Schizophrenia is a mental illness that affects the sufferer’s ability to think clearly and decipher fantasy from reality. As a result of this, the individual can start to become withdrawn, feel confused and lose interest in their normal, daily life.

It is estimated that around one in 100 people are living with Schizophrenia. The disorder affects both men and women, usually in early adulthood. Common symptoms can include:

  • emotional disconnection
  • avoiding people
  • lack of concentration
  • hallucinations
  • delusions and hearing voices
  • feeling the need for protection.

This fact-sheet will look at the causes and symptoms of schizophrenia. We will explore the stigma, common misconceptions of the disorder and how a counsellor may help.

What is Schizophrenia?

Schizophrenia is a relatively common illness. It may develop gradually, making it difficult for the individual or their loved ones to realise anything is wrong. Often family members find coping with the symptoms hard. They have a clear memory of how the person was before becoming unwell, so it can be upsetting.

Most people living with the disorder will suffer either chronically or episodically throughout their lives. They may endure terrifying symptoms. Symptoms may include hearing voices; paranoia or believing others can read their thoughts. However, if getting the right support and help, the majority of those who experience the illness will lead normal, fulfilling lives.

The stigma and lack of knowledge can result in discrimination. These misunderstandings can often make it more difficult for people with the illness to speak up and seek the support they need.

Causes of schizophrenia

The causes of schizophrenia remain unknown. Many believe it is a combination of genetic, environmental and behavioural factors.

Some people may be more at risk and can develop the illness as a result of a traumatic life event. This 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. Some studies have indicated that certain factors can increase the risk of developing schizophrenia. These can include:

Genetics – The disorder has a tendency 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. But it does suggest that schizophrenia may be a slight disorder of the brain.

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, a low birth weight or asphyxia (lack of oxygen) during birth.

Early warning signs

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

The list of early warning signs is not exhaustive. None of the above symptoms alone constitutes the disorder. If several signs are present and lasting for a long period of time, it is recommended to see a professional.

Treatment of schizophrenia

Unfortunately, there is no known cure. However, antipsychotic medication and psychotherapy are used to control and manage the symptoms of schizophrenia. A psychotherapist will be able to help individuals cope with the positive symptoms ('positive' symptoms are those experienced in addition to reality). While it is possible for a full recovery, it should not be expected. It is common for people with the disorder to experience symptoms throughout their lives.

Psychotherapy is most effective when combined with medication, common treatments include:

Cognitive behavioural therapy (CBT) – This can be an effective therapy for schizophrenia. It can teach the individual how to manage stress, the side effects of any medication. It can also help to manage related issues such as anxiety and depression. The therapist may recommend CBT and work with the individual to devise coping strategies. This will help them deal with any positive symptoms of psychosis.

Art therapy – Art therapy is designed with the aim of promoting creative expression. It can be an effective treatment for individuals with schizophrenia. Studies have found that art therapies have been effective in alleviating many individuals’ negative symptoms of schizophrenia (symptoms that involve loss of ability and enjoyment in life). It can be a way for people to express themselves through art, rather than vocally. Often this can help to ease symptoms.

Family therapy – A counsellor/psychotherapist may recommend meetings with loved ones. Many people with the disorder require the care and support of family members. Family therapy can be an effective way to help both the sufferer and their family. The therapist will teach them coping techniques, ways to offer support and how to manage stress.

Symptoms of schizophrenia

Schizophrenia can develop gradually. The initial indications of the illness such as becoming unresponsive, withdrawn and a change in sleeping patterns can be difficult to identify. These symptoms are often overlooked. They can develop during a person’s teenage years and therefore can be mistaken as a “phase”.

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

Positive symptoms

“Positive symptoms” or “psychosis” are terms used to refer to a change in the individual’s thoughts of behaviour.

Delusions – A common symptom, delusions are beliefs the sufferer holds, despite obvious evidence that they are not real. These cause the individual to believe that others are plotting against them. They may think others are reading their thoughts and observing their actions.

