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Understanding Schizophrenia Symptoms and Severity

A guide to positive, negative, and cognitive symptoms, and what these terms mean for your diagnosis.

When treating schizophrenia, healthcare providers focus on identifying specific symptoms and determining the best treatments to address those symptoms.

Medically reviewed in November 2021

Schizophrenia is a serious mental illness that interferes with the way a person interprets reality. Typically diagnosed in the late teens or early adulthood, schizophrenia can cause confusion, difficulty expressing emotions, and psychotic symptoms such as hallucinations and delusions. As a result of these symptoms and the impact that they have on a person’s life, people with schizophrenia often need the help of a caregiver or care-partner.

If you are living with schizophrenia or caring for someone with schizophrenia, it’s helpful to understand the different symptoms and how those symptoms are categorized.

Positive, negative, and cognitive
While schizophrenia used to be classified into different types, mental health professionals no longer use those categories. Instead, healthcare providers focus on identifying specific symptoms and determining the best treatments to address those symptoms. Symptoms are typically classified as positive, negative, or cognitive.

Positive symptoms add something to a person’s thoughts and behavior. Examples of positive symptoms include hallucinations and delusions:

  • Hallucinations occur when a person sees or hears something that is not really there. For example, they may see or hear a person who is not there.
  • Delusions are beliefs or suspicions that are not founded in reality. For example, someone may believe that they are being watched by the government.
  • Hallucinations and delusions feel very real to the person experiencing these symptoms. Many people who have schizophrenia do not realize what they are experiencing is not real.
  • Other examples of positive symptoms can include agitation, abnormal movements, and repetition of words or ideas.

Negative symptoms take something away from a person’s thoughts and behavior. Examples of negative symptoms include:

  • Neglect of personal hygiene
  • Inability to express emotions
  • Social withdrawal, or lacking a desire to speak or interact with others
  • Loss of interest in hobbies or other activities

Cognitive symptoms refer to those symptoms that affect how a person with schizophrenia thinks, and consequently, how they behave and communicate. These can include:

  • Disorganized thoughts, speech, and behavior
  • Moving quickly from one topic to another
  • Answering questions with seemingly unrelated information
  • Making up words
  • Decline in cognition
  • Decline in memory
  • Difficulty paying attention or following instructions
  • Difficulty making decisions

People with schizophrenia may have symptoms in just one category or have symptoms in all three categories.

Your diagnosis
One of the reasons working with a healthcare provider is so important to successfully managing schizophrenia—the condition is a different experience for everyone. Different people experience different symptoms. Symptoms are more severe for some people and less severe for others. Symptoms can also change over time. And beyond symptoms, schizophrenia impacts people’s lives (and the lives of their caregivers) in different ways.

Each of these factors will determine the type of treatment a person needs. Working with a psychiatrist who has experience in treating schizophrenia can help you or your loved one fully understand the diagnosis and its impact—and help find the most effective approach to treatment.

Working with a psychiatrist will also help you determine the type of caregiving a person requires. For some, caregivers will need to manage nearly all aspects of care and everyday life. In others, caregivers will be more of a guiding hand, offering support when a person needs it. And many will fall somewhere in between.

Article sources open article sources

MedlinePlus. "Schizophrenia."
Tim Newman. "Understanding the symptoms of schizophrenia." MedicalNewsToday. April 23, 2020.
Amy Smith. "What are the different types of schizophrenia?" MedicalNewsToday. October 6, 2020.
Mayo Clinic. "Schizophrenia."
Mental Health America. "Schizophrenia."
American Psychiatric Association. "What is Schizophrenia?"
NHS. "Symptoms - Schizophrenia."
National Institute of Mental Health. "Schizophrenia."
Mayo Clinic. "Schizophrenia."

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