen, E. (2017, April). Age at onset and the outcomes of schizophrenia: A systematic review and meta‐analysis. PubMed Central (PMC); Early Intervention in Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724698/
Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annual Review of Clinical Psychology, 2014;10, 425-438.
Lieberman, J., & Dishy, G. (2021, February 1). Milestones in the History of Schizophrenia. A Comprehensive Chronology of Schizophrenia Research: What Do We Know and When Did We Know It. Psychiatric News. https://psychnews.psychiatryonline.org/doi/10.1176/appi.pn.2021.1.7
Miller, S. (n.d.). History of schizophrenia | Abnormal Psychology. Lumen Learning – Simple Book Production. Retrieved August 8, 2021, from https://courses.lumenlearning.com/hvcc-abnormalpsychology/chapter/history-of-schizophrenia/
NIMH » Schizophrenia. (n.d.). NIMH » Home. Retrieved August 8, 2021, from https://www.nimh.nih.gov/health/topics/schizophrenia/
NIMH » Understanding Psychosis. (n.d.). NIMH » Home. Retrieved August 8, 2021, from https://www.nimh.nih.gov/health/publications/understanding-psychosis/
Obsessive Compulsive Disorder (n.d.) national Institute of Mental Health. Retrieved October 26, 2021, from ttps://www.nimh.nih.gov/health/statistics/obsessive-compulsive-disorder-ocd
OConghaile, A., & DeLisi, L. E. (2015). Distinguishing schizophrenia from posttraumatic stress disorder with psychosis. Current Opinion in Psychiatry, 3, 249–255. https://doi.org/10.1097/yco.0000000000000158
Residual schizophrenia (Concept Id: C0036351) – MedGen – NCBI. (n.d.). National Center for Biotechnology Information. Retrieved August 8, 2021, from https://www.ncbi.nlm.nih.gov/medgen/20665
Schäfer, I., & Fisher, H. (2011). Childhood trauma and psychosis – what is the evidence? Trauma, Brain Injury, and Post-Traumatic Stress Disorder, 3, 360–365. https://doi.org/10.31887/dcns.2011.13.2/ischaefer
Schirmbeck, F., & Zink, M. (2013). Comorbid obsessive-compulsive symptoms in schizophrenia: contributions of pharmacological and genetic factors. Frontiers in Pharmacology. https://doi.org/10.3389/fphar.2013.00099
Schizophrenia. (n.d.). WHO | World Health Organization. Retrieved August 8, 2021, from https://www.who.int/news-room/fact-sheets/detail/schizophrenia
Turkington, D., Lebert, L., & Spencer, H. (2016). Auditory hallucinations in schizophrenia: helping patients to develop effective coping strategies. BJPsych Advances, 6, 391–396. https://doi.org/10.1192/apt.bp.115.015214
Teeple, R. C., Caplan, J. P., & Stern, T. A. (2009). Visual hallucinations: differential diagnosis and treatment. The Primary Care Companion to The Journal of Clinical Psychiatry, 1, 26–32. https://doi.org/10.4088/pcc.08r00673
Winklbaur, B., Ebner, N., Sachs, G., Thau, K., & Fischer, G. (2006). Substance abuse in patients with schizophrenia. Dialogues in Clinical Neuroscience, 1, 37–43. https://doi.org/10.31887/dcns.2006.8.1/bwinklbaur