Could it really be Schizophrenia?!


Question:

Could it really be Schizophrenia?

I have a friend who thinks that she is schizophrenic. She came to this conclusion because she says that she sees things and hears things that arent actually there. I sort of doubt (or want to doubt) that she is actually schizophrenic, and maybe just has an overly stimulated mind or really intense dreams, or even some other mental illness. i just do not think it is schizophrenia because i think that involves a lot more and is much more disruptive to living a normal life. Could someone please tell me more about schizophrenia? I dont really know enough about it. Any other helpful information is appreciated.

i am concerned about my friend so serious answers only please.
thanks.


Answers:

Schizophrenia is an illness that is biogically based. You inherit a predisposition for the disorder which is generally triggered by stress. The precise genetic mechanism is not clear, but it appears that multiple genes are involved so it is difficult to predict exact rates for inheritance patterns. The genetic component is demonstrated via twin studies which show concordance rates to be significantly higher between identical twins than between fraternal twins who have genetic make-ups that are the same as siblings. However, concordance rates among identical twins are not nearly 100%, thus there is clearly an environmental component to the disorder.The typical age of onset is in the late teens to early 20's (the college years).

The general characteristics include both "positive" (acute) symptoms and "negative" (residual) symptoms and there is a prodromal phase, acute phases and residual phases. There are a lot of technical aspects to the correct diagnosis which I won't elaborate, but in general the characteristic signs are any combination of the following:

"Positive" signs:
-Hallucinations (primarily auditory, less often visual and rarely tactile, gustatory or olfactory)
-Delusions (fixed or variable, paranoid/persecutory and grandiose, somatic, erotomanic, nihilistic, etc.-they run the gamut of various types, "ideas of reference" where a person believes that random events have a special meaning meant just for them, delusions of thought control or thought insertion)
-Disorganized Thinking ("Loose associations" where thoughts are strung together with little cohesiveness, "perseveration" where a person gets stuck on the same thought or theme over and over like a needle that skips on a record and keeps replaying )
-Disorganized Behavior (catatonic excitement, catatonic stupor which is like posturing-usually only seen in extremely severe cases and rarely any more)
-Poor Concentration and inability to focus on a thought, sometimes "blocking" where a thought becomes interrupted in midstream)
-Disorganized speech (incoherence, rambling or circumstantial speech-lots of fancy terms like echolalia, word salad, verbigeration, clanging)
-Inappropriate Affect (inappropriate giggling, tears, silliness, etc. that is out of context to the situation)

"Negative" signs:
-social withdrawal and preference to isolate
-flattened or blunted affect (emotional expression)
-Amotivation (lack of motivation, apparent apathy)

Prodromal symptoms are less acute and precede the "active" phase where the "positive" symptoms become prominent. A prodrome often looks like a Schizoid or Schizotypal Personality Disorder where you tend to see things like emotional blunting, social withdrawal, odd or eccentric behavior, sometimes manifested in certain unusual preoccupations, idiosyncratic thinking that strikes people as "odd" rather than outright bizarre. For example, strange beliefs that are uncharacteristic, reading hidden and overly personal messages into random events or preoccupation with signs and symbols. Auditory hallucinations may begin at this point and people may wear headphones constantly to drown out the voices or become obsessed with unplugging electrical appliances, etc., believing them to be the source of the stimuli. Again, these are only examples and not present in every case. Outward signs that observers notice tend to be centered around decreased attention to hygiene and appearance generally (like wearing the same clothes for days on end without washing them), disrupted sleep patterns, a more distant interpersonal stance or odd habits that seem out of character, like avoiding certain foods, colors, places, etc. or always wearing a certain item.

There are 5 distinct types:
1-Paranoid: most organized thinking of the types-prominent delusions and hallucinations
2-Disorganized (Hebephrenic): Grossly disorganized thinking and behavior predominates and inappropriate affect with grimacing, giggling, etc. unrelated to the situational context
3-Catatonic: catatonia, with waxy flexibility, posturing or catatonic excitement rarely seen any more
4-Undifferentiated: no clear predominant symptoms
5-Residual: Primary negative symptoms-often seen as a "burned out" version where there are fewer positive or acute symptoms

Schizophrenics often are able to maintain jobs in low stress environments with minimal interpersonal demands once they are stabilized. Others may work in sheltered employment with support and guidance. Social skills are greatly impaired and schizophrenics often have great difficulty reading the social cues most of us take for granted and thus they misjudge or misread social situations which reinforces their tendency to self-isolate as do paranoid symptoms. Intimacy is exceptionally difficult as well and they rarely form close or deep bonds with others, making it difficult to function as husbands and parents. They tend to appear aloof and distant emotionally, although often this is a way of coping with feelings of being overwhelmed by other people's emotional expression and demands.

Medication often serves to either completely control the acute symptoms or dampen their impact, but tends to have minimal impact on the negative symptoms. The side effects are often horrendous and intolerable and this leads to a familiar pattern of stopping medication, beginning the trend of repeated courses of decompensation leading to re-hospitalization.

