What Is High-Functioning Schizophrenia?

Schizophrenia is estimated to affect around 1 in 300 people worldwide. The mental health condition often causes severe functional impairments and distress. However, symptoms can vary widely between any two people. If you, or a loved one, has been described as having “high-functioning schizophrenia,” you might be curious as to what exactly that means.

Many mental health conditions can make it hard to get through the day and manage daily tasks. Schizophrenia — a mental health disorder that can alter how your brain thinks, how you act, and what you feel — is no exception. Symptoms of schizophrenia, such as those that make you question reality, often have a significant impact on daily life and interactions with others. But, do “high-functioning” people face the same challenges as others with the condition?

If you’ve heard the phrase “high-functioning schizophrenia” and wondered what it means, you’re not alone. Below, we’ll explore the meaning behind this mysterious label.

The Meaning Behind High-Functioning Schizophrenia

You won’t find “high-functioning schizophrenia” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5-TR) — the main reference used by health professionals to diagnose mental health conditions. Instead, the DSM-5 speaks to the range of symptoms and quality-of-life effects of schizophrenia by referring to the condition as a spectrum disorder. So, you likely won’t hear healthcare providers using the phrase “high-functioning schizophrenia.”

As is the case with “high-functioning” labels applied to other mental health conditions like depression, high-functioning schizophrenia isn’t an official diagnosis. Rather, it’s an informal term often used to describe people with mental health conditions who are able to manage daily tasks like working or living on their own.

To others, people with high-functioning schizophrenia may appear to be getting through their days without much trouble. But, that doesn’t mean that they’re not facing serious challenges due to their condition. Because this mental health disorder so often limits people’s ability to connect with others or go to school or keep a job, those with the condition who are able to do these things may be seen as having high-functioning schizophrenia.

Traits Often Linked to High Functioning

Schizophrenia symptoms can come and go, which can affect someone’s level of functioning at any given point or cause it to change over time. This is even true for people who respond well to their treatments. It’s important to remember that everyone’s ability to function with schizophrenia is different. Having high-functioning schizophrenia doesn’t necessarily mean symptoms are milder or fewer challenges are present.

Traits of high-functioning schizophrenia often include:

• The ability to perform daily tasks when circumstances are ideal
• Less bothersome cognitive symptoms or a better ability to focus, remember, and problem-solve
• Having good relationships with others
• Feeling motivated to function well and improve quality of life

Certain things may make high functioning more likely in people with schizophrenia, such as:

• Learning coping mechanisms, such as through cognitive behavioral therapy (CBT) or another treatment
• Having stable support systems, such as those offered through rehabilitation services that provide help with work, school, and relationships, and teach resilience strategies
• Following your treatment plan
• Having an older age of onset, which is associated with having a more established routine and social connections
• Having early intervention from an empowering treatment team

Do People With High-Functioning Schizophrenia Still Have Distressing Symptoms?

With symptoms occurring on a spectrum, it seems as though people who are less affected by schizophrenia would be the ones labelled as high functioning. But, is this really the case?

Symptoms of high-functioning schizophrenia aren’t different from other “types” of schizophrenia. High-functioning individuals may still have the same symptoms as others with the condition, which can include severe symptoms. The following symptoms can be experienced by anyone with schizophrenia:

• Delusions — Believing in something despite evidence that it isn’t true
• Hallucinations — Hearing, seeing, or feeling something around you that isn’t actually there, such as hearing voices
• Disorganized movements, actions, or catatonic behavior — Doing something in a way that others are surprised by or find strange, such as staying very still
• Disorganized speech — Disorganized thoughts while talking that can make it hard for others to understand you or cause you to switch topics without notice
• Negative symptoms — Limited ability to express emotions, such as through facial expressions, or lack of motivation to do things like activities with others

It may seem that high-functioning people experience these symptoms to a lesser degree, but that’s not necessarily true. It is true, however, that some people can experience milder symptoms while others have more severe symptoms. This can happen if someone is good at masking (hiding) their symptoms from others. Also, the challenges and impairments of someone living with schizophrenia may not always be obvious to others.

Why High-Functioning Schizophrenia Isn’t a Formal Term

High-functioning schizophrenia — as is the case with “high-functioning” versions of other mental health conditions — isn’t a phrase used by psychiatry providers. The reason why is more complicated than simply not being included as an official diagnosis in the DSM-5.

Mental healthcare providers don’t use this label because it’s both subjective and controversial. Calling someone high functioning can downplay their struggles with schizophrenia, such as with daily functioning and maintaining quality of life. It can also put pressure on them to appear “normal,” by unfairly comparing them to others without a schizophrenia diagnosis. This, in turn, may prompt people to mask what they’re going through for the sake of others.

How Mental Health Treatment Can Help

Effective treatment often plays a big part in the daily functional ability of someone living with schizophrenia. Individualized treatment plans may include a combination of medications, such as antipsychotics, psychotherapy (talk therapy), as well as support groups and other community resources.

Some research shows that people with schizophrenia who achieve remission — or who have sustained mild symptoms for six months or longer — tend to function better in daily life. Not only that, but there’s often a marked improvement in their well-being. People who achieved remission tended to feel better about themselves compared to those whose symptoms had only improved for brief periods of time. With treatment, it’s estimated that between 20 percent and 60 percent of people with schizophrenia can achieve remission.

Functional Recovery

One review noted that clinical improvement of symptoms doesn’t always translate into people with schizophrenia feeling recovered. Rather, what appears to make more of a difference is how well someone can function during daily activities, like in social interactions or at work. Being able to find meaning, hope, and a sense of identity is more reflective of recovery than simply having fewer or milder symptoms of schizophrenia.

Moreover, study authors have pointed out that recovery with regard to schizophrenia means different things to healthcare providers, researchers, and people with the condition. Clinicians think of recovery as an improvement in overall functioning, while researchers are more concerned with reduced symptoms of psychosis. On the other hand, people living with the condition tend to think of recovery as being able to return to who they were before their diagnosis and get through their days without needing medication.

Some research has shown that there might be a long-term benefit to stopping or reducing doses of antipsychotic medications over time. One study found that people with schizophrenia who carefully weaned off or lowered their doses of antipsychotics with the help of their provider had better functional recovery at their seven-year follow-up. Meanwhile, another study found that people who stopped using antipsychotics had more, or longer, periods of functional recovery than those taking the medications. It’s important to discuss medication changes with your healthcare provider.

It’s important to keep in mind that everyone living with schizophrenia can have various levels of functionality at any given time. Be honest with your mental health provider about how you’re feeling, so that they can help you find the right treatment plan for you.

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