Can Stress Cause Schizophrenia?
Schizophrenia is a severe mental illness that usually affects how an individual perceives reality, influencing how one thinks, feels, and behaves in the world. Symptoms can be difficult to control in some cases, and most people require treatment from a mental health professional to manage them.
While stress itself generally does not cause schizophrenia, the relationship between the two is often closely intertwined. Stress experienced early in life may interact with a genetic predisposition to schizophrenia and influence the condition’s onset. Stress may also worsen schizophrenia symptoms in some people. Developing healthy stress management tactics can be part of schizophrenia treatment and is often achieved by working with a licensed therapist in person or online.
The role of stress in schizophrenia
Stress is defined as "a physiological or psychological response to internal or external stressors."
Stress often influences how people think and behave, and in moderate doses, stress can benefit individuals with adequate coping skills.
Long-term or chronic stress that interferes with daily life, however, can negatively impact an individual in several ways, both psychologically and physically.
Research efforts into how stress triggers schizophrenia symptoms are ongoing, but there are several possibilities. For example, the dual-hit or two-hit hypothesis of schizophrenia posits that an individual may have a genetic predisposition for schizophrenia, but certain stressful environmental factors may interact with those genes during vulnerable phases in brain development to influence schizophrenia onset later in life.
Although more research may be required to establish a definitive connection, preliminary studies have linked first-trimester prenatal maternal stress (PNMS) with an increased risk of schizophrenia in offspring. Contributing psychosocial stressors considered can include warfare, famine, genocide, terrorism, and the loss of or severe illness associated with a spouse during pregnancy.
Other considerations
Other factors with direct links to stress might trigger symptoms of psychosis in schizophrenia patients, such as substance use and sleep disruption.
The prevalence of substance use disorders in people with schizophrenia tends to be considerable, with some studies indicating that up to 47% of schizophrenic patients have serious problems with substance or alcohol use during their lifetime, compared to 16% of the general population.
This relationship appears to be bi-directional, and scientists are still exploring how schizophrenia might cause substance use disorders and how some substances can encourage the onset of psychosis in some individuals.
The relationship between sleep and schizophrenia may also be bi-directional in nature. Research reveals that most people with schizophrenia report having comorbid sleep disorders, such as insomnia, restless legs syndrome, and sleep apnea. Further, data indicates that sleep disruptions may predict and precede the onset of psychotic symptoms.
Potential integration of stress management strategies into schizophrenia treatment
Stress management strategies can be used in conjunction with therapy and medication as part of a comprehensive treatment approach for schizophrenia, enhancing the effectiveness of therapy sessions and helping individuals apply what they learn in treatment to their daily lives.
The ability to effectively cope with stress can have far-reaching impacts on symptom management, medication adherence, and quality of life. If you are living with schizophrenia and struggling to manage stress in your life, here are some suggestions.
- Talk to your doctor first: Before you begin a stress management program, communicate with your mental health provider. They can help you identify symptoms and create a stress management plan tailored to your needs.
- Keep a stress journal: Write down times and circumstances in which you experienced stress. Record the coping skills you used and any insights you gained.
- Try relaxation exercises: Be sure to consult your healthcare provider for guidance on determining which relaxation techniques might work best for you. Activities like yoga, tai chi, and time in nature can improve mindfulness and well-being.
- Prioritize self-care: Try to dedicate regular time every week to relaxing and doing activities you enjoy.
- Take care of your physical health: This generally includes getting regular checkups at the doctor, prioritizing nutritious eating habits, engaging in regular physical activity, and getting enough sleep.
- Ask for help: Daily tasks like paying bills, keeping appointments, and completing household chores may present unique challenges for people experiencing common schizophrenia symptoms, such as lack of motivation and concentration. Don't be afraid to contact friends and loved ones for help managing such tasks or if you need support managing stressful life events.
Schizophrenia overview
The symptoms of schizophrenia typically emerge in adolescence or early adulthood. They often vary between individuals according to several factors, including age, environmental conditions, and gender. They are usually grouped into three categories: positive, negative, and cognitive.
Positive symptoms
In this context, "positive" typically refers to symptoms that represent changes in thoughts and behaviors due to a break with reality.
Delusions
Delusions can be defined as false beliefs that an individual holds despite clear evidence to the contrary. These can take many forms, typically falling into grandeur, paranoia, or persecution categories. For example, one may believe they are being stalked by someone famous or that they can communicate with unseen entities. A person with delusions might think they're a well-known historical figure or that they have special powers. Delusions can be distressing and often seem very real to those who experience them.
Hallucinations
Hallucinations typically involve sensory perceptions of nonexistent stimuli, which can be distressing and hyper-realistic. Auditory (particularly verbal) hallucinations tend to be the most common, but individuals may also experience visual, olfactory, gustatory, and tactile hallucinations.
