Schizophrenia

Written by Ellen Hoggard

Ellen Hoggard

Counselling Directory Content Team

Head of Content

Last updated on 22nd December, 2021

Schizophrenia is a mental health condition that affects people’s ability to think clearly and decipher fantasy from reality. This can lead those affected to become withdrawn, feel confused and lose interest in their day-to-day life.

It is estimated that around one in 100 people are living with Schizophrenia. The condition 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

Here we will look at the causes and symptoms of schizophrenia. We’ll also explore the stigma, common misconceptions, and how talking therapies can help.


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 the individual or their loved ones to realise anything is wrong. However, when offered the right support, the majority of those with schizophrenia will lead fulfilling lives. 

Most people living with schizophrenia will experience symptoms either chronically or episodically throughout their lives. The stigma and lack of knowledge around conditions like this can result in discrimination. These misunderstandings can 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 are largely unknown, however, 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 traumatic life events. Some groups can also be affected more than others, for example studies suggest Black people in the UK are more likely to be diagnosed with schizophrenia.

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. Some studies have indicated that certain factors can increase the risk of developing schizophrenia. These can include:

Genetics

The condition 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. 

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.


Schizophrenia symptoms

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

Early warning signs of schizophrenia include:

  • 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 and 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.

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

Positive symptoms

“Positive symptoms” refer to symptoms that the condition adds to the person’s life, including the following:

Delusions – A common symptom, delusions are beliefs the person with schizophrenia holds, despite 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 aren’t real, or hear voices that aren’t heard by anyone else. Hearing voices is the most common form of hallucination. The voice(s) can be pleasant or mean and may issue orders to the individual, hold a conversation or provide warnings of danger.

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. They may find that they do not know who they are and lose their sense of self.

Negative symptoms

These refer to symptoms that take away from a person’s life. 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 lacking 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.

One symptom does not identify 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 doctor will assess all the symptoms the individual is experiencing, consider the person’s history and observe the course of the illness over a six-month period to determine a diagnosis.

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.

Forms of schizophrenia

There are different forms of schizophrenia, with each type having its own key characteristics.

Paranoid schizophrenia

The most common form of the condition. 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.


Schizophrenia treatment

Talking therapies and antipsychotic medication are generally used to manage the symptoms of schizophrenia. While it is possible for a full recovery, it should not be expected. It is common for people with the condition to experience symptoms throughout their lives.

Common psychotherapy treatments include:

Cognitive behavioural therapy (CBT)

CBT can be an effective therapy for schizophrenia. It can teach the individual how to manage stress and 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 to promote creative expression. It can be an effective treatment for individuals with schizophrenia with studies showing art therapies to be effective in alleviating 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. 

Family therapy

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


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

Therapists who can help with schizophrenia

Common misconceptions of 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 publicity often highlights images of frightening behaviour and violence that have contributed to a negative stereotype associated with schizophrenia. However, research has shown that people with the condition are not prone to violence.

The stigma attached to the disorder can make it hard for the individual to manage. Families might 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.


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

When living with schizophrenia, it is important to ensure you get plenty of sleep. 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. 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. Ask 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.


Further help

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