Positive Symptoms in Schizophrenia

Table of ContentsView AllTable of ContentsHallucinationsDelusionsDisorganized ThinkingAbnormal Motor BehaviorTreatment

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Table of Contents

Hallucinations

Delusions

Disorganized Thinking

Abnormal Motor Behavior

Treatment

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The typical positivesymptoms of schizophrenia, such as hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive—not a positive experience at all for you or someone you care about who is experiencing them.

From the outside, a person with positive symptoms might seem distracted, as if they are listening to something. Psychiatrists call this “responding to internal stimuli”. They may have difficulty formulating their thoughts, and they speak in what is known as “word salad”.

So why are these types of symptoms called “positive”?

In the medical world, positive and negative do not equate to good and bad. The phrase “positive symptoms” refers to symptoms that are in ​excessoraddedto normal mental functioning.

The positive symptoms of schizophrenia according to the DSM-5-TR are hallucinations, delusions, disorganized thoughts, and abnormal motor behaviors. In contrast, thenegative symptomsinclude a decrease in expressed emotions (previously known as flat affect), disinterest in usual activities and hobbies, and lack of motivation.

While these symptoms can be scary and extremely debilitating, taking the time to understand them (and the available treatments) can help you better cope or help a loved one do so.

Discover More About Schizophrenia Diagnosis, Symptoms, and Treatment

Hallucinations, which are not part of the normal, day-to-day experience for most people, are classified as a positive symptom for people with schizophrenia.In short, to hallucinate means to perceive things that others do not.

Each individual has a unique experience of hallucinations that can change over time with sounds and voices that can be quiet or loud, familiar or unfamiliar, frequent and infrequent. These can include:

Hearing voices specifically is known asverbal auditory hallucinations. Some people experience helpful or useful auditory hallucinations that make them feel important and help them with daily tasks.

However, most of the time, the voices are described as mean, derogatory, threatening, and dismissive. At times, the voices can be in the form of commands and can tell you to do something that may cause harm to yourself or others.

Hearing Voices (Auditory Hallucinations) in Schizophrenia

In fact, a common reason for people with schizophrenia to come to the hospital is that the voices are telling them to harm or even kill themselves or others. If you feel like you are losing control and/or might act on the voice’s orders, call your mental health provider or911immediately.

5 Types of HallucinationsAuditory:hearing voices or sounds that are not thereVisual:seeing people, colors, shapes, or items that aren’t realTactile:feeling sensations (bugs crawling on or under your skin) or as if you’re being touched when you’re notOlfactory:Smelling something that has no physical sourceTaste:Experiencing taste in your mouth when you have not eaten anything

5 Types of Hallucinations

Auditory:hearing voices or sounds that are not thereVisual:seeing people, colors, shapes, or items that aren’t realTactile:feeling sensations (bugs crawling on or under your skin) or as if you’re being touched when you’re notOlfactory:Smelling something that has no physical sourceTaste:Experiencing taste in your mouth when you have not eaten anything

Delusions versus Hallucinations: What Are the Differences?

Prior to the DSM 5, there were subtypes of schizophrenia, includingparanoid type, orparanoid schizophrenia. This is no longer the case; however, some of the delusions experienced may involveparanoia.

The Internal Experience of Schizophrenia

There are several types of delusions and, most often, they involve a specific theme. The DSM-5-TR recognizes the following subtypes:

Persecutory Delusions

Understandably, this can cause the person to become guarded, suspicious of anyone’s intention, and reluctant to answer questions or even associate with other people.

Reference Delusions

Erotomanic Delusions

Erotomaniaoccurs when a person believes that someone is in love with them, most frequently a famous or important person (like an actor or politician) but could be a co-worker or a stranger. This often results in them reaching out to that person who they believe is in love with them, and sometimes stalking behavior ensues.

Grandiose Delusions

Rooted in the French term “grande,“grandiosityrefers to an exaggerated sense of one’s importance, power, talent, knowledge, or identity—without any corroborating evidence. They may believe they are a specific person who actually exists, and accuse the other of being an imposter. There are often religious themes of grandiosity, such as being “the chosen one” or Jesus himself.

