Understanding schizophrenia

Lots of people have heard of schizophrenia. But it's still very misunderstood. We're here to help explain this complicated mental health problem.

The onset of schizophrenia for me was sudden and dramatic. Though it followed a period of depression and acute stress. A really compelling and powerful voice started to try to control me.

What is schizophrenia?

'Schizophrenia' is a controversial mental health diagnosis related to psychosis.

But there's no clear definition of what this condition is. People given this diagnosis can have very different symptoms to each other. And these symptoms might be explained in a wide range of ways.

So there's lots of debate and disagreement about schizophrenia.

Because of this, some experts say that doctors shouldn't use this diagnosis anymore.

Especially because it can be a stigmatising and difficult label to live with.

But others still find it a useful diagnosis to convey how hard it can be to live with certain symptoms. And to help people get support and care.

What is paranoid schizophrenia?

'Paranoid schizophrenia' is an outdated term.

Schizophrenia used to be split up into lots of different diagnoses. One of these was 'paranoid schizophrenia'. So you might have been given this diagnosis in the past. And you might still hear people use this term in the news and media.

But schizophrenia isn't diagnosed this way anymore. It's just called schizophrenia.  

What are the symptoms of schizophrenia?

Many experiences and behaviours can be part of schizophrenia.

Each person's experience is unique.

But a doctor might say you have schizophrenia if you experience some of the following for at least 1 month:

• Delusions – strong beliefs that others don't share
• Hallucinations, such as hearing voices or seeing things that others don't
• Disorganised thinking and speech
• Being unable to express emotions, or feeling disconnected from them
• Difficulty concentrating
• Lack of interest or enjoyment in things
• Avoiding other people, including friends and family

You might also find it difficult to continue with day-to-day activities. Like going to work or taking care of yourself.

Schizophrenia symptoms can start suddenly, or they might develop gradually over time.

Most people who get a schizophrenia diagnosis are between 18 and 35 years old. But symptoms can happen at any age.

Positive and negative symptoms

You might hear doctors talk about schizophrenia symptoms as being positive and negative. But this doesn't mean good or bad.

• Positive symptoms are thoughts and feelings it adds to your everyday experiences. This might include hearing or seeing things that others don't. Or believing that something is real or true when it isn't.
• Negative symptoms are thoughts and feelings it takes away from your everyday experiences. You might have a lack of interest in things, be less able to express emotion, or not want to talk to others.

Some symptoms of schizophrenia might affect your ability to drive. Our fitness to drive page has more information.

I began to feel I wasn't in connection with the current world. I started to hear things in my head. Disturbing voices were telling me: 'Oh boy, you belong to me. You're the son of the devil.'

Common myths about schizophrenia

There's a lot of misinformation in the media about schizophrenia. Stories in the news, in films and on TV might be sensationalised for drama. They can be misleading. And sometimes false.

Some people may have negative or outdated ideas about schizophrenia. They may make assumptions about you that aren't true.

The truth is:

• It doesn't mean you have a 'split personality' or 'multiple personalities'. Experiences like this are a part of dissociative identity disorder (DID). But schizophrenia isn't anything to do with personality or identity.
• It doesn't mean that someone will be dangerous or violent. Most people with schizophrenia do not commit violent crimes. Some research suggests that the risk is slightly higher among people who have this diagnosis than people who don't. But it's not clear that schizophrenia is the cause. Evidence shows that factors like drug and alcohol misuse are far more likely to play a part in violence.

People with schizophrenia are more likely to be victims of crime – or to harm themselves – than to harm someone else.

You might worry about having a label of schizophrenia, and the stereotypes. You might see yourself negatively too because of this stigma.

Remember that these wrong assumptions are often due to a lack of knowledge. Or bad information. You deserve support and respect.

For tips on how to cope with stigma see our page on stigma and misconceptions.

Movies and television would have you believe that having schizophrenia is a one-way ticket to a lifetime of loneliness and violent outbursts.

How is schizophrenia diagnosed?

Diagnosing schizophrenia is complicated. There's no straightforward test for schizophrenia. But if you're experiencing symptoms, it's important to talk to your doctor.

They can refer you to a psychiatrist or psychologist, who will assess you. They should ask you questions about how your symptoms impact your day-to-day life. And they should look at your physical health too.

If they give you this diagnosis, they should refer you to a community mental health team (CMHT). You can find more information about community mental health teams in our page on mental health support services. 

