Schizophrenia involves a range of cognitive, behavioral, and emotional symptoms, and as clinicians know, it can be difficult to diagnose. There’s no simple physical or lab test for schizophrenia, and diagnosis involves the recognition of a constellation of symptoms negatively impacting social or occupational functioning.

According to the DSM-5, the lifetime prevalence of schizophrenia is approximately 0.3% to 0.7%. Psychotic features of the disorder typically emerge between the mid-teens and mid-30s, with the peak age of onset of the first psychotic episode in the early to mid-20s for males and late 20s for females. More on age of onset and racial disparities in schizophrenia.

Schizophrenia Diagnosis

Defined as a psychotic disorder characterized by disturbances in thinking (cognition), emotional responsiveness, and behavior, schizophrenia falls under the DSM chapter for Schizophrenia Spectrum and Other Psychotic Disorders Class. The DSM-5 outlines the following criterion to make a diagnosis of schizophrenia:

1. Two or more of the following for at least 1 month (or longer period of time), and at least one of them must be a 1, 2, or 3:

1. Impairment in one of the major areas of functioning for a significant period of time since the onset of the disturbance: Work, interpersonal relations, or self-care.

2. Some signs of the disorder must last for a continuous period of at least 6 months. This six-month period must include at least one month of symptoms (or less if treated) that meet criterion A (active phase symptoms) and may include periods of residual symptoms. During residual periods, only negative symptoms may be present.

3. Schizoaffective disorder and bipolar or depressive disorder with psychotic features have been ruled out:

  • No major depressive or manic episodes occurred concurrently with active phase symptoms
  • If mood episodes (depressive or manic) have occurred during active phase symptoms, they have been present for a minority of the total duration of the active and residual phases of the illness.

1. The disturbance is not caused by the effects of a substance or another medical condition

2. If there is a history of autism spectrum disorder or a communication disorder (childhood onset), the diagnosis of schizophrenia is only made if prominent delusions or hallucinations, along with other symptoms, are present for at least one month.

Associated Features

There are a number of symptoms that contribute to a diagnosis of schizophrenia, including:

  • inappropriate affect (laughing in the absence of a stimulus)
  • disturbed sleep pattern
  • dysphoric mood (can be depression, anxiety, or anger)
  • anxiety and phobias
  • depersonalization (detachment or feeling of disconnect from self)
  • derealization (a feeling that surrounding aren’t real)
  • cognitive deficits impacting language, processing, executive function, and/or memory
  • lack of insight into the disorder
  • social cognition deficits
  • hostility and aggression

Cognitive impairments caused by the disorder may persist when other symptoms are in remission. This contributes to impairments in functioning in employment, interpersonal relationships, and the ability to engage in proper self-care.

Schizophrenia and Suicide Risk

Five to 6% of people with schizophrenia die by suicide, about 20% make suicide attempts on more than one occasion, and many more have significant suicidal thoughts. Males with schizophrenia are more likely to attempt or die by suicide. The incidence rate ratio for suicide among those with schizophrenia is about 20 times higher than the general population

Suicidal behavior may be in response to hallucinations and suicide risk remains high over the lifespan of individuals with schizophrenia.

See also, how to address suicidal ideation in patients with schizophrenia, and unique risks of suicide in the LGBTQ community.

Functional Consequences

Schizophrenia is associated with social and occupational dysfunction. Completing education and maintaining employment are negatively impacted by symptoms of the illness, and most individuals diagnosed with schizophrenia are employed at a lower level than their parents. Many have few or limited social relationships outside of their immediate family.

Treating Schizophrenia

See updated treatment guidelines for schizophrenia and clinical perspectives on managing schizophrenia.


Editor’s Note: This article was originally published on See our sister site’s 2021 consumer report on schizophrenia in Black Americans.



Last Updated: Sep 14, 2021