Hallucinations, delusions, disorganized thinking and behaviors… knowing these signs and what they look like can be a good step toward the right treatment plan.

Schizophrenia is a chronic mental health condition that affects a person’s behaviors, thoughts, and feelings.

Symptoms of schizophrenia develop slowly over time and typically appear between late adolescence and early adulthood. Symptoms usually fall into one of three categories:

Positive symptoms: Perceiving reality differently than others; seeing, hearing, smelling, or tasting things that others don’t.
Negative symptoms: Experiencing a lack of interest and motivation to engage in typical activities or interactions.
Cognitive symptoms: Difficulties with attention, concentration, and memory recall.

Signs of schizophrenia

Schizophrenia is one of the top 15 leading causes of disability in the world.

Those living with schizophrenia may experience challenges with social interactions, disruptions in thought processes, and emotional responses.

Symptoms, however, can range in severity among individuals due to varying social and environmental factors associated with the condition. Common signs of schizophrenia may include:

Hallucinations

When a person with schizophrenia has hallucinations, they see, hear, smell, or taste things that don’t exist.

But to that person, what they see, hear, smell, or taste is very real. This may confusing or upsetting if you care about the person who’s having hallucinations, especially as they might hear voices for a long time before anyone else notices.

These voices may be from people they know or don’t know. They might be judging or threatening them. They could also be a narration of what the person is doing or demanding them to do certain things.

Sometimes the voice isn’t a voice at all — instead it’s a sound like a whistle or hissing noise.

Delusions

While often named together, delusions are different from hallucinations.

Delusions are false beliefs about things that may seem strange or illogical to others. Even if you present the person with facts that prove their idea isn’t based on reality, they’re unlikely to change their mind.

A person having delusions may believe that people on TV or radio are sending them secret messages that tell them to do something. Or they might believe they’re in danger or a specific person or group of people are trying to harm them.

People with delusions may find it difficult to concentrate. They may get confused or feel as though their thoughts have been blocked.

Disorganized thinking

When thinking is “disorganized,” it means that it’s difficult for someone with schizophrenia to keep their thoughts or speech in order.

They might have trouble remembering things or finishing tasks. They may start talking and then suddenly stop because they can’t remember what they were saying. Or, they may jump from topic to topic while having a conversation. Sometimes they’ll make up words.

If they’re experiencing severe symptoms, they may be difficult to understand. They might have “word salad” — a jumble of words thrown together in confusing order, or they might just choose to stop talking altogether.

Often, people with schizophrenia have anosognosia, lack awareness of having an illness. Different from being in denial, they may be incapable of thinking clearly enough to choose to deny something. Anosognosia can make treating schizophrenia more difficult.

Concentration and memory problems

Cognitive difficulties are another common sign of schizophrenia, though admittedly, these can occur in various other conditions, too. The person may have trouble paying attention, concentrating, and remembering things.

Similar to disorganized thinking, this can make it hard for them to have a conversation.

These symptoms can also make it difficult for someone to learn new things or remember appointments. They might struggle to use information they just learned or make decisions that affect their life.

Overly excited

If you know someone with schizophrenia their speech and movements may be fast, or they may have an “outburst” of energy that seems to come out of nowhere.

Increased excitement may affect their ability to eat or sleep, and it can make it very difficult to talk to others. Or, they may move around so much and talk so quickly that they exhaust themselves.

Sudden movements and excitability are typically related to symptoms of psychosis, like hallucinations or delusions.

People who experience mania — a symptom of bipolar I disorder — may also appear overexcited with extra energy and little need for sleep. If you’re noticing this in yourself or someone else, consider speaking with a mental health professional to receive the right diagnosis.

Grandiosity

Some people with schizophrenia have an exaggerated opinion of themselves, sometimes called delusions of grandeur. They may think they’re superior to others or have extraordinary abilities. They may also incorrectly believe they’re very wealthy, smart, famous, or powerful.

Depending on the severity of the symptom, they may only believe these things about themselves or these beliefs may only impact their attitude about themselves.

In severe cases, they may believe they have multiple special qualities. Often, they’ll act on these beliefs in ways that may seem strange or even dangerous to themselves or others.

Emotional withdrawal

When a person with schizophrenia emotionally withdraws from things, they may gradually experience a disregard for all aspects of daily life.

When you talk to a person who’s emotionally withdrawing, they may seem distant and uninterested in having a conversation. As they progress, they begin to lose all interest speaking with others and can end up completely withdrawn.