Jealous Delusions

Nihilistic Delusions

Nihilistic thinking can reflect beliefs about the world or about one’s own existence. They may believe the world is coming to a catastrophic end or has already ended, or that reality doesn’t exist.

Somatic Delusions

A person withsomatic delusionshas central themes involving bodily functions or sensations. This may manifest as a feeling of bugs crawling on or inside your body. One might insist that they have a medical ailment or are pregnant even though medical tests assure them otherwise. There can be oral fixations, where you believe you have horrible bad breath, or you feel there are foreign bodies in your mouth.

Delusions of Control

Delusions of control refer to the belief that one does not have control over their own mind or body. There are several variations:

Delusions of Misidentification

There are several variations of delusions of misidentification that involve mixed themes of paranoia, conspiratorial thinking, magical thinking, and delusions of persecution:

In the worst-case scenarios, there have been cases where people believe their family members have been filled with dark spirits, reptile DNA, or are living zombies. In this delusional state, there is an increased risk of violence because they may come to believe harsh physical discipline or death is the only way to release their family’s spirit from evil.

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Disorganized thinking can be extremely frustrating, making it nearly impossible for people with schizophrenia to keep their thoughts straight or express what’s on their minds. This positive symptom causes a series of disjointed thoughts, making it hard to follow or make sense of what a loved one with schizophrenia is trying to say.

At times, the language structure is completely lost and the process of thinking may come to a complete, sudden stop (known as thought blocking).

Types of Disorganized ThinkingCircumstantial thinking:Answering questions or sharing stories that add unnecessary details and it may take a while to come back to the original pointTangential thinking:Explanations or answers to questions can go off course with topics that are obscurely related, where one thought leads to another and another. Your conversation has been sidetracked with vaguely related ideas but goes off-topic and never comes back to the original point.Derailment and loose associations:Sometimes, thinking becomes illogical and ideas are completely disconnected. You may shift topics mid-sentence and move on to something else without completing the original thought.Clang associations: This is when speech is comprised of words for their sound (rhyming or pun associations) rather than meaning.Incoherence (“word salad”):Although real words are being used,speech becomes incomprehensible to the listener,with no discernible connection between words.

Types of Disorganized Thinking

Circumstantial thinking:Answering questions or sharing stories that add unnecessary details and it may take a while to come back to the original pointTangential thinking:Explanations or answers to questions can go off course with topics that are obscurely related, where one thought leads to another and another. Your conversation has been sidetracked with vaguely related ideas but goes off-topic and never comes back to the original point.Derailment and loose associations:Sometimes, thinking becomes illogical and ideas are completely disconnected. You may shift topics mid-sentence and move on to something else without completing the original thought.Clang associations: This is when speech is comprised of words for their sound (rhyming or pun associations) rather than meaning.Incoherence (“word salad”):Although real words are being used,speech becomes incomprehensible to the listener,with no discernible connection between words.

Thinking Process Abnormalities in Schizophrenia

Another positive symptom of schizophrenia is disorganized or abnormal movements. This could look like agitation, pacing, silliness, and catatonia. Catatonia can have a range of motor behaviors including a severely diminished reaction to the environment, bizarre posturing, and resistance to instructions. There can be facial grimacing, repetitive movements, and echoing what others say.

Catatonic Symptoms in Schizophrenia and Other Conditions

Treating the positive symptoms of schizophreniaideally involves a multidisciplinary approach that includes psychiatric medication, psychological treatment, and social support.

Psychiatric Medication

Antipsychotic medications are the mainstay of treatment for positive symptoms. These include first generation or"typical” antipsychotics, including Haldol (haloperidol) and Thorazine (chlorpromazine), and second-generation antipsychotics or"atypical” antipsychotics, such asAbilify (aripiprazole), Clozaril (clozapine),Risperdal (risperidone), orINVEGA (paliperidone).

The Relationship Between Schizophrenia and Dopamine

Psychological Treatment

When combined with the proper medication, therapy is a crucial part of treatment for people with schizophrenia as well as their family members. There are various types of therapies that can help you or someone you love better understand and cope with positive symptoms, including:

The Best Online Therapy ProgramsWe’ve tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.

