How to Identify Schizophrenia

Diagnosing schizophrenia is a complex clinical process that has been a topic of much debate in the past. You cannot self-diagnose schizophrenia; instead, you need to consult a clinical expert such as a psychiatrist or a clinical psychologist. Only mental health professionals can make an accurate diagnosis. However, if you suspect that you might have schizophrenia, you can learn about certain symptoms to gain a clearer understanding of the disorder and assess whether you are at risk.

Distinguish the specific symptoms (Criterion A). To diagnose schizophrenia, mental health professionals will first look for symptoms in five categories: delusions, hallucinations, disorganized speech and thinking, disorganized or abnormal motor behavior (including psychological disorders), and negative symptoms indicating reduced behavior expression.

• At least two symptoms must be present. Each symptom should persist for a significant period, typically a month or more (or shorter if treated). At least one of these symptoms must be related to delusions, hallucinations, or disorganized speech.

Recognizing Delusions. A delusion is an illogical belief that often arises when the person perceives a threat, but others do not recognize this danger. The delusion persists even when there is evidence showing it cannot be true.

• There is a difference between delusions and skepticism. Many people occasionally have irrational doubts, like believing a colleague is “intentionally bothering them” or thinking they are “unlucky.” You should differentiate based on the intensity of these beliefs—whether they cause such stress that it affects your ability to work effectively.
• For example, if you believe the government is monitoring you to the point where you are afraid to leave your house for work or school, this could indicate a delusion that is disrupting your life.
• Occasionally, there are very bizarre delusions, like thinking you are a different species or a supernatural being. If you find yourself believing in something that is beyond normal possibility, this could be a sign of a delusion (though not the only possible sign).

Pay attention to whether you experience hallucinations. A hallucination is a sensory experience that seems real, but only exists in your mind. Hallucinations can involve any of the senses: auditory (hearing), visual (seeing), olfactory (smelling), or tactile (feeling sensations like something crawling on your skin). Hallucinations can affect any sense.

• For example, do you frequently feel something crawling on your hand? Do you hear sounds when no one is around? Do you see things that “shouldn’t” be there, or that no one else can see?

Consider religious beliefs and cultural practices. Just because someone believes something others find “strange” doesn’t mean they are delusional. Similarly, seeing things others cannot see isn’t always a harmful hallucination. A belief can only be judged as a “delusion” or harmful when considered within the local religious and cultural practices. A person’s beliefs or perceptions are usually only a sign of mental disorder or schizophrenia if they cause significant disruption in daily life.

• For example, believing that wicked actions will be punished by “karma” or “destiny” may seem delusional to some cultures, but is perfectly normal to others.
• How hallucinations are perceived also depends on cultural norms. For example, children in many cultures might hear voices of deceased relatives or see visions without being considered mentally ill, and they do not continue to experience these symptoms as they grow older.
• Highly devout people are more likely to have unusual experiences, such as hearing the voice of a deity or seeing angels. Many belief systems accept these experiences as real and even desirable, unless they cause distress or harm to the person or others.

Is your speech and thinking disorganized? You should understand “disorganized speech and thinking” in its literal sense. This means that you may find it difficult to answer questions clearly and completely. Your responses are often irrelevant, fragmented, or incomplete. In many cases, disorganized speech is accompanied by helplessness or an unwillingness to make eye contact, or it may involve non-verbal communication, such as gestures or body language. You should ask someone else to observe whether this is happening.

• In severe cases, speech becomes “mixed up,” with thoughts and words unrelated to each other, making it hard for the listener to understand.
• As with other symptoms, you should consider disorganized speech and thinking in the context of the culture and society in which you live. For instance, some belief systems state that people will speak in an incomprehensible language when encountering a divine figure. Additionally, storytelling conventions vary greatly across cultures, and some stories may appear “strange” or “disorganized” to outsiders unfamiliar with the storyteller’s traditions.
• Your speech can only be considered disorganized if others familiar with your cultural and religious practices still cannot understand it (or in situations where your speech “should” be understood).

Identifying Disorganized or Completely Chaotic Behavior. Disorganized or chaotic behavior can present in several ways. You might find it hard to concentrate or unable to complete simple tasks like washing your hands, or become overly agitated, irrational, or exhibit behavior that seems excessively excited or erratic. The motivation behind ‘abnormal’ behaviors may manifest as actions that are inappropriate, unfocused, excessive, or aimless. For example, you might wave your hands wildly or make strange movements.

• Mental disorders are another sign of abnormal behavior. In severe cases of schizophrenia, individuals may sit silently for days without speaking. Those with a mental disorder do not respond to external stimuli, such as conversation prompts or physical contact like touch or nudges.

Assessing Functional Decline. Negative symptoms refer to behaviors that show a ‘decline’ in normal functioning. For example, a reduced emotional expression is a ‘negative symptom,’ as is a loss of interest in things you once enjoyed or a lack of motivation to work, all of which are seen as functional decline.

• Negative symptoms can also affect cognitive aspects, like trouble focusing. Cognitive symptoms are usually more damaging and easier for others to notice compared to the attention deficits commonly seen in people with Attention Deficit Hyperactivity Disorder (ADHD).
• Unlike Attention Deficit Disorder (ADD) or ADHD, cognitive difficulties in schizophrenia occur across many areas of life and create significant challenges.

