Although schizophrenia can significantly impact someone’s personality and functioning, it is not classified as a personality disorder. Instead, it falls under the category of psychotic disorders in the DSM. That said, it is possible to experience comorbid personality disorders with schizophrenia. In addition, many symptoms in both conditions overlap.
Understanding Psychotic Disorders
Psychotic disorders refer to mental disorders associated with abnormal thought processes and the loss of touch with reality (1). The main symptoms include delusions (false beliefs about oneself or others) or hallucinations (false sensations or perceptions). Psychotic disorders exist on a spectrum and are generally diagnosed in early adulthood.
When someone is in a psychotic state, they lose their sense of reality. These states can last for several days or months. That said, psychosis is relatively rare- it’s estimated that about 15-100 people out of 100,000 people experience psychosis each year (2).
Many people show behavioral changes before the psychotic episode occurs. Some of the main symptoms include:
Increased paranoid thinking or discomfort around others: Many people experiencing psychosis experience heightened anxiety around other people. They might believe that others are out to hurt them. This can lead to increased fears about persecution or threat.
Difficulties thinking concretely or logically
Declining personal hygiene or grooming: Difficulties with disorganization or apathy (lack of feeling positive) can cause people to neglect their physical health. In fact, one of the earlier signs of psychosis is failing to brush teeth, wear clean clothes, or shower.
Withdrawing from others and preferring to spend time alone: Paranoid thinking can lead people to think that others are not safe, which can lead them to withdraw from friends and family. They may also prefer to be alone to not have to “answer” to other people.
Strange or illogical speech: Psychosis can result in disorganized thinking, which then comes across as incoherence to others. Disorganized thinking affects everything from memory recall to solving problems to making decisions.
Problems discerning reality from fiction or fantasy: Psychosis results in hallucinations and delusions, and people often can’t tell what’s real or not. For this reason, it’s generally considered unhelpful to try to “prove” the truth to someone experiencing psychosis.
Drastic changes in daily routine (i.e. failing out of school or losing a job) without a significant emotional reaction: The combination of apathy, paranoia, and intense hallucinations or delusions can become consuming. As a result, people often find it difficult to adhere to other tasks in daily life.
Lack of motivation: Because psychosis can be so consuming, it’s difficult to be goal-oriented or think about the future. In most cases, the person is just trying to survive each moment, and life can feel extremely scary and chaotic.
Someone in psychosis may act in unpredictable and irrational ways. In some cases, they can be a danger to either themselves or others. It’s important to note that psychosis isn’t someone’s fault- there is no defined cause for it happening, and it appears to occur due to a rich combination of genetic factors, traumatic experiences, and environmental issues.
Understanding Schizophrenia
Schizophrenia is a chronic and pervasive mental health disorder that affects about 0.3% of the global population. Schizophrenia includes both positive symptoms (like hallucinations and delusions) and negative symptoms (like flat affect or anhedonia).
Schizophrenia also entails cognitive symptoms. These include difficulties with focus, attention, memory, and goals. These cognitive issues tend to be the most disabling for people trying to function and live a normal life.
The average onset of schizophrenia is during late adolescence or the twenties, but men tend to show symptoms earlier than women(3). There are some cases of young children and adolescents having schizophrenic symptoms. Most people do not have the onset of schizophrenia symptoms after age 45.
Unfortunately, schizophrenia is highly stigmatized in general society. Many people experience immense discrimination, which can affect everything from employment to relationships to healthcare access. In some cases, people with schizophrenia lie or downplay their symptoms to avoid judgment or ostracization. Other times, people are not aware of the condition until it is diagnosed. Even then, they may not necessarily believe the diagnosis.
While there is no cure for schizophrenia, medication and therapy can help people live meaningful and happy lives. Like other chronic illnesses, staying on top of treatment is critical for success. Relapses can and do occur if people do not remain compliant with their recommendations.
Schizotypal Personality Disorder vs. Schizophrenia
Some people mistake schizophrenia for a personality disorder because it does have some parallels with schizotypal personality disorder. However, while there are some overlapping symptoms, it’s important to discern the key differences.
People with schizophrenia personality disorder often have themes of bizarre thinking. They may have distorted perceptions, which can lead to paranoia about others. Their thinking and speech may come across as odd (it can be very vague, circumstantial, or overly detailed). They also tend to have excessive social anxiety, even in familiar situations, which results in difficulties forming friendships.
That said, most people with schizotypal personality disorder do not experience hallucinations or delusions. If they do, the nature of them is not as severe as people with schizophrenia. They are also more open to accepting the nature of their distortion.
A personality disorder entails persistent unhealthy thoughts and behavioral patterns that affect multiple parts of life. However, psychotic disorders are characterized by the presence of psychosis. Someone with schizotypal personality disorder is not experiencing psychosis, even if their thoughts or patterns may seem unusual.
