Symptoms of Schizophrenia: Positive, Negative, and More

Navigating life with schizophrenia can be challenging, especially when the symptoms seem confusing or unpredictable. Understanding what these symptoms look and feel like is a step toward feeling more in control.

Schizophrenia affects people in several ways. The symptoms are grouped into three main categories — positive, negative, and cognitive. In this article, we’ll help you understand the different types of schizophrenia symptoms so you can recognize what you’re experiencing or provide support for someone you care for.

Positive vs. Negative Symptoms of Schizophrenia

Before we dive into the different types of symptoms, it’s important to understand the difference between positive and negative symptoms of schizophrenia. When describing schizophrenia symptoms, these terms don’t mean “good” and “bad.” Instead, they refer to whether something has been added or taken away from how a person typically experiences the world around them.

• Positive symptoms are experiences that add something new to a person’s normal mental functioning that influences their thoughts or behavior.
• Negative symptoms refer to a loss or reduction in a person’s usual abilities.

Each individual experiences schizophrenia differently, and the combination and severity of symptoms can differ from person to person.

Positive Symptoms of Schizophrenia

Positive symptoms involve changes in how a person thinks, behaves, and perceives the world around them. For some people with schizophrenia, positive symptoms may come and go. Other people may experience positive symptoms constantly.

These symptoms can make it difficult to tell the difference between what’s real and what isn’t. When a person can’t tell what’s real, it can cause paranoia, panic, and suspicion.

Positive symptoms of schizophrenia include symptoms of psychosis, such as hallucinations, delusions, and disorganized thinking. We’ll explore each of these symptoms below.

Hallucinations

A hallucination happens when a person sees, hears, smells, tastes, or feels something that isn’t actually there. When someone experiences a hallucination, it feels real, even though nothing is actually happening outside of their mind.

The most common type of hallucination is an auditory hallucination, or hearing sounds that aren’t there. Between 40 percent and 80 percent of people with schizophrenia experience auditory hallucinations. Most people with auditory hallucinations describe hearing voices. These voices can talk to them, give instructions, or comment on what they’re doing. Sometimes the voices can be friendly, but most people describe these voices as rude, critical, or upsetting.

Auditory hallucinations aren’t limited to just voices — some people can hear other noises, like music or machinery. The sounds or voices may seem like they’re coming from inside a person’s head or from an outside source, as if there is a radio or television playing somewhere.

Other types of hallucinations include:

• Visual hallucinations — Seeing something that isn’t there, such as a glowing orb, flashing lights, human figures, or faces
• Somatic hallucinations — Feeling a sensation in your body, such as experiencing pain that has no obvious cause
• Tactile hallucinations — Feeling like you’re being touched when nothing is there
• Olfactory hallucinations — Smelling something that isn’t there
• Gustatory hallucinations — Tasting something that isn’t there

Delusions

A delusion is a strong false belief that isn’t based in reality and may seem irrational to others. When a person is experiencing a delusion, they believe it completely, even when there’s clear evidence it isn’t true. About 80 percent of people with schizophrenia experience delusions. Delusions can begin suddenly or develop slowly over time. People experiencing delusions can feel confused and frightened, making it hard to trust others.

People with paranoid delusions may believe they’re being followed, watched, or persecuted even when they’re safe. Some people may develop a delusion as a way to explain a hallucination. For example, if someone is hearing voices that describe what they’re doing, they might believe they’re being monitored.

Additional examples of delusions can include a false belief that:

• You are very important or famous.
• Something significant is about to happen.
• There are hidden messages in everyday things, like the colors of passing cars or the gestures of people on television.
• Someone is controlling your thoughts.

Disorganized Thinking

Disorganized thinking makes it hard for a person with schizophrenia to think clearly and follow conversations. They may feel like their thoughts are hazy, foggy, or difficult to grasp. This can make concentrating on a task or having a conversation difficult.

When a person with disorganized speech has a conversation with others, they may make up words, stop talking abruptly, or jump quickly from one topic to another. Disorganized thoughts can make it difficult to concentrate on activities like watching television or reading.

Negative Symptoms of Schizophrenia

Negative symptoms of schizophrenia involve a loss or reduction in a person’s abilities or behaviors. These symptoms usually develop gradually and often begin several months or years before other schizophrenia symptoms, like hallucinations or delusions, begin.

About 70 percent of people experience negative symptoms before their first positive symptom. When negative symptoms come first, this is referred to as the prodromal period of schizophrenia. Negative symptoms alone aren’t enough to diagnose a person with schizophrenia.

Common examples of negative symptoms of schizophrenia include:

• Avolition — Lack of motivation and difficulty planning or sticking with goals
• Alogia — Reluctance to speak or responding to others with short, limited answers
• Anhedonia — Reduced interest in or enjoyment of activities that were once pleasurable
• Flat affect — Difficulty showing outward emotional expression
• Social withdrawal, avoiding loved ones, or interacting with others awkwardly
• Slow movements
• Difficulty keeping up with self-care routines
• Changes in sleep habits

Many of these symptoms can be found in other types of mental health conditions, such as depression. This can result in mistaking schizophrenia for depression. In some cases, friends and family members may not recognize these as symptoms of a mental condition, mistaking them for laziness or rudeness instead.

Cognitive Symptoms of Schizophrenia

In addition to positive and negative symptoms, people with schizophrenia can also experience cognitive symptoms that affect thinking, concentration, and memory. A person with cognitive symptoms can have trouble participating in everyday tasks and holding conversations.

People with cognitive symptoms of schizophrenia may have difficulty:

• Focusing and paying attention
• Processing information to make decisions
• Using new information immediately after learning it
• Thinking quickly
• Understanding and solving problems
• Learning and remembering information
• Communicating clearly

Healthcare providers have special tests to measure a person’s cognitive function. The level of cognitive function is one of the best predictors of how well a person with schizophrenia can function daily.

What Do Schizophrenia Symptoms Look Like to Others?

Most people with schizophrenia don’t recognize that they have any symptoms. That means that friends and family members are often the first to notice the signs. These might include:

• Dramatic changes in normal behavior
• Paranoia or suspicion
• Confusion
• Anger
• Depression and irritability
• Increased substance use
• Withdrawal from social interactions

Schizophrenia symptoms can be confusing and difficult to handle for the person with schizophrenia and those around them. One of the biggest challenges is that the person with schizophrenia may not think they need help, which may make it difficult to get appropriate treatment.

If you or a loved one has symptoms of schizophrenia, it’s important to seek medical care as soon as possible. The right treatment plan with antipsychotic medications and therapy can help improve symptoms and quality of life.

Talk With Others Who Understand

On MySchizophreniaTeam, the site for people living with schizophrenia and their loved ones, people come together to ask questions, give advice, and share their stories with others who understand life with schizophrenia.

Which schizophrenia symptoms developed first for you or your loved one? How have medications and therapy helped to improve symptoms? Share your experience in the comments below.