Am I Schizophrenic? Understanding The Schizophrenia Diagnostic Process

Schizophrenia can be a complex psychotic disorder that usually causes symptoms like hallucinations, delusions, and disorganized thinking. If you think you may be living with schizophrenia, understanding the symptoms of this condition, as well as the criteria that doctors and mental health professionals require for diagnosis, may be the first step toward treatment and improved quality of life. Once a person has been diagnosed with schizophrenia, they may pursue treatment in the form of doctor-prescribed medication and various types of therapy. 

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What is schizophrenia? 

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), schizophrenia is considered a schizophrenia spectrum disorder. There are no subtypes of this condition listed in the DSM-5. C

Core symptoms of schizophrenia include the following: 

• Delusions (Strictly held false beliefs)
• Hallucinations (Sensory perceptions that are not truly occurring — for example, an individual may hear voices others don’t hear or experience visual hallucinations)
• Disorganized speech and behavior
• Catatonia 
• Paranoia 
• Negative symptoms, such as diminished emotional expression 
• Decreased function in significant areas of life 

Symptoms of schizophrenia, like hallucinations and delusions, vary

Not everyone with schizophrenia shows the same symptoms. Because schizophrenia is generally considered a spectrum, people may experience a few of the above symptoms while not experiencing others.

Some people with schizophrenia may struggle with paranoia, whereas others may experience frequent episodes of catatonia, which can involve becoming non-verbal and non-moving or having uncontrollable and unusual movements. 

Conditions with symptoms similar to schizophrenia 

If you think you may be living with schizophrenia, it could be helpful to understand that various conditions can share symptoms with it, which is why professional diagnosis and testing can help ensure you receive an accurate diagnosis. Below are some of the most similar conditions to consider: 

• Bipolar disorder (specifically bipolar I disorder, which usually causes mania) 
• Schizoaffective disorder 
• Schizotypal personality disorder
• Schizoid personality disorder
• Delusional disorder
• Substance use disorder
• Schizophreniform disorder 
• Autism spectrum disorder (ASD) 

Mental illness and other medical disorders could mimic signs of schizophrenia

Outside of serious mental illness, medical disorders and physical health symptoms can cause symptoms similar to schizophrenia, such as encephalitis, brain tumors, syphilis, infection, autoimmune conditions, Fahr’s syndrome, malaria, and some cancers. 

Mental health professionals typically consider these factors when performing diagnostic testing. Reach out to a healthcare provider if you are experiencing distressing physical symptoms or a mental health concern that may be related to a physical condition. 

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources.

The process of diagnosing schizophrenia 

Official testing may also be administered to understand the factors that can cause an individual to develop schizophrenia. Some of the tests that might be used include personality tests, cognitive tests, the intelligence quotient test (IQ), open-ended questioning, the Rorschach (inkblot) test, and the Positive and Negative Syndrome Scale (PANSS). Other tests might include the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). 

Some providers use the Brief Psychiatric Rating Scale (BPRS) to check the severity of schizophrenia symptoms, including hostility, hallucinations, and delusions. The Clinical Global Impression-Schizophrenia (CGI-SCH) test can be used to evaluate whether someone’s current treatment is helpful. 

Am I schizophrenic?: Requirements of diagnosis for people with schizophrenia

If someone is showing symptoms of other mental health conditions, the provider may provide additional screenings, such as a depression or anxiety screening or a test for substance use. For someone to be officially diagnosed with schizophrenia, the following must be true: 

• They are experiencing two or more schizophrenia symptoms that have been present for at least one month.
• Symptoms are causing severe functional disability in one or more areas of life. 
• If the individual has been diagnosed with autism spectrum disorder, they must have significant hallucinations and delusions to be diagnosed with schizophrenia. 
• Symptoms must not be due to another mental health condition or medical disorder, such as epilepsy or encephalitis. 

Changes from the DSM-IV to DSM-5 

Since the release of the DSM-5 in 2013, the category for schizophrenia was changed from “Schizophrenia and Other Psychotic Disorders” to “Schizophrenia Spectrum and Other Psychotic Disorders.” Classifying schizophrenia as a spectrum can enable diagnostic providers to take into consideration the whole, unique spectrum of symptoms that individuals with the condition may experience rather than categorizing them in ways that may not fully represent their symptoms.

This change from the DSM-IV to the DSM-5 removed the subtypes of schizophrenia that were initially part of the diagnostic process, including catatonic type, paranoid type, disorganized type, undifferentiated type, and residual type. These categories are no longer assigned to individuals in a clinical setting. 

However, the catatonic specification may still be added to the general schizophrenia diagnosis if it is significant in individuals with the condition. Comorbid catatonia usually requires a different billing code than schizophrenia on its own, which is why the DSM-5 makes the distinction. 

How to proceed after a schizophrenia diagnosis 

If you have received a schizophrenia diagnosis, it may be beneficial to try the following ways of proceeding with your wellness plan. 

Practice self-care

Lifestyle changes and self-care can reduce the severity of schizophrenia symptoms. Below are a few techniques you might implement in daily life: 

• Sleep hygiene: Proper sleep tends to be associated with a reduced risk of psychosis. Get seven to nine hours of sleep each night and sleep in a comfortable, low-lit, and cool environment. 
• Nutritious eating habits: Eat meals high in vitamins, supplements, and nutritious ingredients. It may be helpful to talk to a registered dietician to understand what this type of eating could look like for you and your unique body. 
• Hobbies and interests: Partaking in your interests and having hobbies can keep you distracted and be an outlet for challenging emotions. Art, music, and spending time in nature are a few options. 
• Exercise: Exercising may reduce the severity of schizophrenia symptoms. Consider getting at least 30 minutes of exercise daily to improve your physical and mental health. 
• Journaling: Journaling can improve mental well-being, although updated evidence may be needed. If you don’t enjoy writing long-form journal entries, consider using prompts, audio journals, video diaries, art journals, or scrapbooks.

Consider talking to a psychiatrist 

Schizophrenia symptoms can often be managed using medications like antipsychotics. Talking to a psychiatrist or your primary care physician can be a way to learn more about the medication options or medical treatments available to you. Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) may also be options if you experience treatment-resistant symptoms. 

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

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Chat with a friendly therapist online

Talk to a therapist

It can be helpful to talk to a therapist about your diagnosis of schizophrenia or a similar disorder. A therapist can guide you in developing personalized coping mechanisms and ways to move forward healthily. However, it may be difficult for some people to obtain in-person care due to barriers like psychotic symptoms, financial challenges, or a lack of transportation. In these cases, online platforms like BetterHelp may be a solution. 

Benefits of online therapy

Clients can be matched with a therapist who has experience treating symptoms like theirs, often within 48 hours of signing up on an online platform. In addition, they can choose between phone, video, and live chat sessions each week and use additional tools like worksheets and journaling prompts. 

Online therapy for schizophrenia and mental health care

Studies show that online therapy can be effective for people living with schizophrenia, although those experiencing acute psychosis may require in-person care. In a 2021 study, researchers found that young people living with first-episode psychosis often found online treatment effective in reducing visits to emergency rooms for psychiatric admission. The online treatment also seemed to reduce distress in these individuals.