The ineffectiveness of meds and the emotional blunting they can cause often leads to attempts to self-medicate with alcohol or marijuana (usually) which often increase symptoms.

Schizophrenics often perceive the world in unique and idiosyncratic ways which can cause them difficulty in complying with social norms and expectations, even simple things like generally accepted standards for cleanliness or hygiene. It can also lead them to exceptional creativity and expression in arts and abstract disciplines. Examples of famous schizophrenics are the poet and artist, William Blake (I have many of his works in my office for inspiration) and John Nash, the Nobel Prize winner featured in the movie "A Beautiful Mind".

People with Dissociative Identity Disorder also here voices frequently, but generally the voices are always experienced as being within one's head. Despite this common symptom, DID is often misdiagnosed as Schizophrenia. Here's a little blurb on DID from one of my previous answers that may shed light too:

DID is the existence of two or more separate personalities or personality states within one person, with each alter having distinctly different ways of thinking, feeling, behaving and relating to the world and distinctly different memories, each part having amnesia for the other parts' memories. It is born from repeated and severe abuse and involves the defense mechanism of dissociation and generally develops before the age of 10 as children are far more likely to dissociate.
DID is often misdiagnosed and it is very common for a person to have had multiple different psychiatric diagnoses before it is definitively identified as DID. The symptoms frequently overlap with symptoms of schizophrenia, Bipolar Disorder, Depression, Anxiety Disorders (all), PTSD, other Dissociative Disorders and Somatoform Disorders as well as Borderline Personality. It requires extremely careful assessment and a high level of trust by the patient before alters reveal themselves. The diagnosis cannot be finalized before a therapist has actually made contact with another alter and observed the switch between alters.
The hallmark symptom is amnesia, which can be partial or complete depending on the level co-consciousness that exists between alters. Folks with the disorder describe the amnesia as "missing time" or blank periods, often daily or weekly, where they cannot account for their whereabouts or behavior. It is this amnesic barrier between parts that often leads to the most bizarre and distinctive signs and symptoms: not recognizing familiar people; not remembering highly significant events in their lives (like the birth of their first child, for example); finding purchases or articles of clothing/possessions, writings or drawings that they have no recollection of having bought or created. They are frequently accused of lying because they disavow their own behavior which is remembered by one part, while the amnestic part is completely unaware of it. Other unusual symptoms include: an exceptionally high tolerance for physical pain (they split off physical sensation which becomes encapsulated in one or several alters without others feeling it); not recognizing themselves in a mirror; using different names; having dramatically different skills and abilities that seem to be alternately present and then vanish (one alter may be able to drive a car while the sudden emergence of a child alter results in complete loss of this ability until the adult alter re-emerges); completely different opinions and behaviors (leading to the mislabeling of Bipolar or Borderline Personality.
Often communication across between separate alters takes place in the form of hearing voices, hence these folks frequently get misdiagnosed as schizophrenic. The key distinction here is whether the voices are experienced as coming from inside the person's head (DID) or outside one's head (Schizophrenia/Bipolar Disorder).
The separate identities develop in response to traumatic experiences which the child is unable to integrate and so they become "split off" from awareness and begin to take on a life of their own.
Folks with DID often self-injure, frequently a result of internal battles between persecutor alters and weaker alters and there are continual battles for control of the body and "time out" in the body between competing alters.
Symptoms of depression and anxiety are frequent and common and the picture is further complicated by the fact that one alter can meet all clinical criteria for Depression, while another part experiences no symptoms whatsoever. One part can be psychotic and experience no side effects from meds while another non-psychotic part has all the side effects and will stop taking meds. You can imagine that attempting to medicate such a disorder becomes an absolute nightmare.
Other symptoms include flashbacks and nightmares, hence the confusion with PTSD. Sometimes there are fugue states and clients will switch and "come to" in the body and have no idea how they arrived in the situation they are in, not know the people they are with and be completely disoriented. I had one client call me from another state after being away for a few days and having no idea how she got there or how to get home. Depersonalization and trance states are common and hence the overlap with other Dissociative disorders.
Folks with DID frequently experience multiple somatic symptoms for which there is no organic basis. They experience partial body memories of abuse without the actual memory of the event and thus exhibit strange physiological symptoms and are often labeled as Somatoform disorders or hypochondriacs.
I could go on and on, but suffice it to say that virtually any symptom of any disorder can be found at some point in a person with DID. Treatment is almost exclusively through psychotherapy as medication is merely palliative and an adjunct during periods of acute anxiety or depression. Treatment aims at initially contracting against suicidal and self-destructive behavior and attempts to establish safety first. Many DID folks enter treatment in horrendous circumstances where they are frequently in highly abusive relationships or are themselves abusive. Given the multiple alters, they may be both victim and perpetrator both within themselves alone and in the context of their relationships. The second primary goal is establishing communication and negotiation among alters to decrease amnesia and contradictory, self-defeating behavior. Ultimately the goal becomes integration of alters into one cohesive whole which involves sharing of memories and feelings across alters and a merging, where all parts continue to be present, but constant.

I included the other symptoms in casr=e there may be others that you recognize. Hope this helps some.




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