What Is Living With Schizophrenia Like? Navigating Daily Functioning
Schizophrenia is a complex mental illness that often impacts cognitive, emotional, social, and physical functioning. This spectrum disorder can make independent living difficult for some people, potentially causing challenges with self-care, finances, work, and relationships. However, individuals with schizophrenia may be able to effectively navigate daily life with a healthy support system and various treatment options, often including therapy.
Understanding schizophrenia: Symptoms and presentations
Schizophrenia is a spectrum disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and International Classification of Diseases, 11th Edition (ICD-11). In the fourth edition of the DSM, the DSM-IV, schizophrenia was classified into subcategories. However, this classification has since been updated to reflect the spectrum of diverse symptoms and experiences with which individuals may live. Diagnostic criteria for schizophrenia normally include the following:
- Hallucinations (sensory perceptions that are not genuinely occurring)
- Delusions (strongly held false beliefs)
- Disorganized thinking and speech
- Disorganized or catatonic behavior
- Negative symptoms, such as social withdrawal and a lack of emotional expression
- A significant lack of functioning in one or more major areas of life, such as relationships or self-care
In general, to be diagnosed with schizophrenia spectrum disorder, an individual must experience positive, negative, and cognitive symptoms for at least six months, with at least one month of active-phase symptoms or a psychotic episode.
In addition, a diagnostic provider usually must rule out schizoaffective disorder and bipolar disorder as causes of symptoms. Individuals diagnosed with autism spectrum disorder (ASD) generally must show psychotic symptoms in adulthood to be diagnosed with schizophrenia.
Daily functioning challenges with schizophrenia
Functional challenges are typically a part of the diagnostic criteria for schizophrenia. Some people who are currently in treatment for schizophrenia or who are not in an active phase or psychotic episode may not experience as many challenges in these areas.
Below are some challenges people might face due to schizophrenia symptoms.
Social functioning
People with schizophrenia may have difficulty forming and maintaining healthy or long-term relationships with others due to symptom severity, difficulty trusting others, isolation, or personal beliefs about relationships. Studies report that some people with schizophrenia may also have lower social knowledge than those without the condition.
Professional opportunities
Symptoms of schizophrenia can be severe and life-altering. Some people may struggle to find or keep jobs due to difficulty practicing self-care and hygiene. Others might have trouble due to often-noticeable symptoms like delusions, hallucinations, and disorganized speech or behavior. If someone requires time off for an episode, it may not be possible for a workplace to accommodate long-term absences. In addition, people with schizophrenia may have difficulty performing their duties at work when an episode is occurring.
Education
Individuals with schizophrenia might struggle to attend school due to symptoms. In addition, studies show that individuals with this condition usually have lower educational attainment than the general population. People with schizophrenia who did obtain higher education typically had a slightly lower risk of younger death.
Despite potential barriers, people with schizophrenia can and do obtain college degrees. In a paper published in the Schizophrenia Bulletin by the University of Maryland School of Medicine, Bethany Yeiser described her experience of going from being homeless to graduating from college, despite her schizophrenia diagnosis. After starting treatment, she achieved her molecular biology degree, graduating with high honors. Many other people with schizophrenia achieve degrees and work in distinguished industries, with some aiming to reduce mental health stigma in their respective fields.
Self-care
Self-care can involve personal hygiene, self-regulation skills, spending time with loved ones, maintaining a healthy schedule, eating nutritious meals, and sleeping enough. People with schizophrenia can struggle with all aspects of self-care and may neglect specific health needs to the point of developing physical health challenges.
Studies show that people with serious mental illnesses like schizophrenia tend to be more likely to practice self-care when they have attained higher education, have a support system, and are not living with a physical health condition. Support systems and professional help can promote self-care, even during an episode.
Organization and executive function
Because schizophrenia can cause disorganized thoughts and behavior, it might be difficult for some people to organize a routine, daily to-do lists, paperwork, and requirements to achieve professional or educational goals. Disorganized thought and speech patterns can cause someone to get stuck on certain ideas that may not make sense to others.
Meanwhile, psychotic episodes can make it challenging for someone with schizophrenia to focus on anything other than the hallucinations or thoughts they may be experiencing. They may become fixated on their delusions, which can lead to a lack of sleep and potential cognitive decline.
How to improve daily functioning
If you are struggling with daily functioning during episodes or because of your schizophrenia symptoms, you’re not alone. Below are a few options for managing daily life and meeting your goals in multiple areas.
Medication adherence
It can be common for people with schizophrenia not to adhere to their prescribed medication schedule, with medication non-adherence occurring in approximately 50% of people with this disorder. Adhering to medication can reduce relapse rates and inpatient hospitalization rates. In addition, medication can often reduce or eliminate symptoms like hallucinations that may make it difficult to function in multiple areas of life.
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.
Support systems
A support system is often cited as the most critical factor for treatment success for people with schizophrenia. One study found that 43% of individuals achieved remission of symptoms due to having social support from family members. Family-centered culture likely played a role in this result. However, not all people with this condition have family guidance or a reliable social network.
If you’re struggling to build a social network and find mutual support, below are a few options for making friends and meeting people that you might consider:
- Support groups for people with schizophrenia spectrum disorders and other psychotic disorders to find peer support
- Meetup groups
- Apps that match you with new friends
- Online groups or forums for people with schizophrenia
- School clubs
- Mentoring programs
Some people with schizophrenia have long-term, severe symptoms and may not live with family members who can offer the care they need. In these cases, group homes or intensive mental health services, like residential living facilities, may be an effective way to receive treatment and meet others living with severe mental illness who may understand your experiences.
Group living can be a way to find “chosen family” members, which can build mental health and social skills. One study found that people with schizophrenia living in residential care facilities usually had improved mental well-being and lower biomarkers of aging.
Therapy
Alongside medication and social support, therapy can be a way for people with schizophrenia to build independence, coping strategies, and self-care abilities. In therapy, a mental health professional can guide you through specific exercises, notify you when you show warning signs or an increased risk of an episode, assign homework, build a treatment plan, and help you track symptoms so you have more control over your daily experiences and can respond to symptoms with a safety plan.
In some cases, attending in-person therapy may be challenging for individuals living with mental illness, as it can come with financial and transportation barriers. In these cases, online therapy through a platform like BetterHelp may be helpful. Although online platforms are not a replacement for crisis services and may not be beneficial for a psychotic episode, they can be used from home to learn new coping skills and talk to a licensed provider. In addition, online platforms typically allow users to choose between phone, video, or live chat sessions, giving them control over the therapy experience.
Studies show online therapy may be helpful for psychotic disorders. More studies are likely needed to understand these treatments' benefits fully. However, in limited studies, online counseling has been shown to benefit people with schizophrenia and their family members.
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