Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. The main symptoms include hallucinations, delusions, disorganized thinking and speech, and lack of emotional expression. Many people with schizophrenia do not realize they have it, especially in the early stages. Here is an overview of the key things to know about not knowing you have schizophrenia.
What is schizophrenia?
Schizophrenia is a chronic brain disorder that affects less than 1% of the population. It usually starts in the late teens to early 20s for men, and late 20s to early 30s for women. It is characterized by a breakdown in thinking, emotional expression, and contact with reality. The symptoms fall into three categories:
- Positive symptoms – Psychotic behaviors not seen in healthy people. This includes hallucinations, delusions, disorganized thinking and speech.
- Negative symptoms – Disruptions to normal emotions and behaviors. This includes speaking little, lack of motivation, reduced expression of emotions.
- Cognitive symptoms – Issues with attention, certain types of memory, and executive functioning skills.
Schizophrenia has different subtypes based on the predominant symptoms. The main subtypes are paranoid, disorganized, catatonic, undifferentiated, and residual schizophrenia.
Why do people not know they have schizophrenia?
There are several reasons why someone may have schizophrenia but be unaware of it:
- Lack of insight – Insight refers to a person’s awareness and understanding of their condition. Around 50% of people with schizophrenia have poor insight early on. They are unable to recognize their symptoms and need for treatment.
- Denial – Some people go through a period of denial and struggle to accept the diagnosis. The symptoms cause significant distress, so denial is a defense mechanism.
- Negative symptoms – Negative symptoms like social withdrawal, lack of motivation, and flat emotions make it hard to realize something is wrong.
- Cognitive deficits – Problems with memory, attention, and disorganized thoughts affect self-awareness.
- Stigma – The stigma around mental illness prevents some from recognizing or accepting their symptoms.
Additionally, the gradual onset of symptoms can make schizophrenia hard to detect. Friends and family members sometimes notice symptoms before the person does.
What are the early signs and symptoms?
Here are some common early signs and symptoms of schizophrenia:
- Social withdrawal – Losing interest in friends and activities; increased isolation
- Drop in functioning – Decline in self-care, work/school performance, hygiene
- Odd or irrational beliefs – Superstitious or paranoid ideas not based in reality
- Confused thinking – Struggles to concentrate, focus, remember things
- Extreme mood changes – Shifting between very anxious to very calm
- Trouble sleeping – Insomnia, waking frequently, sleeping excessively
- Hallucinations – Most often hearing voices but could include sights, sounds, smells
These symptoms tend to slowly develop over the course of months to years. People often write them off as stress or other problems at first. The symptoms also fluctuate and may not always be present.
When does someone realize they may have schizophrenia?
There are a few common times when someone may start to suspect they have schizophrenia:
- After their first psychotic episode – Experiencing delusions, seeing hallucinations, having disorganized speech makes the person realize something is very wrong.
- When symptoms worsen – More frequent hallucinations, delusions, or cognitive deficits prompt the need for evaluation.
- After a hospitalization – Being admitted for mental health concerns leads to a diagnosis.
- When friends/family notice symptoms – Feedback from loved ones encourages them to seek help.
- Following a significant decline in functioning – An inability to keep a job, dropping out of school, self-care neglect prompts evaluation.
It takes an average of 1-2 years after symptoms start before a person is diagnosed with schizophrenia. With treatment and support, many people can regain awareness of their condition over time.
When should someone seek help?
It is important to seek help as soon as symptoms are noticed because early treatment leads to better outcomes. Here are some signs that it’s time to see a doctor:
- Experiencing hallucinations like hearing voices
- Having delusions like believing external forces control thoughts
- Withdrawing socially for more than 2 weeks
- Feeling confused and struggling to think clearly
- Major decline in self-care lasting weeks
- Inability to work/attend school or care for yourself
- Suicidal thoughts
- Family/friends express concern about your behavior
Look for a psychiatrist or mental health clinic that specializes in schizophrenia and psychotic disorders. Be completely open about all symptoms to get an accurate diagnosis.
How do doctors diagnose schizophrenia?
There is no lab test for schizophrenia – doctors diagnose it based on symptoms. The diagnostic process involves:
- Physical exam – To check for underlying conditions causing symptoms
- Psychiatric evaluation – Discussing onset and duration of symptoms, family history, drug/alcohol use, etc.
- Mental health screening tools – Questionnaires to evaluate symptom severity
- Diagnostic criteria – Comparing symptoms against the latest DSM or ICD criteria
- Psychological testing – Assesses thinking patterns, concentration, memory, etc.
- Lab tests – Test blood counts, hormone levels, and rule out substances causing psychosis
- Brain scans – CT or MRI to check for tumors, brain damage, or structure abnormalities
It may take a few appointments to make an accurate diagnosis. Doctors also need to rule out other possible causes like bipolar disorder, schizoaffective disorder, drug abuse, brain tumors, infections, and some autoimmune disorders.
What is the treatment?
While schizophrenia has no cure, the symptoms can be managed with a combination of medication and psychosocial treatment. The main treatment approaches include:
- Antipsychotic medication – Helps control delusions, hallucinations, and disordered thinking. Newer generations have less side effects.
- Psychotherapy – Cognitive behavioral therapy and social skills training can provide coping techniques.
- Self-help groups – Peer support groups help reduce isolation and build social skills.
- Rehab services – Help develop skills needed for independent living and working.
- Hospitalization – Short-term inpatient treatment may be needed during acute psychotic episodes if a person is suicidal, violent, or severely impaired.
Treatment is tailored to each person’s needs and phase of illness. With consistent treatment, many people with schizophrenia can manage symptoms long-term.
What is the prognosis?
The long-term prognosis for schizophrenia varies greatly between individuals. With consistent treatment and healthy habits, many people can lead productive lives and experience long periods of relatively stable remission of symptoms. In general:
- 1 in 4 recover completely and return to their pre-illness level of functioning
- 1 in 4 are able to return to work and be mostly independent
- 1 in 2 see a reduction in symptoms and some degree of independent living
- 1 in 10 do not respond well to treatment and have significant disability
Factors linked to better outcomes include:
- Early treatment after first episode
- Closely following treatment plans
- Avoiding drug and alcohol abuse
- Developing social support and coping skills
- Minimizing stress and triggers
- No/brief duration of untreated psychosis
While schizophrenia is a chronic condition, many people can live rewarding lives with proper management. Ongoing advances in treatment provide hope for better long-term trajectories.
Conclusion
In the early stages, many people with schizophrenia do not realize they have it. Symptoms like social withdrawal, thinking disturbances, lack of motivation, and gradual onset make it easy to miss. But loved ones or events like a psychotic episode often make the person aware of the problem over time. Seeking help after the first symptoms appear leads to the best chance of recovery with the right medications and psychosocial treatment. While schizophrenia is a chronic illness, long-term remission is possible for many patients who follow their treatment plan.