Social Support

With schizophrenia, you will need a good support system in place to be on the lookout for behavioral changes or signs of relapse; it’s tough to notice these symptoms in yourself. This can include trusted friends and family members, peers, doctors or social workers, or coworkers or schoolmates who want to help you feel good and function at your best.

How Social Support Contributes to Psychological Health

In addition to joining a local or online support group, people with schizophrenia may want to consider community housing and/or group homes, which can provide high-quality care in a safe environment. Of course, this is an individual decision best made with guidance from your family, mental health professional.

What Is Residual Schizophrenia?

A Word From Verywell

Schizophrenia can be extremely isolating, especially when positive symptoms prevent you from organizing and communicating your thoughts or cause you to see, hear, and believe things no else does. Remember, you are not alone. Taking the time to find the right medication, therapy, and support can help you cope with your symptoms and gain better control of your life.

Living With Schizophrenia

6 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders(5th ed., text rev.); 2022. https://doi.org/10.1176/appi.books.9780890425787Batinic B.Cognitive models of positive and negative symptoms of schizophrenia and implications for treatment.Psychiatr Danub. 2019;31(Suppl 2):181-184.National Institute of Mental Health.Schizophrenia.Lorente-Rovira E, Grasa E, Ochoa S, et al.Positive and useful voices in patients with schizophrenia: Prevalence, course, characteristics, and correlates.J Nerv Ment Dis. 2020;208(8):587-592. doi:10.1097/nmd.0000000000001183National Institute of Mental Health.Understanding psychosis.Gionfriddo MR.Balancing feasibility and comprehensiveness: Examining medications for reducing emergency hospital admissions.BMC Med. 2018;16(1):169. doi:10.1186/s12916-018-1104-9

6 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders(5th ed., text rev.); 2022. https://doi.org/10.1176/appi.books.9780890425787Batinic B.Cognitive models of positive and negative symptoms of schizophrenia and implications for treatment.Psychiatr Danub. 2019;31(Suppl 2):181-184.National Institute of Mental Health.Schizophrenia.Lorente-Rovira E, Grasa E, Ochoa S, et al.Positive and useful voices in patients with schizophrenia: Prevalence, course, characteristics, and correlates.J Nerv Ment Dis. 2020;208(8):587-592. doi:10.1097/nmd.0000000000001183National Institute of Mental Health.Understanding psychosis.Gionfriddo MR.Balancing feasibility and comprehensiveness: Examining medications for reducing emergency hospital admissions.BMC Med. 2018;16(1):169. doi:10.1186/s12916-018-1104-9

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders(5th ed., text rev.); 2022. https://doi.org/10.1176/appi.books.9780890425787Batinic B.Cognitive models of positive and negative symptoms of schizophrenia and implications for treatment.Psychiatr Danub. 2019;31(Suppl 2):181-184.National Institute of Mental Health.Schizophrenia.Lorente-Rovira E, Grasa E, Ochoa S, et al.Positive and useful voices in patients with schizophrenia: Prevalence, course, characteristics, and correlates.J Nerv Ment Dis. 2020;208(8):587-592. doi:10.1097/nmd.0000000000001183National Institute of Mental Health.Understanding psychosis.Gionfriddo MR.Balancing feasibility and comprehensiveness: Examining medications for reducing emergency hospital admissions.BMC Med. 2018;16(1):169. doi:10.1186/s12916-018-1104-9

American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders(5th ed., text rev.); 2022. https://doi.org/10.1176/appi.books.9780890425787

Batinic B.Cognitive models of positive and negative symptoms of schizophrenia and implications for treatment.Psychiatr Danub. 2019;31(Suppl 2):181-184.

National Institute of Mental Health.Schizophrenia.

Lorente-Rovira E, Grasa E, Ochoa S, et al.Positive and useful voices in patients with schizophrenia: Prevalence, course, characteristics, and correlates.J Nerv Ment Dis. 2020;208(8):587-592. doi:10.1097/nmd.0000000000001183

National Institute of Mental Health.Understanding psychosis.

Gionfriddo MR.Balancing feasibility and comprehensiveness: Examining medications for reducing emergency hospital admissions.BMC Med. 2018;16(1):169. doi:10.1186/s12916-018-1104-9

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