Assessing Your Work and Social Life (Criterion B). The second criterion for diagnosing schizophrenia is “social/occupational dysfunction.” Dysfunction must occur over a significant period since symptoms first appeared. Many other health issues also lead to dysfunction in work and social life, so struggling in one or more areas of life does not automatically mean you have schizophrenia. One or more “important” areas affected may include:

• Work/School
• Personal Relationships
• Self-care

Think About How You Handle Tasks. One of the criteria for evaluating “dysfunction” is your ability to fulfill work-related demands. If you’re a student, consider your ability to focus on your studies. Ask yourself these questions:

• Do you feel confident leaving the house to go to work or school?
• Do you struggle to attend class on time or keep up with your schedule?
• Is there any task that now causes you fear?
• If you’re a student, have your academic results suffered?

Reflect on Your Relationships with Others. This should be evaluated based on what feels normal for you. If you’ve always been a shy person, avoiding communication with others might not necessarily indicate dysfunction. However, if you start to notice that your behavior or motivations seem ‘abnormal’ to you, this could be something to share with a mental health professional.

• Do you still find joy in relationships you once had?
• Do you still enjoy socializing as you used to?
• Do you feel less inclined to engage in conversations with others?
• Do you feel anxious or fearful when interacting with others?
• Do you feel bothered by others or suspect they have hidden motives towards you?

Reflect on Your Self-Care Behavior. Self-care refers to your ability to look after yourself to maintain both health and functional well-being. This criterion should be assessed based on what’s considered ‘normal for you.’ So, if you’ve been accustomed to exercising 2-3 times a week but have lost interest in it over the last three months, that could signal a potential disorder. The following behaviors may indicate neglect in self-care:

• You begin using or increasing the abuse of substances like alcohol or drugs.
• You experience disrupted sleep patterns or have extreme fluctuations in sleep duration (e.g., sleeping 2 hours one night, 14 hours the next, etc.).
• You feel emotionally “empty” or “dull.”
• Your personal hygiene begins to suffer.
• You no longer clean or maintain your living space.

Pay Attention to How Long Symptoms Have Been Present (Criterion C). To diagnose schizophrenia, mental health professionals will ask about the duration of the disorder and its symptoms. If schizophrenia is present, the disorder must have lasted for at least 6 months.

• This period must include at least one month of active symptoms mentioned in Section 1 (Criterion A), although this 1-month requirement may be shorter if the symptoms are being treated.
• The 6-month period can also include stages where ‘prodromal’ or residual symptoms are present. During these stages, symptoms may be milder (i.e., ‘subtle’) or only include ‘negative symptoms,’ such as emotional flatness or a lack of motivation to engage in any activities.

Exclude Other Potential Causes (Criterion D). Mood disorders like affective psychosis and bipolar disorder (or depression), along with other neurological disorders, can produce symptoms that closely resemble schizophrenia. Other medical conditions or physical injuries, such as strokes or brain tumors, can also result in neurological symptoms. This is why it’s essential to seek help from a clinical mental health professional. You cannot differentiate these symptoms on your own.

• The clinician will inquire whether periods of mixed emotions or severe depression have coincided with the active symptoms.
• Depression includes at least one of the following conditions for a minimum of 2 weeks: a depressed mood or loss of interest in activities that were once enjoyed. During this period, you may also experience persistent symptoms such as weight fluctuations, changes in sleeping habits, fatigue, irritability or lethargy, feelings of guilt or worthlessness, trouble concentrating, or recurrent thoughts of death. The mental health professional will help determine if you’ve experienced major depressive episodes.
• Mixed mood states are clearly recognizable (typically lasting at least 1 week) and involve unusually elevated moods, irritability, or increased social openness. You might also show at least three other symptoms such as reduced sleep, inflated self-esteem, fleeting or grandiose thoughts, distractibility, increased goal-directed activities, or engaging excessively in potentially dangerous activities. The clinician will help determine if you’ve ever had a mixed mood period.
• They will also ask how long these mood states last in the ‘active phase’ of the symptoms. If the mood states are brief compared to the duration of the active and residual symptoms, this could indicate schizophrenia.

Exclude the Possibility of Substance Use (Criterion E). Using substances like alcohol and drugs can lead to symptoms similar to those of schizophrenia. When diagnosing this condition, clinical professionals must ensure that the disorder and symptoms you’re experiencing are not caused by the ‘direct physiological effects’ of stimulants such as drugs or illegal substances.

• Even legal prescription drugs can cause side effects like hallucinations. It is the clinical doctor’s responsibility to differentiate between medication side effects and symptoms of the disorder.
• Substance use disorders (often referred to as ‘substance abuse’) often occur alongside schizophrenia. Many people with schizophrenia attempt to ‘self-medicate’ their symptoms with drugs, alcohol, or other substances. A mental health professional will help determine if substance abuse is a contributing factor to your symptoms.