Disordered thoughts and speech
People with schizophrenia may experience disorganized thought patterns reflected in how they speak. In such cases, the person's speech may appear nonsensical and fractured. Colloquially, this is sometimes referred to as "word salad."
Negative symptoms
Negative symptoms often impact an individual's emotional state, social behavior, and thought processes. They are typically similar to symptoms experienced in other mental health disorders, like severe depression and bipolar disorder, and are usually less evident than positive symptoms. However, some signs may appear outwardly. For example:
- Flat affect: An absence of emotional reaction or response to outside stimuli through tone of voice, body language, or facial expression
- Anhedonia: Diminished ability to experience pleasure
- Social withdrawal: Aversion or reluctance to engage in social activities or relationships
- Avolition: A significant lack of motivation to engage in regular activities
Cognitive symptoms
Cognitive symptoms of schizophrenia typically refer to those that hinder an individual’s executive function, memory, problem-solving abilities, and concentration. They often create significant functional difficulties at work or school, potentially impacting individuals' abilities to care for themselves.
Schizophrenia phases
Symptoms of schizophrenia typically emerge in phases. These phases might include the prodromal phase, the acute phase, and, sometimes, the residual phase. However, the residual phase is not included in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Prodromal
Negative symptoms may emerge during this stage, and friends and loved ones may notice changes in the individual's mood and behavior. They may become withdrawn and isolated. They might also lose interest in activities they once enjoyed, show signs of depression, and have trouble expressing emotion.
Acute
Positive symptoms like hallucinations and delusions typically present during this stage. The individual may seem disoriented, communication may become erratic and nonsensical, and their behavior might seem agitated or bizarre.
Residual
This phase usually marks a decrease in or the end of positive symptoms and a reemergence of negative symptoms, although they might not be as intense.
Diagnostic criteria
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines clear diagnostic criteria for schizophrenia diagnosis.
- At least two core symptoms (one of which must be a positive symptom, such as hallucinations or delusions) must be present for a significant portion of time over the course of one month.
- The individual must show decreased function in areas of life like self-care, social interaction, and occupational or academic environments.
- Signs must present continuously for at least six months, with at least one month of active prodromal, acute, or residual phase symptoms.
- Symptoms must not be better explained by another medical or mental health condition. Additionally, they cannot be attributed to medication side effects or substance use.
Potential causes and risk factors
Scientists don't yet have a definitive answer for what causes schizophrenia, but a large body of research indicates it's most likely a combination of a few factors.
- Genetics: Twin and family studies suggest that schizophrenia has around an 80% heritability rate.
- Neurological: Dopaminergic dysfunction and structural abnormalities in brain cells may be associated with schizophrenia development.
- Environment: Factors like complications in utero, early trauma, family environment, birth season, substance misuse, certain types of infections, and brain trauma may contribute to the development of this disorder.
If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.
Therapeutic interventions and coping strategies
Recent research reveals differences between how the brains of people with schizophrenia respond to stress compared with those who don’t have schizophrenia. These differences may provide more insight into the relationship between schizophrenia and stress and how schizophrenia develops in the brain. Additionally, these findings might help researchers develop schizophrenia intervention strategies before symptoms emerge.
Current schizophrenia treatments typically involve a combination of methods, some of which can also help individuals cope with secondary stress.
Medication
Antipsychotic medications are typically the first-line treatment for schizophrenia. In some cases, physicians may prescribe mood stabilizers or antidepressants to manage symptoms associated with depression and anxiety. Always talk to your doctor or psychiatrist before you start, stop, or change the way you take medication.
Individual therapy
Psychotherapy, particularly cognitive behavioral therapy (CBT), can be used in tandem with medication to help individuals manage symptoms and develop coping skills to handle daily challenges, including stress.
For some people, scheduling and attending therapy appointments can add to the stress they already experience. In these cases, virtual alternatives to traditional therapy may overcome such barriers.
Online therapy platforms can match individuals with compatible, experienced mental health professionals. Such platforms typically allow clients to schedule sessions at their convenience and switch providers as needed. Additionally, online therapy is often more affordable than conventional treatment without insurance, and a growing body of research suggests that internet-based cognitive behavioral therapy (iCBT) can be just as effective.
Family therapy
Family therapy is often integral to a schizophrenia treatment program. Treatment may focus on developing better conflict resolution and communication skills between family members. Psychoeducation in family therapy can decrease the stigma associated with schizophrenia and cultivate greater empathy. The goal of family therapy is generally to provide families with the tools and knowledge they deserve to better support their loved one with schizophrenia.
Community support programs
In many locations, community programs can assist individuals with schizophrenia with gaining and retaining employment (if necessary), coping with the challenges of school, developing social skills, and improving overall daily function.
In some cases, individuals may benefit from group therapy. Interacting with others, discussing experiences, and providing support can be very effective in helping individuals with schizophrenia manage stress and cultivate overall well-being.
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