Hallucinations – Hallucinations are another common symptom. The sufferer may see visions that are not real, or hear voices that are not heard by anyone else. Hearing voices is the most common form of hallucination. The voice may issue orders to the individual, hold a conversation or provide a warning of danger.

Disorganised thinking – Many sufferers of schizophrenia have trouble processing and organising their thoughts. This often results in their speech, emotions and behaviours becoming confusing and incoherent. The individual may begin to move more slowly, believing someone else is in control of his/her movements. They may also find that they do not know who they are and lose their sense of self.

Negative symptoms

These refer to symptoms or characteristics you may see in a healthy person. It can often be difficult to distinguish whether these symptoms are caused by schizophrenia or another illness.

  • A lack of motivation or interest in life is a symptom of the disorder but is easily mistaken for laziness. The sufferer will have little energy, therefore unable to do much physical activity.
  • Feelings of despair and depression can develop as a result of the individual seeing a hopeless future.
  • Flatness or lacking expression is a common negative symptom of schizophrenia. 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 is also a negative symptom; the individual can often find it easier to be alone.

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 the more difficult.

Forms of schizophrenia

There are different forms of schizophrenia. Each type has its own key characteristics.

Paranoid schizophrenia

The most common form of the disorder. Sufferers may experience prominent delusions and/or hallucinations. However their emotions and speaking ability may be unaffected. This form can develop at a later age than other types.

Catatonic schizophrenia

This is a rare form of schizophrenia. The individual may make unusual movements, switching from stillness to over-activity. You may find they do not speak at all.

Hebephrenic schizophrenia

Individuals with hebephrenic schizophrenia may suffer fleeting delusions and hallucinations. Thoughts and behaviour are often disorganised. This form commonly develops between the age of 15 and 25.

Common misconceptions

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 two personalities.

There are many misconceptions surrounding the term schizophrenia. It has lead to much confusion and as schizophrenia is not well understood, it can be feared. Media publicity often highlights images of frightening behaviour and violence that have contributed to this stereotype. However, research has shown that people with the disorder are not especially prone to violence.

The stigma attached to the disorder makes it hard for the individual to manage. Often, families will try to hide the illness, fearing they may be to blame. Research has found that families affected by the disorder agree that blame was a huge barrier to seeking or receiving the support needed.

According to the World Health Organisation (WHO), schizophrenia affects over 21 million people worldwide.

One symptom does not identify schizophrenia. All the symptoms of this disorder can also occur in other mental disorders. At times, it can be difficult to distinguish between each illness. However, a doctor will assess all the symptoms the individual is experiencing. They will consider the sufferer’s history and observe the course of the illness over a six-month period to determine a diagnosis.

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 disorder 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 physical health - When living with schizophrenia, it is important to ensure you get plenty of sleep. If you are struggling to sleep, it will become more difficult to cope with symptoms and manage your feelings of worry. Eating a balanced diet can help you to feel healthier. Eating regular meals and healthy snacks can also help to avoid changes in blood sugar levels, related to psychosis.

Be involved - If you are suffering with schizophrenia, being involved in your treatment can be effective. Try to ask your doctor and therapist about your diagnosis and the treatments available to you. Asking questions about a professional’s opinion and make sure you understand what is happening.

Minimise stress - Being in a stressful situation can increase the chances of illness and can often make symptoms of schizophrenia worse. Try to be aware when you are feeling overwhelmed or need to ask for help.

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

Currently, there are no laws that specify what level of training or qualifications a counsellor needs for treating schizophrenia. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines providing advice about the recommended treatments. These include:

  • Anyone experiencing symptoms of the disorder, or psychotic symptoms should be offered treatment and support at an early intervention service. This service should provide a range of treatments.
  • Treatments include medication and psychological therapy including cognitive behavioural therapy (CBT).
  • People with schizophrenia may also be offered art therapy. This can be effective if symptoms include isolating themselves from family or losing interest in previously enjoyed hobbies.

Read the full NICE guidelines: Schizophrenia

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