Please help me understand the symptoms of schizophrenia. What does "positive" or "negative" symptoms mean? How is this illness different from split personality or other behaviors often described as "schizophrenic?"

Schizophrenia is a complex psychiatric disorder characterized by severely disrupted perceptions, beliefs and behaviors. During an acute psychotic episode of schizophrenia, a person’s experience and interpretation of the outside world is severely distorted. The individual may lose touch with reality, see or hear things that are not there, and act in unusual ways in response to these abnormal perceptions.

 Schizophrenia is a biologically-driven condition, stimulated by an imbalance in brain chemistry. Symptoms of schizophrenia are generally categorized into two groups: positive and negative. Positive symptoms are abnormal perceptions and bizarre behaviors. Three prominent positive symptoms include: 1) feelings of being controlled by outside forces (i.e., having one’s mind taken over), 2) hearing, seeing, smelling or feeling things which are not there (hallucinations), and 3) unusual beliefs (delusions). Positive symptoms tend to occur during acute episodes, often triggered by stress, recreational drugs, changes in medication or for no apparent reason at all.

Negative symptoms of schizophrenia are more subtle deficits of functioning and are often not recognized as part of the disorder. These include loss of concentration, lack of energy and motivation, tiredness, blunted emotions, social withdrawal, poverty of thought, disinterest in the environment or personal hygiene and few intimate relationships. Negative symptoms are associated with the stigma of psychological weakness, lack of will or drive to lead a more active life, and inability to take care of oneself. Sometimes negative symptoms are misinterpreted by family and friends as signs of "laziness."

The type and severity of symptoms can vary considerably over the course of the illness and from one person to another. When positive symptoms are present during an acute episode, the individual will have great difficulty functioning socially and may require admission to a psychiatric hospital. Antipsychotic medication can eliminate or reduce positive symptoms and lessen the chance that they will recur, but the individual may still be affected by negative symptoms.

Another chronic psychiatric disorder is Dissociative Identity Disorder (formerly called Multiple Personality Disorder). Dissociative Identity Disorder is diagnosed when there are two or more distinct identities or personality states that recurrently take control of the individual’s behavior. Each personality state may be experienced as if it were a separate person with a distinct identity, self-image and personal history. The "host personality" is often depressed, dependent, guilty and passive, and maintains the individual’s given name. New names are given to the "alternative personalities" which may have characteristics that contrast with the primary identity. Alternate identities often emerge in specific circumstances and may vary in reported age, gender and fund of knowledge. Dissociative Identity Disorder appears driven by the individual’s psychological experience, rather than imbalances in brain chemistry. Individuals with this disorder frequently report a history of physical and sexual abuse during childhood.

Dave Overstreet, Ph.D.
Overstreet Psychology Services, Inc.
Florissant, MO
314-831-7774

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