Unlike virtually every other mental illness, schizophrenia is fairly unique in that its first onset is nearly always in young adulthood — not childhood or as a teen, and rarely after one’s 30s. Most people who are diagnosed with schizophrenia have their first symptoms and episode in their 20s — early to mid-20s for men, a little later (late-20s) for women.
This is, in part, what makes it such a devastating disorder. Just as a person is finding their way in the world, exploring their personality and relationships with others, schizophrenia strikes.
Unlike other disorders, too, its symptoms can be especially scary and troubling to the person’s loved ones.
So what is schizophrenia? It’s a constellation of symptoms and behaviors that revolve primarily around delusions, hallucinations, incoherent speech, diminished expression of emotions, and disorganized or catatonic behavior. Its basic symptoms haven’t changed over the years, even with the release of the DSM-5. ((The only significant changes from the DSM-IV definition are that delusions no longer need to be “bizarre” and one of the primary symptoms must be either delusions, hallucinations or disorganized speech — a requirement not in the DSM-IV.))
A hallucination is a sensation or sensory perception that a person experiences in the absence of a relevant external stimulus. That is, a person experiences something that doesn’t really exist (except in their mind). A hallucination can occur in any sensory modality — visual, auditory, olfactory, gustatory, tactile, etc.
A delusion is a persistent false belief someone holds about themselves or the reality around them. The person holds it despite what almost everyone else believes or other evidence. Delusions can be bizarre or not, and might involve any of a number of things, such as: that another person is in love with them; their sexual partner is unfaithful; being persecuted, harassed or conspired against; of being controlled by someone or something else; something isn’t right with their body; they can broadcast their thoughts to others or that others can insert their thoughts into their own mind; or they may have an inflated sense of worth, knowledge or power.
According to the DSM-5, “The peak age at onset for the first psychotic episode is in the early- to mid-20s for males and in the late-20s for females. The onset may be abrupt or insidious, but the majority of individuals manifest a slow and gradual development of a variety of clinically significant signs and symptoms.”
Worse, “earlier age at onset has traditionally been seen as a predictor of worse prognosis,” but the DSM-5 attributes this more to the gender differences — males get the symptoms earlier, so have had less time to gain maturity in their normal development (cognition, emotional adjustment, etc.)
I’ll never forget one of my friends calling me in a panic one day:
“My friend, he’s just gotten stranger and stranger. It started over the summer, where he started saying that people were talking to him inside his head. Then the other week, he left home and didn’t come home for days — nobody knew where he was! He thinks others are out to get him, and when you talk to him, it seems like he’s not all there. The easy-going person I knew is gone. He’s just not all there, like he’s got no emotions. He doesn’t think he needs help, and doesn’t think anything’s changed… But his family and friends clearly see it. What can we do to help him?”
Unfortunately, some people with schizophrenia lack insight or awareness of their illness. This isn’t a coping strategy they’re using (e.g., they’re just “in denial”) — this is a part of the constellation of symptoms of schizophrenia itself. And that makes helping the person get treatment all the more difficult.
Eventually he agreed to go see a doctor, was diagnosed with schizophrenia, and was prescribed a medication that helped control his symptoms. But it was a process that involved a lot of patience on the part of his family and friends, who had to gently suggest that seeing a doctor might help him feel more like himself again.
Some believe those with schizophrenia have a hard life ahead of them, and that’s usually true. The DSM-5 suggests that the course of the disorder “appears to be favorable in about 20 percent of those with schizophrenia” — not an optimistic number.
However, schizophrenia is not a sentence — it’s simply a diagnosis. But a diagnosis that can help inform a person’s choices for treatment and support.
While there’s no test for schizophrenia, you can take our short experimental screening test for schizophrenia. It can’t tell you if you have schizophrenia, but it can tell you if whether you have symptoms that may be consistent with schizophrenia. (Only a mental health professional can make an accurate diagnosis of schizophrenia.)
10 comments
My 23yr old daughter was diagnosed with schizophrenia at age 19/20 after having a full assessment with a PhD.She always a stellar student at the top of her class since as far back as pre-k. She was sheltered growing up and very much an introvert who never made friends. Her first year at school her grades began to drop and that’s where her bottom fell out. .She has never been hospitalized nor has she ever had an episode. In fact the psychiatrist was not fully convinced of the PhD’s report and did a MRI which came back normal. She has since been on and off several meds and tried a couple IOP and Day treatment services to no avail. The one trauma that may have triggered her illness is losing her uncle to gun violence and he was the only male figure in her life and she was very close to him. She is refusing to take meds anf in denial and will start a program but not finish. I have little to no control because she is no threat to herself or others and I feel frustrated watching her deteriorate with the only hope she will eventually get hospitalized for a point of reference to force compliance or me getting her more help.