Problems with diagnosing schizophrenia

Schizophrenia can be problematic to diagnose, and can be misdiagnosed.

For example, many other conditions share overlapping symptoms with schizophrenia.

These include:

• Schizoaffective disorder
• Bipolar disorder
• Depression with psychotic symptoms – where psychosis can happen alongside severe depression

So doctors might find it hard to decide which diagnosis fits you best.

Also, one of the most common symptoms of schizophrenia is psychosis. But psychosis doesn't always mean you have schizophrenia. It's possible to have an episode of psychosis without meeting the criteria for a diagnosis of schizophrenia.

It's also possible that you can have more than one diagnosis at once.

If you're worried that your diagnosis of schizophrenia is wrong, talk to your mental health team.

Our pages on seeking help for a mental health problem have information on how to make sure your voice is heard.

Racial inequality and discrimination in schizophrenia diagnosis

Another issue with diagnosing schizophrenia is racial inequality.

Black people are more likely to have a schizophrenia diagnosis than white people. But there's no evidence that being Black makes you biologically more likely to have these symptoms.

Reasons for the diagnosis may include:

• Differences in life experiences. Black people in the UK are more likely to have experience of some types of adversity. Like discrimination, racism, social deprivation and migration (having to move to a new place or culture). These kinds of highly stressful life experiences may trigger symptoms of schizophrenia.
• Differences in access to early support, before problems become more severe.
• Unconscious bias and lack of cultural competence among doctors. Some doctors may interpret similar symptoms differently in Black patients and white patients. They may make assumptions based on racial stereotypes. This may lead them to diagnose schizophrenia more often in Black people.

Mind is working to remove inequality of opportunity in the mental health sector. Read about our equality work and our campaigns. You can become a campaigner for a fairer system.

I could sense fear in the behaviour of white professionals. I saw how they activated the stereotypes of my past in their minds. They told me I was dangerous, unpredictable, dysfunctional, and angry.

What causes schizophrenia?

The symptoms of schizophrenia could have a range of causes and explanations. There's a lot that researchers still don't know.

But schizophrenia symptoms are likely to be caused by a combination of factors.

These factors will be different for everybody. These could be personal, environmental and inherited. This may include some of the following:

Stressful life events

Highly stressful or life-changing events may sometimes trigger symptoms. These can include:

• Abuse or harassment
• Losing someone close to you
• Being unemployed
• Loneliness or isolation
• Money problems
• Homelessness

Sometimes stressful events like these can be traumatic.

For more information see our pages on trauma.

Cannabis and other drugs

Some people may develop symptoms of schizophrenia after using drugs. Most research is on cannabis. There is also research on some other drugs like LSD and cocaine.

Researchers still aren't sure whether using drugs directly causes these symptoms. And other factors, like previous experiences of psychosis and how long you have used drugs for, seem to play a role as well. Using high-potency cannabis (skunk) might also increase risk.

But there's evidence that using recreational drugs can make symptoms worse.

If you're currently dependent on recreational drugs or alcohol, help is available. Visit our page on support for recreational drugs and alcohol problems for more information.

Family inheritance

You're more likely to have symptoms of schizophrenia if you have a parent or sibling who has the same symptoms.

Researchers aren't yet sure why this is. But they think that some genes might make it more likely.

Birth complications

For some people, symptoms of schizophrenia might be linked to complications before or during your birth.

These include:

• Not enough oxygen getting to your body
• Being born at a low birth weight
• If your birth mother had infections during pregnancy

These complications might impact the way your brain develops. 

Brain differences

Some researchers think that some symptoms might be due to differences in the brain. This includes the way the brain develops. And levels of certain brain chemicals.

But researchers don't agree on how this works. And these differences don't explain all symptoms of schizophrenia.

What's it like living with schizophrenia?

Watch Miles talk about his experience of living with schizophrenia.

Talking about schizophrenia

Watch Alice, Brian, Jamie, Martin and Louise talk about their experiences of living with schizophrenia.

Finding support for schizophrenia 

There's no quick and simple treatment for schizophrenia. You might find your symptoms never go away completely. Everyone is different.

But with the right self-care, treatment and support it is possible to manage your symptoms.

So if you get this diagnosis, it might help to think of it as a way to get treatment and support. Not as a definite condition or label that you must live with forever.

Our pages on coping and self-care tips for schizophrenia and treatment for schizophrenia have more information.