It's confusing when your own reality seems out of sync with the rest of the world's view of things. You might jump to the conclusion that the problem is schizophrenia. But other conditions can also cause symptoms such as delusions and hallucinations. Getting a correct diagnosis is the first—and very important—step toward finding effective help.
Life would be simpler if there were a lab test or brain scan that could definitely tell whether you have schizophrenia. Unfortunately, it's not so easy. To make the diagnosis, a health care professional first evaluates your symptoms, how long they've lasted, and how they affect your daily life. Then the professional considers all possible causes before deciding whether the symptoms are due to schizophrenia or something else.
For a diagnosis of schizophrenia, you must have two or more of the symptoms described below. (Only one symptom is required if you have certain types of delusions or hallucinations.) The symptoms are long-lasting or frequently recurring and lead to serious problems in everyday life. But remember: All these symptoms can have other causes as well. The only way to know for sure what's going on is to see a medical professional.
Delusions are false beliefs based on a misinterpretation of reality. These beliefs aren't shared by others in the same culture. People cling to their delusions even when all evidence points in the other direction. Some people with schizophrenia believe that they are being followed everywhere or plotted against by strangers. Others might believe that aliens are controlling their bodies or that the radio is broadcasting their thoughts. Or they might think that they are a famous figure from history or that a TV newscaster is talking just to them.
Hallucinations are things a person hears, sees, feels, tastes, or smells that no one else can perceive. The most common type of hallucination in schizophrenia is "hearing voices." These voices seem to be distinct from the person's own thoughts. They may keep up a running commentary on the person's behavior. Or they may issue warnings or commands. Other examples of hallucinations include seeing people who aren't there or feeling another person's touch when no one else is around. The most immediately concerning hallucinations are command hallucinations—voices demanding specific actions to be taken—especially if these actions could be dangerous and if the person can't resist these demands.
Other possible causes: Severe depression, bipolar disorder, delirium (brain dysfunction due to a medical illness), dementia, substance abuse or withdrawal, epilepsy, narcolepsy, sensory disorders (such as deafness or blindness), traumatic stress
Disorganized Thought or Speech
Many experts believe that disorganized thinking is the core symptom of schizophrenia. This involves a lack of orderly flow and logical connection in a person's thought processes. To the outside world, it often shows up as disorganized speech. When talking, people may slip off track, veering from one train of thought to another, unrelated one. Or they may garble their words so much that it's difficult for others to understand them.
Other possible causes: Severe depression, bipolar disorder, delirium (brain dysfunction due to a medical illness), dementia, substance abuse or withdrawal, stroke, Tourette syndrome, autism, speech and communication disorders
Disorganized Behavior or Odd Movements
People with schizophrenia may be extremely disorganized in their behavior. Some behave bizarrely. Others act agitated at unpredictable times. In severe cases, people may become catatonic, a state in which they seem totally unaware of the world around them. They might repeat certain motions over and over without any obvious purpose, or they might not move at all. Catatonic schizophrenia is rare today, but it occurred more often in the era before modern treatments.