Schizophrenia

What is schizophrenia?

Schizophrenia is a relatively common condition that is related to psychosis. Symptoms can include hearing voices and paranoia. It may develop gradually, making it difficult for those affected or their loved ones to realise anything is wrong. However, when offered the right support, the majority of people with schizophrenia lead fulfilling lives.

Schizophrenia affects people of any gender, usually in early adulthood. The stigma and lack of knowledge around conditions like this can result in discrimination. These misunderstandings can make it more difficult for people with schizophrenia to speak up and seek the support they need.

Causes of schizophrenia

The exact causes of schizophrenia are unknown. Research suggests that a combination of physical, genetic, psychological and environmental factors may make someone more likely to develop the condition.

Some people may be more vulnerable to developing schizophrenia, with stressful or traumatic life events sometimes acting as a trigger. There are also inequalities in who is recorded as having schizophrenia. Recent England data show higher recorded prevalence among Black people than other ethnic groups.

Traumatic life events could include redundancy, being bullied, losing your home or the death of a loved one. While these kinds of events will not cause the disorder, the stressful experience can be a trigger. Research has indicated that certain factors can increase the risk of developing schizophrenia. These can include:

Genetics

The condition tends to run in families, though no specific gene is responsible. It is thought that varying combinations of genes can make a person more vulnerable.

Brain development

Studies have shown that people living with schizophrenia have subtle differences in brain structure. These differences aren’t apparent in everyone. 

Birth complications

Research suggests that people who experienced birth complications before or during their birth are more likely to develop the disorder. Complications could include a premature birth, low birth weight or asphyxia (lack of oxygen) during birth.

In this video, counsellor Kayan Houssein, MBACP (Reg.), talks more about schizophrenia and how counselling can help. 

Schizophrenia symptoms

Schizophrenia can develop gradually, and the initial indications can be difficult to identify. As they can develop during the teenage years, they can be mistaken for a “phase”.

Some changes that may occur as schizophrenia develops include:

• difficulty concentrating
• suspicion
• fearfulness
• unusual emotional reactions
• isolation
• difficulty sleeping
• loss of personal hygiene
• staring
• change in behaviour.

Experiencing these changes does not necessarily mean someone has schizophrenia. If you're concerned about changes in your thoughts, feelings or behaviour, consider speaking to your GP.

People can experience a range of symptoms. Usually, professionals will refer to them under two categories:

Positive symptoms

'Positive symptoms' refers to experiences that develop as part of the condition, such as hallucinations or delusions.

Delusions – A common symptom, delusions are beliefs the person with schizophrenia holds, even though there is evidence that they are not real. These can cause the individual to believe that others are plotting against them. They may think people are reading their thoughts and observing their actions, which understandably can be upsetting.

Hallucinations – Hallucinations are another common symptom. The affected person may see things that other people do not or hear voices that aren’t heard by anyone else. Hearing voices is the most common form of hallucination. Voices can be positive, negative or neutral, and everyone's experience is different.

Disorganised thinking – Many of those with schizophrenia have trouble processing and organising their thoughts. This often results in speech, emotions and behaviours becoming confusing and incoherent. 

Negative symptoms

'Negative symptoms' refers to changes where certain abilities or experiences are reduced, such as motivation, emotional expression or interest in everyday activities.

It can often be difficult to distinguish whether these symptoms are caused by schizophrenia or another illness, but they may include:

• a lack of motivation or interest in life
• feelings of despair and depression;
• flatness or lack of expression (expressions may be limited, and the individual may appear to show little emotion; this does not mean emotions are not felt on the inside)
• social withdrawal.

While negative symptoms are, in a way, less dramatic than positive symptoms, they can last longer and vary in severity. Many people living with schizophrenia believe the negative symptoms are more difficult.

Experiencing one symptom does not mean you have schizophrenia. All the symptoms of this condition can also occur in other mental health conditions, and at times, it can be difficult to distinguish between each illness.

A mental health professional will assess the person's symptoms, personal history and circumstances, while considering whether there may be another cause.

To anyone else experiencing schizophrenia, I say: aspire to great things. Aim high and let your creativity provide a cathartic release to all that torments you. Keep your faith strong and confront with vigour all that challenges.

- Read Robert's story.

Common misconceptions about schizophrenia

It is a common assumption that schizophrenia means ‘split personality’, but this is incorrect. The term ‘schizophrenia’ was actually introduced by Swiss psychiatrist Eugen Bleuler. It stands for ‘split mind’ in Greek. Bleuler wanted to convey the split of the personality from reality and not the split into different personalities.

Media portrayals have sometimes reinforced negative stereotypes linking schizophrenia with frightening or violent behaviour. However, research has shown that people with the condition are more likely to be victims of violence.

The stigma attached to the disorder can make it hard for the individual to manage. Families might also try to hide the illness, fearing they may be to blame. 

Schizophrenia treatment

Treatment for schizophrenia usually involves a combination of antipsychotic medication and psychological support, tailored to the person's individual needs.

Psychological therapies recommended by the National Institute for Health and Care Excellence (NICE) include:

Cognitive behavioural therapy (CBT)

CBT can help people understand their experiences and develop ways to cope with symptoms of psychosis. It may also help with related difficulties, such as anxiety and depression. CBT for psychosis and schizophrenia should be delivered by a professional with appropriate training and experience.

Art therapy

Art therapy uses creative expression to explore thoughts and experiences. NICE recommends considering arts therapies for people with psychosis or schizophrenia, particularly to help with negative symptoms, such as a loss of motivation or enjoyment.

Arts therapies should be delivered by an appropriately trained and registered arts therapist with experience of working with people with psychosis or schizophrenia.

Family therapy

Family therapy can help people with schizophrenia and those close to them better understand the condition and find ways to cope and communicate together. It may be particularly helpful when someone is in close contact with family members or carers.

Living with schizophrenia

Many people living with schizophrenia continue to live regular, fulfilling lives even if they continue to experience symptoms. With the right support and treatment, many people can learn to manage the disorder.

Spotting the signs

An effective way to manage the condition is learning to recognise the signs that you are becoming unwell. This can include feelings of anxiety, stress or loss of appetite.

There may also be less obvious symptoms developing. Feeling fearful, suspicious or worrying about people’s motives is common.

Look after your physical health

Looking after your physical health, including getting enough sleep and eating a balanced diet, can support your overall wellbeing. If you are struggling to sleep, it can become more difficult to cope with symptoms and manage your feelings of worry. Eating a balanced diet can help you to feel healthier. 

Be involved

Being involved in decisions about your treatment and support can help you understand the options available and what works best for you. This might include asking your mental health team questions about your diagnosis, treatment or medication and discussing any concerns you have with them.

Minimise stress

Stressful experiences can sometimes make symptoms of schizophrenia more difficult to manage. Recognising situations or experiences that contribute to stress may help you identify when you could benefit from additional support.

Your mental health team can also help you develop strategies for managing stress and recognising signs that you may be becoming unwell.

What should I be looking for in a counsellor or psychotherapist?

If you have schizophrenia, talking therapy may form one part of your wider treatment and support. If you're looking for a therapist, consider asking about their training and experience of working with psychosis and schizophrenia, and whether they can work alongside your wider mental health team.