Dear Alice,

I'm worried I have schizophrenia.

My main reason for this worry is that I have a number of voices in my head. They are present most every day, most of the day. We are able to hold conversations. (Usually screaming fights where one of us ends up crying.) Sarah is a distinct person in my mind. The rest are a large crowd. All are almost always hostile towards me. Any confidence I build for myself they knock down.

I am always agitated and anxious, and sometimes have panic attacks. Among my medical symptoms are dizziness and being tired all the time, and moderate headaches over half the week. I also have hypoglycemia. When my blood sugar is low, everything gets even worse. (Just last week I pushed all the furniture in front of the door and locked myself in my room for hours.)

I have been able to keep from injuring myself for the last 8 months, but only after major intervention and hospitalization. I want to be able to stay strong so I don't end up getting hospitalized again, because I would get behind in my college classes.

I try to talk to my parents about this, but the therapist they used to take me to believed that I was possessed or at least haunted by demons, and they agree with her.

— A frustrated, determined soul

Dear A frustrated, determined soul,

Though it can be frustrating, asking for more information and seeking help (or even a second opinion) when you need it is a key first step to prioritizing your health and your personal goals. More to your concern, schizophrenia is a mental disorder characterized by hallucinations, delusions, and disordered thinking and behavior, often resulting in a withdrawal from the outside world. Whether or not schizophrenia is the cause of what you’re experiencing, passing it off as a spiritual ailment can be dangerous, particularly because it may delay beneficial and effective treatment. Though it’s a good idea to speak with a medical professional to identify what it is you’re dealing with and how to address it, keep reading for more on symptoms, the diagnostic process, and treatment methods associated with schizophrenia.

While the word "schizophrenia" means "split-mind," the disorder is not to be confused with dissociative identity disorder, which was previously referred to as “split personality” or “multiple personality disorder.” The condition is likely caused by a combination of genetics, neurochemistry, and environmental factors. There’s a strong genetic contribution, but most people who are diagnosed don’t have a family history of psychosis. A person’s environment and life stressors also play a role in the emergence or reoccurrence of symptoms in those who are vulnerable or predisposed to the condition. While there’s variation in frequency of schizophrenia across different demographic groups, such as geographic origin, countries, race, ethnicity, and sex assigned at birth, the lifetime prevalence has been found to be between 0.3 to one percent.

Symptoms of schizophrenia typically emerge between late teens and mid-30s, but may also start during childhood. The condition can manifest in a wide range of cognitive, behavioral, and emotional symptoms, and there’s no one single symptom or experience that's unique only to schizophrenia. According to the Diagnostic and Statistical Manual (DSM-V), the three key symptoms are the presence of delusions (beliefs that don't change despite evidence to suggest otherwise), hallucinations (perceiving things that others don't, such as hearing voices), and disorganized thinking or speech. Other symptoms of schizophrenia vary from person to person, over time, and in severity, but can include:

  • Irritability or feeling tense
  • Difficulty with decision-making, concentration, and comprehension
  • Difficulty sleeping
  • Extremely disorganized or catatonic behavior (involving abnormal or rigid muscular movement and lack of speech)
  • Loss of emotional expression
  • Loss of motivation for self-directed activities
  • Lack of interest in relationships

Reaching out to a medical professional (in your case, perhaps someone different than you’ve seen previously for another opinion) can help determine a diagnosis. To be diagnosed with schizophrenia, a person has to display at least two of symptoms (one of which must be in the previously mentioned three key symptoms) for at least one month. Folks must also demonstrate that areas of their life and typical day-to-day experience has been impacted by related symptoms for at least six months. Details about the duration of the person’s symptoms, daily functioning, childhood and development, genetic and family history, medication history, any prior or current substance abuse, or other medical conditions is commonly sought from the patient and sometimes their friends and family. This information along with other tests (that may include brain scans or blood tests) may help eliminate the possibility of other conditions that can cause similar symptoms.

You may also be wondering when it's appropriate to contact a health care professional. For those who are hearing voices (particularly if they’re encouraging harm to self or others), experiencing urges to self-harm or harm others, are fearful, overwhelmed, having visions or delusions, feeling overwhelmed, are unable to leave their house, or are concerned that they can’t take care of themselves, it’s critical to seek professional help. Because symptoms can be very disruptive, some people find it difficult to continue with their daily lives, responsibilities, and relationships; others are able to function rather well. Either way, it may be wise to find out what’s causing you to feel agitated, anxious, dizzy, and to hear voices in your mind that are hurting your self-confidence. For more information on finding help, check out How to find a therapist in the Go Ask Alice! archives.

It’s also good to point out that people with schizophrenia may be more likely to have other conditions such as depression, anxiety disorders, obsessive compulsive disorder, and panic disorder. They’re also more likely to develop a substance-related disorder. The most common cause of premature death for those with schizophrenia is suicide, and the risk may increase if they experience additional depressive symptoms, feelings of hopelessness, unemployment, or are currently in a period following a psychotic episode or hospital discharge. About 20 percent of those diagnosed with schizophrenia attempt suicide at least once and more than that will experience suicidal thoughts. Therefore, timely and proper treatment is critical.

Schizophrenia can be a chronic condition that requires lifelong treatment. Unfortunately, there’s no way to prevent it, but symptoms can be managed. The earlier treatment is initiated, the better the outcome, including a decreased risk of relapse, lessened severity of psychotic symptoms, and improved functioning. Medication (antipsychotics) is often utilized in treatment since it addresses the imbalance of the brain’s neurotransmitters, which contribute to much of the condition. In addition to medication, myriad forms of talk therapy are available, which may also help ease symptoms. These include individual psychotherapy to learn how to cope with challenges in daily life brought on by schizophrenia, assistance for family and friends to help them better understand the disorder and learn ways they can be supportive, art therapy for a more creatively expressive approach, cognitive-behavioral therapy for a more practical approach, and general education about the condition to empower those living with the condition to take an active role in their treatment plan. Joining a support group in order to meet others in a similar situation and learn how they’ve met with and handled their challenges may also be helpful. People living with schizophrenia may also benefit from social and community rehabilitation, which may improve day-to-day functioning, such as maintaining a job, taking care of themselves, and leading a more stable life.

It's a sign of bravery that you've reached out for help and greater understanding. A good next step may be to make an appointment with a health care provider or mental health professional (often, these folks can be found at your campus’ student health and counseling services) to talk about what you’ve been experiencing. Together, you can start to uncover the underlying cause — be it schizophrenia or not — and devise a treatment plan so that you can start feeling better.

Take care,

Alice!

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