How Does Schizophrenia Affect Someone’s Personality?
It’s important to note that schizophrenia does not inherently have a distinct look or type. That’s why it’s so important to avoid typecasting or stereotyping people based on societal stigma. People of all races and demographics have schizophrenia.
Despite some misconceptions, schizophrenia is not the same as multiple personalities (now known as dissociative identity disorder). Someone with schizophrenia does not have altars or transition into various identities at different points.
Likewise, people with schizophrenia are not inherently violent or dangerous to others. In most cases, if an injury occurs, it’s far more likely to be self-inflicted.
That said, schizophrenia can significantly impact how someone feels, thinks, and behaves. Many people with schizophrenia spend significant time alone. It’s challenging to deal with other people, and the fear of being judged or hurt can be extremely intense. Certain thoughts may feel highly intrusive or repetitive.
What Causes Schizophrenia?
There is no exact known cause of schizophrenia. Instead, research indicates that a combination of genetic, psychological, and environmental variables likely increases the risk of someone developing this particular condition (4).
Genetics: It’s known that schizophrenia runs in families. Many people with schizophrenia have a first-degree relative with the condition. This may speak to various combinations of genes that make people more susceptible to schizophrenia symptoms.
Neurotransmitters: Neuroimaging research shows that schizophrenia is associated with differences in the brain structure and central nervous system. This likely affects communication between key neurotransmitters like glutamate, dopamine, and serotonin.
Pregnancy and birth complications: There is an association between pregnancy/birth complications and developing schizophrenia. Such issues include premature labor, lack of oxygen (asphyxia) during the birth process, and being born at a low birth weight. During pregnancy, issues related to malnutrition or exposure to toxins can also impact brain development.
Significant drug and alcohol use: Some people exhibit schizophrenia symptoms after using mood-altering substances. However, it’s unlikely that drug use alone causes schizophrenia. Instead, it’s likely that people who are predisposed to schizophrenia may experience exacerbated symptoms due to drug use.
What Are the Best Treatments for Schizophrenia?
Proper treatment requires accurate diagnosing. Schizophrenia is generally diagnosed after ruling out other physical and mental health disorders. Unfortunately, misdiagnosis is a rampant problem, particularly among people with substance use disorders.
Diagnosis may be multifaceted. A skilled psychiatrist or other mental health professional will conduct a thorough biopsychosocial assessment to review past and present symptoms, family history, and other medical conditions.
If the symptoms are severe and the person is in imminent danger of hurting themselves or someone else, hospitalization may be necessary. Hospitalization provides brief stabilization under safe monitoring and care.
Medications: Many people with schizophrenia take second-generation antipsychotics, including Abilify, Latuda, Zyprexa, and Seroquel. First-generation antipsychotics may also be prescribed, but they have more intense side effects that may be permanent. Antipsychotics affect dopamine and can reduce distressing symptoms.
Individual therapy: People with schizophrenia may benefit from talk therapy to work on changing negative thought patterns and recognizing concerning signs of relapse.
Family therapy: Family therapy may also be beneficial to help loved ones understand and support someone with schizophrenia.
Social skills support: This type of support specifically focuses on strengthening relationships and improving communication and boundaries in everyday life.
Vocational training and employment support: This type of treatment helps people with schizophrenia obtain and maintain work.
What Should You Do If You Suspect a Loved One Has Schizophrenia?
It may feel frightening and confusing to see a loved one act irrationally or unsafely. You might feel angry, guilty, or helpless about what to do.
It’s first important to educate yourself about schizophrenia and its symptoms and treatment. This knowledge will remind you that you’re not alone in your struggles and that your loved one isn’t trying to intentionally make things challenging for you.
Be aware of the warning signs of relapse (increased agitation, withdrawal, declining personal hygiene). In addition, try to best prepare for potential crisis issues. This means having emergency contact information on hand. It also means knowing where your local hospital is and having a plan for who can take care of the loved one’s home, children, or other needs.
It’s also important to emphasize treatment. You may need to help them access resources, drive them to a therapy or doctor’s appointment, or refill their prescription. Keep in mind that people tend to be more willing to seek support if they feel they have a sense of control over the situation. If your loved one presents as resistant, focus on another symptom that they’re struggling with (i.e. their lack of motivation or social withdrawal).
Aim to be collaborative in their treatment and empower them to use healthy coping skills to manage their emotions. Model taking care of yourself, too. It’s important to prioritize your own emotional well-being and self-care. It may be helpful to work with a therapist to better help you recognize your own limits and set reasonable boundaries.
Final Thoughts
While schizophrenia is not a personality disorder, it can significantly impact someone’s personality. Although it can be a difficult condition to live with, the right treatment can make an invaluable difference in someone’s emotional and physical well-being.
