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Schizophrenia: Symptoms and Diagnosis

Updated on February 3, 2009


Schizophrenia is one of hundreds of disorders listed in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision (DSM-IV-TR).

The DSM-IV-TR is published by the Aperican Psychiatric Association (APA) and is used to determine diagnoses by all mental health professionals in the United States.

Diagnoses are determined most often by psychologists, psychiatrists, or other licensed mental health workers who are treating the individual - either conducting therapy or prescribing medications.

This is done in a process referred to as diagnostic assessment.


Schizophrenia is characterized by the following symptoms:

(1) delusions: beliefs which are held certainly by an individual and said individual persists in his or her belief despite concrete proof to the contrary - most often, these delusions are bizarre and outside the possibility or experiences of normal life, i.e. "they can read my thoughts, they take them right out of my head," " I am the President, but it's a secret," etc. 

(2) hallucinations: perception of stimuli that does not exist, often bizarre, i.e. hearing voices, seeing people no one else sees 

(3) disorganized speech: speech which does not adhere to the confines of typical conversation, i.e. making up words, incoherence, and constant tangential speaking 

(4) grossly disorganized or catatonic behavior: extremely unusual behavior which is either active (i.e., overenergetic, acting childlike or aggressive) or rigid (i.e. lack of motor response to external stimuli and muscular tightness - sitting perfectly still for hours and hours) 


(5) negative symptoms: symptoms which seem to indicate a lowering of client's functioning, i.e. inability to move, loss of affect/facial expression, etc. 


To diagnose an individual with schizophrenia several criteria must be met.

The first, and most obvious, is that the individual must be presenting at least two of the above-listed symptoms.  The exception to this is if the person is having delusions which are bizarre (i.e. "I have been implanted with a chip which allows me to read minds") or auditory hallucinations where the individuals actions are constantly narrated or there are two voices in the hallucination which are talking to one another.

Secondly, these symptoms must present a significant impairment for the person in his or her daily life functioning.  For example, a person who believes he or she is implanted with a mind-reading chip but is able to maintain adequate employment and friendships does not qualify for a diagnosis of schizophrenia.

Thirdly, the individual must have been experiencing impairment for at least six months, including at least one month of active symptoms.

Finally, the diagnosing clinician must determine that this individuals symptom cluster are not better accounted for by another disorder -- and there are several disorders which are very like schizophrenia but are not schizophrenia.  The clinician must also determine that the symptoms are not due to a substance (i.e. cocaine, LSD), or an organic braing disorder (i.e. tumor). 


Clinical Implications

Given the requirements to receive a diagnosis of Schizophrenia, it should be clear that this disorder is very serious and generally makes it difficult for an individual to participate in the world functionally.

Many persons with schizophrenia are hospitalized regularly throughout early adulthood, and the prognosis for complete recovery is poor.

For both these reasons, working as a clinician with a schizophrenic individual is exceptionally difficult.  The only treatment indicated as most efficacious for this population is pharmacotherapy (or psychotropic drugs) to limit the frequency and intensity of the hallucinations or delusions. 


Schizophrenia is a serious mental disorder, but only occurs in approximately 1% of adults.

Only a clinician can diagnose a person with a mental disorder, and a large number of considerations go into making such a diagnosis, especially the clinician's experience, judgement, and knowledge.  One must consider myriad variables when making a diagnosis, and especially one of such magnitude.

Please note that the above is only a cursory discussion of schizophrenia and should not be considered sufficient for determining a diagnosis. 


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