Consider Your Situation in Relation to Intellectual Disability or Autism Spectrum Disorder. This is another factor that clinical professionals need to consider. Intellectual disabilities or autism spectrum disorders can also produce symptoms resembling those of schizophrenia.

• If you had a history of autism spectrum disorder or communication difficulties in childhood, schizophrenia can only be diagnosed when the delusions or hallucinations are ‘clearly’ present.

These Criteria Do Not ‘Guarantee’ Schizophrenia. The criteria used to diagnose schizophrenia and many other mental health disorders share ‘many commonalities.’ This means there are various explanations for symptoms, and they can combine in different ways, manifesting differently depending on personal perspectives. Diagnosing schizophrenia can be extremely difficult, even for trained experts.

• As mentioned earlier, your symptoms could stem from trauma, illness, or another disorder. You must rely on a mental health professional to accurately diagnose your condition or disorder.
• Cultural practices, individual characteristics, and local community ways of thinking and speaking can influence how behavior is perceived as ‘normal.’

Ask Friends and Family for Help. There are things that can be very difficult for you to recognize yourself, such as delusions. Therefore, it’s essential to ask your family and friends to help identify whether you are showing any of these symptoms.

Start Keeping a Journal. Begin writing when you suspect that you're experiencing hallucinations or other symptoms. Track what happens just before and during these episodes. This way, you’ll have a record of how often these symptoms occur, which can also provide useful data for the professional you consult for a diagnosis.

Pay Attention to Unusual Behavior. Especially in adolescents, schizophrenia can develop slowly over 6 to 9 months. If you notice unusual behavior in yourself and are unsure of the reason, it’s important to speak with a psychiatrist. Don’t ignore these behaviors as if nothing is wrong, especially if they are out of the ordinary for you or causing stress or dysfunction. These changes are a sign that something may be amiss. It may not be schizophrenia, but it’s something worth considering.

Screening Tests. Online screenings cannot definitively tell you whether you have schizophrenia. Only a clinical doctor can provide an accurate diagnosis after an examination, testing, and interview. However, a good questionnaire for screening can help you identify symptoms you may be experiencing and assess whether they could be signs of schizophrenia.

• The Mental Health Library offers a free version of the Schizophrenia Test and Early Psychosis Screening Index (STEPI) on its website.
• Psych Central also provides an online screening test.

Talk to a Professional. If you're concerned that you might have schizophrenia, it's best to speak with a doctor or therapist. While they may not have the expertise to diagnose schizophrenia, a general doctor or therapist can help you better understand the condition and decide whether you should see a psychiatrist.

• A doctor can also help rule out other possible causes for your symptoms, such as trauma or other illnesses.

The Causes of Schizophrenia Are Still Being Studied. While researchers have identified several factors that may be linked to the development of schizophrenia, the exact cause remains unclear.

• Discuss your family’s medical history with your doctor or a mental health professional.

Consider Whether Anyone in Your Family Has Been Diagnosed with Schizophrenia or a Similar Disorder. At least to some extent, schizophrenia may be genetic. You are more likely to develop schizophrenia if at least one first-degree relative (such as a parent or sibling) has the condition.

• If you have a twin or both parents have been diagnosed with schizophrenia, your risk could range from 40-65%.
• However, approximately 60% of those diagnosed with schizophrenia have no close blood relatives with the condition.
• If another family member or yourself has a similar disorder, such as delusional disorder, your risk of developing schizophrenia increases.

Evaluate Whether You Were Exposed to Any Risks While in the Womb. Newborns who were exposed to viruses, toxins, or malnutrition while in the womb are more likely to develop schizophrenia. This is especially true if such risks occurred during the first and second trimesters of pregnancy.

• A lack of oxygen during birth can also make it more likely for newborns to develop schizophrenia.
• Newborns born in areas experiencing famine have twice the risk of developing schizophrenia, possibly due to insufficient nutrition for women during pregnancy.

Pay Attention to the Father’s Age. Some studies have shown a link between the father’s age and the likelihood of developing schizophrenia. One study found that children born to fathers aged 50 or older are three times more likely to develop schizophrenia compared to those whose fathers are 25 or younger.

• It’s believed that older men may have higher risks of genetic mutations in their sperm, which could increase the chances of schizophrenia in their offspring.

• Write down all of your symptoms on paper, and ask friends or family members to observe any changes in your behavior.
• Be honest with your doctor about your symptoms. It's important to share all your experiences and symptoms. Doctors and mental health professionals are not there to judge you, their role is to help you.
• Remember that social and cultural factors influence how we perceive schizophrenia. Before seeing a psychiatrist, it is beneficial to research the history of mental health diagnoses and treatment approaches for schizophrenia.

• Do not try to manage your symptoms with drugs, alcohol, or illegal substances. This will worsen the situation and could potentially be life-threatening.
• This article is purely informational and is not intended to diagnose or treat any illness. You cannot diagnose schizophrenia on your own; it is a serious medical condition that requires professional evaluation and treatment.
• As with any illness, the earlier you are diagnosed and treated, the better your chances of recovery.
• Schizophrenia has no one-size-fits-all treatment. Be cautious of any treatments or individuals claiming they can “cure” you, especially if they guarantee a quick and easy fix.