According to research from 2022, factors of motivation are associated with occurence of social withdrawal in those who live with schizophrenia. Having a reduced drive or apathetic disinterest to engage with others is suggested to significantly predict social functioning.

Difficulty with abstract thinking

Another classic sign of schizophrenia is the difficulty to form generalizations or think beyond a solid idea or concept.

Those with schizophrenia may have a difficult time understanding things that aren’t physical or real. They may also have difficulty understanding a proverb, simile, or metaphor because they can only interpret things literally.

Abstract thinking may impact your ability to identify, explain, differentiate, or integrate meaningful aspects or social situations.

Extremely disorganized or catatonic behavior

Disorganized behavior can include odd behaviors like smiling or laughing for no apparent reason, or talking to yourself. It can also include movements that seem to happen for no reason, or even being stressed or annoyed without a clear cause.

Catatonic behavior can include not moving much or at all, or refusing to do things or speak.

Someone might also do a lot of unusual movements that don’t seem to have a purpose. You may find them purposely in strange positions or notice their unusual gestures or grimacing.

People with schizophrenia may also have echolalia (repeating what others say) or echopraxia (repeating how others move).

Lack of emotional expressions

A characteristic symptom of schizophrenia is a lack of emotional expression, also known as emotional blunting.

You begin to show fewer facial expressions and gestures when you respond to good or bad news. For example, although you may feel upbeat, your voice may be “flat” when you speak.

Symptoms, such as having a lack of emotional expression, could significantly increase the risk of suicidal thoughts or behavior. Additional signs may include:

asociality
delusions
anhedonia
comorbid depression
history of suicidal behaviors
negative feelings toward treatment

Preventing suicidal behaviors could include being aware of the signs mentioned above and receiving proper support to manage comorbid or psychotic symptoms.

What are the earliest signs of schizophrenia?

Schizophrenia is typically diagnosed between the ages of 16 and 30, after a person has experienced their first psychotic episode. It’s rare for a young child to have schizophrenia.

You may begin to see signs in early teen years, such as:

spending more and more time alone
having less or no interest in how they look
suddenly having trouble thinking clearly or concentrating
having new passionate ideas that seem strange to others
becoming suspicious of others or having paranoid thoughts
experiencing a significant drop in grades or job performance
being unable to speak clearly or struggling to communicate with others
having strange feelings or seeming like they experience no feelings at all
finding it difficult to tell the difference between what’s real and what’s not real

The bottom line

There are many common signs of schizophrenia, and you don’t need to have all of them for a doctor to diagnose the condition.

If you recognize several of these symptoms and are concerned that you or a loved one may have schizophrenia, you can always reach out to a mental health professional for further support. They’ll be able to confirm a diagnosis and create a personalized treatment plan.

While schizophrenia may be a challenging condition, it’s manageable with the right tools and support. Early treatment will increase your chances of successful treatment.

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.). Arlington, VA: American Psychiatric Association.
Anosognosia. (n.d.). https://www.nami.org/About-Mental-Illness/Common-with-Mental-Illness/Anosognosia
Driver DI, et al. (2020). Childhood-onset schizophrenia and early-onset schizophrenia spectrum disorders: An update. https://www.sciencedirect.com/science/article/pii/S105649931930094X
Fact sheet: Early warning signs of psychosis. (2022). https://www.nimh.nih.gov/health/topics/schizophrenia/raise/fact-sheet-early-warning-signs-of-psychosis.shtml
Farina EA, et al. (2023). Factors related to passive social withdrawal and active social avoidance in schizophrenia. https://pmc.ncbi.nlm.nih.gov/articles/PMC9243431/
Marder SR, et al. (2017). The current conceptualization of negative symptoms in schizophrenia. https://onlinelibrary.wiley.com/doi/full/10.1002/wps.20385
Schizophrenia. (n.d.). https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/Schizophrenia
Schizophrenia. (n.d.). https://www.nimh.nih.gov/health/statistics/schizophrenia.shtmlSchizophrenia. (2024). https://www.nimh.nih.gov/health/publications/schizophrenia/index.shtml
Sher L, et al. (2019). Suicide in schizophrenia: An educational overview. https://www.mdpi.com/1648-9144/55/7/361
Sokolova E, et al. (2021). Relationship of abstract thinking to mentalization in schizophrenia. https://pmc.ncbi.nlm.nih.gov/articles/PMC9475916/

This article originally appeared on PsychCentral. © 2025 Healthline Media LLC. All rights reserved. Our website services, content, and products are for informational purposes only. Healthline Media does not provide medical advice, diagnosis, or treatment.

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