Feeling exhausted at this point and my hands are tied as her only caregiver and payee for SSI?
My question has always been, what if someone showed symptoms of schizophrenia in young adulthood but never received a diagnosis or treatment? What happens then?
My other question has always been: what if the delusions lessen over time on their own? For example, what if something happens that makes the undiagnosed person lose track of their delusion (such as a much more traumatic event,) and then suddenly they remember it much later, but can see it as a delusion. After that they have residual issues with reality/fantasy but no real big breaks like that first time. Then what? Is that even possible?
These questions are very important to me and have no answers as far as I can tell.
I do not have an answer for your questions. In fact I love your questions and I’d like to see the answers because I’m loosing my best friend to schizophrenia.
His family is not helping him, in fact, he moved to my place and spends most of the time in my conversion van. He sleeps there and eats a very small amount. I find most of the meals I provide to him in the trash. It is heartbreaking to see him like that and gets even worse when he drinks. He tells me he is perfectly fine and does not admit anything wrong in himself.
I have been on antipsychotic medication for the last 15 years schizophrenia was diagnosed in 1999. I donot know what caused it. It was like something made me have a terrible headache. That got worse then diagnosed with it. email me with feedback
I am about to take on caring for my 22 year old nephew who’s been diagnosed with schizophrenia. He dropped out of college 2 years ago and since play online video games every waking second. His mother works 3 jobs and is unable to supervize him during the day. She lives in a very small rural town with not access to day programs nor much resources. I am his only option to try to him as I live in a large metro agrea. I am lost on where to even start. He has come and stayed for a few weeks at a time to give his mother a break. He won’t leave the house, can’t initate getting a daily shower or doing personal cares. He is on anitpyscotic medication but his new Psyh does not feel it is helping. Any advice would be most welcome!
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As I was reading this article I had remembered a time where I was very different from the person I am today, and I not talking ohhh that just a growing up. I used this be really out there talk to everyone nice with everyone always did all my work nicely and neatly but then in my mid teens something about me changed and I seem to have fallen more into the definition of schizophrenia. I’m not saying that I have gone ahead and diagnosed myself just simply stating that i fit the textbook definition of it. I would guess that my question here would be would this be something that I should talk to with Psychologist or just something should keep an eye on and see how it goes? Any feedback would be really appreciated.
It was and still is very hard getting my son treatment who has recently been diagnosed with schizophrenia. I noticed a year after high school when his behavior changed he started by isolating himself and doing odd things like setting the trash can on fire and staring into space. He would sometimes say people are watching him. I knew something was wrong because I experienced this with my own mother who was diagnosed with schizophrenia when I was very young and sent to the foster care system because of it. I didn’t know much about the disease just remembering the things she would do when I was young. Because my son was 19 and had never had mental health issues I received no help from anyone. He would disappear for weeks and sometimes months at a time and I would file missing persons reports and he would turn up 90% of the time in jail for doing something off the wall. This last time he had been missing for nearly a year and was sent to a mental hospital which I had no idea until they contacted me to say pick him up that he was discharged and here is the medicine he needs to take. They did not give me a diagnosis but the medicine they gave me is for individuals with schizophrenia and bipolar disorder. After being home for 5 days he did not want to take the medication and took off again. He was gone 3 days and now back I just don’t know what to do or where to go for help as contacting the hospital he was in came up with nothing and they referred me to county mental health services which I can’t get him to even come out the room to go to an appointment. He hardly eats and won’t shower and clings to the old torn up clothes and shoes that he has been wearing while on the streets. I’m in desperate need of guidance I am scared to even go to work and have taken a leave of absence because he has tried setting fires in the house. Now he is 23yrs old with his first semi diagnosis after 4yrs and still no signs of help for him or me as a mother.
Renee, please know you aren’t alone. The illness runs in my family as well. Sometimes things get better and sometimes things get worse. I am sending all my thoughts and prayers to you, your son, and your family. He is so blessed to have a woman like you. Support groups are always a great option. Equal opportunity housing is also sometimes available. There are resources out there. Unfortunately, you have to fight for them most of the time because this illness is so misunderstood.
My 28 year old son has been acting different for the past year. He has no friends, no girlfriend and on 2 occasions has accused my daughter and myself of taking his money. He first claimed we took $1000 and then recently he accused us of of taking $100. He came into the living room yelling and then went back into his room and began talking to himself for about 30 minutes. He refuses to eat any meat; he only eat snacks and maybe chicken once in a while, but he rarely eats anything I cook; he is skin and bones. I am not sure whether he is suffering with schizophrenia, but he is definitely not the same son; please help me.