People with schizophrenia can have a hard time telling what’s real and what’s not. They may see things that aren’t there or hold firm beliefs that fly in the face of fact. Understanding schizophrenia’s nature can help patients and their loved ones regain a sense of control.
Psychiatrists have the most experience with diagnosing schizophrenia. A psychiatrist or other licensed mental health professional should be involved in making a schizophrenia diagnosis whenever possible.
A schizophrenia diagnosis can be made when all of the following are true about a patient:
Patient is significantly impaired by the symptoms. For example, has serious difficulty working or with social relationships, compared to the period before symptoms began.
Symptoms can't be explained by another diagnosis, such as drug use or another mental illness.
Some people with schizophrenia are afraid of their symptoms. Or they may be suspicious of others (paranoid). They may conceal their symptoms from doctors or loved ones. This can make it more difficult to confirm a schizophrenia diagnosis.
Diagnosing Schizophrenia by Symptoms
People with schizophrenia have at least some of its main symptoms. For a psychiatrist to make a confident schizophrenia diagnosis, some of these symptoms must be present:
Hallucinations. This means hearing voices or other sounds that aren't there or seeing things that don't exist.
Delusions (unshakeable beliefs that aren't true).
Disorganized speech and behavior (talking and acting strangely).
Lack of motivation and emotional expression.
Lack of energy.
Poor grooming habits.
Specific types of psychotic symptoms (called first-rank symptoms), when present, make a schizophrenia diagnosis more likely:
Hearing your own thoughts spoken aloud.
Feeling that thoughts are being inserted into your mind, or removed from it, by an outside force.
Feeling like other people can read your mind.
Feeling that an outside force is making you feel something, want something, or act in a certain way.
Hearing voices discuss you or argue about you.
Hearing voices narrate your actions as you perform them.
A person with schizophrenia may describe these symptoms openly. Or a psychiatrist may deduce they are likely present based on observations of a person's speech and behavior.