Talking to Self as a Symptom of Schizophrenia: When Is It Concerning?

Children often start talking to themselves around the same time they first learn to speak. It’s a natural part of development — a way to process thoughts out loud. Even in adulthood, talking to yourself isn’t unusual. It can help people stay focused, work through problems, or calm their nerves in stressful situations. But in certain contexts, such as schizophrenia, it may be a sign of something more serious.

Talking to yourself, also called self-talk, can be related to schizophrenia symptoms in some cases. In schizophrenia, self-talk may be a concern if the person is responding to internal voices that others can’t hear or if they’re experiencing paranoia. However, that’s not to say a person is dangerous to others or in immediate danger just because they’re talking to themself. Here’s how to tell if self-talk is worth worrying about.

Why Do People Talk to Themselves?

Self-talk is part of how our brain works. It’s not something we learn from other people. Before young children start speaking, they use gestures to themselves as a form of self-talk. Versions of self-talk are also observed in deaf children, who may be seen signing to themselves at times. There’s even some evidence that nonhuman primates taught basic sign language will spontaneously sign to themselves as well.

Talking is generally thought of as a way to communicate with others. But we also use words to process our thoughts. People self-talk to plan and practice what they want to say to someone else. Self-talk can help rehearse conversations that you’re nervous about having. It’s also helpful when figuring out a difficult task. You can talk yourself through each step.

Studies show that self-talk increases during problem-solving. If kids are doing a difficult task, they start talking to themselves more as it gets harder. In one study, self-talk was an in-between step to work through a tricky task before the children gave up on it altogether.

Some people develop a harmful habit of self-talk that puts themselves down. They may tell themselves that they’re worthless, which reinforces unhelpful thinking and low self-esteem. Psychotherapy can help the person learn to recognize those self-critical thoughts and replace them with positive affirmations. Training yourself to use positive self-talk (either internally or out loud) can increase motivation, focus, and performance.

Who Is More Likely To Self-Talk?

Some people talk to themselves often, while others rarely do. Researchers have different theories on why. Some think people are more likely to talk to themselves if they’ve gone through an upsetting event that they’re trying to make sense of. Others believe self-talk increases when people spend more time alone. People who are more isolated may use self-talk to manage their limited social interactions more carefully.

Childhood appears to set the stage for self-talk behavior in adults. An article from Frontiers in Psychology suggests that adults who grew up without siblings engage in more self-talk compared to those who had brothers and sisters around when they were young. Only children may be more comfortable being alone and socializing with themselves. In addition, adults who said they had an imaginary friend as a child have higher rates of self-talk in adulthood. Perhaps this is related to their ability to think creatively and imagine.

Self-talk has also been linked to mental health disorders, like obsessive-compulsive disorder (OCD). People with OCD try to control their thoughts more often, which can lead to more self-talk.

Self-Talk in Schizophrenia

Schizophrenia is another mental health condition that can increase self-talk behavior. Self-talk in schizophrenia may be related to symptoms like disorganized thinking and confusion.

People with schizophrenia may have auditory hallucinations. They may hear voices in their head and then relay what the voices are saying out loud. In fact, hearing voices is one of the most common hallucinations that people with schizophrenia develop.

These voices can range from being pleasant to annoying or abusive. They may passively discuss what’s going on or directly tell the person what to do. When someone with schizophrenia hears voices, their brain thinks the voices are real. As a result, they may respond to these voices out loud without realizing that they’re talking to themselves. Speaking with internal voices may be a cause for concern. It can mean the person’s schizophrenia symptoms aren’t well controlled.

Over time, these voices can lead to delusions, or false beliefs. Someone with schizophrenia may try to rationalize why they’re hearing voices by coming up with an explanation that isn’t true. For example, if voices describe what the person is doing, they may start to feel like someone is watching or following them. They may feel paranoid, anxious, or angry. This also raises the person’s stress levels, which is a common trigger for more severe episodes and psychotic symptoms — such as seeing or hearing things that aren’t there or believing things that aren’t true.

How Should You Respond to Self-Talk?

When someone you love has schizophrenia, you may be alarmed or worried to see them talking to themselves, especially if it’s not something they usually do. But it’s important not to jump to conclusions. Self-talk isn’t necessarily harmful.

Seek Medical Advice

However, any noticeable change in someone’s normal functioning may signal a problem and is worth mentioning to a qualified healthcare provider. Drastic shifts in behavior could mean the person is experiencing psychosis. This is a serious condition that causes someone to disconnect from reality. You may have trouble convincing them that there’s a problem and that they need medical help.

Sometimes, schizophrenia treatment may need to be adjusted to get a better handle on symptoms. Maybe someone hasn’t been taking their medication or their current treatment plan isn’t working. A mental health professional can revisit their treatment options and provide more support.

Antipsychotic medications usually take time to work. They may help with anxiety or aggression first, while hallucinations can take a few weeks to fade or stop.

Call 911 if They’re at Risk of Harm

If the person seems like they’re distressed or confused, you should call their healthcare provider for medical advice. For those who appear to be a danger to themselves, call 911 for more support. Make sure you explain to first responders that the person has schizophrenia to help them understand what’s going on.

Consider Family Therapy

If you have a friend or family member with schizophrenia, it helps to be prepared for the ups and downs. It’s not unusual for symptoms to get better or worse at times. Family therapy offers a chance to learn what to expect and how to respond. It can also help you create a plan so you know what to do if you’re concerned about your loved one.

Talk to Others Who Understand

On MySchizophreniaTeam, the social network for those living with schizophrenia and their loved ones, people come together to share their stories and offer support to others who understand what daily life is like when living with a mental health condition.

Have you noticed an uptick in self-talk as a sign of schizophrenia? How do you cope with self-talk? Share your experience in the comments below.