What Is High-Functioning Schizophrenia?

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What Is Schizophrenia?

Schizophrenia is a psychiatric disorder that changes how the brain works. It is usually a chronic and lifelong issue that includes symptoms such as hallucinations, delusions and a lack of ability to express emotions, also known as a blunted affect.

While schizophrenia significantly affects many of those who have it, those with high-functioning schizophrenia are often able to perform daily tasks more independently. Although not an official diagnosis, high-functioning schizophrenia generally refers to being able to function successfully in work or social realms in the face of symptoms of the illness.

The following are criteria that must be met for a schizophrenia diagnosis per the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5):

  • Criterion A: Two or more of the following must be present for a significant amount of time during a one-month timespan: the presence of symptoms in thinking, behavior, and emotions including delusions and hallucinations, disorganization or catatonic behavior, and/or negative symptoms (such as a lack of emotional expression or a significant lack of motivation).
  • Criterion B: Since the onset of symptoms, a person's level of functioning is affected in one or more major areas such as work, relationships, or self-care, to the point where it is far below the level it was prior to symptoms surfacing.
  • Criterion C: Signs of these disturbances last at least six months, with at least one month of active symptoms from criterion A. 
  • Criterion D: Schizoaffective disorder and depressive disorder or bipolar disorder with psychotic features have been ruled out due to no manic or depressive episodes with the active-phase symptoms—or if they have occurred, the active-phase symptoms outweigh them.
  • Criterion E: The symptoms are not due to substance use or another medical condition.
  • Criterion F: If there is a history of autism spectrum disorder or a communication disorder during childhood, the schizophrenia diagnosis is only added if the delusions, hallucinations, and other signs of schizophrenia have been present for at least a month.

Severity is determined by a quantitative assessment of the primary symptoms of the illness.

What Does High-Functioning Mean?

Schizophrenia is considered a serious mental illness by healthcare providers, meaning it significantly affects one’s quality of life. In fact, somewhere between 70% to 90% of people living with schizophrenia are unemployed.

High functioning can often be a subjective—and sometimes problematic—term. But, generally, it means that a person is able to carry out their daily activities. This includes self-grooming, carrying on meaningful interpersonal relationships, and the general ability to function socially and occupationally or educationally. 

Those with schizophrenia who have been able to successfully work share some similar characteristics, according to research. Proactively managing their symptoms and engaging in self-care were commonly cited as factors that helped people with schizophrenia remain high-functioning.

One key takeaway was that many altered their work schedules (for example, shifting to part-time) to suit them so that they were not feeling stressed or exacerbating their symptoms. 

In fact, some of the people in this study report that working is its own coping strategy—it allows them to remain high functioning in ways. However, some of the participants did still report active schizophrenia symptoms like delusions and hallucinations and trouble managing other things in their daily lives.

This research shows that while schizophrenia still impacts the lives of those who have it, it is possible for some to maintain high-functioning lifestyles as well.

Additionally, these days, more programs such as the Americans With Disabilities Act allow for protections for people with schizophrenia to be able to work without discrimination.

It also allows for reasonable accommodations such as flexible hours, adjusted work load, leave (paid or unpaid) during illness or hospitalization, being assigned a supportive boss, and regular feedback about job performance. 

Diagnosing High-Functioning Schizophrenia

Schizophrenia can be diagnosed by most mental health professionals, but if you are suspecting you or a loved one might have schizophrenia, it is best to consult with a psychiatrist, as usually medication is needed.

Some common assessments used to diagnose schizophrenia include:

  • The DSM Structured Clinical Interview 5: This measure is not specific to schizophrenia, but it can diagnose schizophrenia along with many of the other major psychiatric disorders.
  • Positive and Negative Syndrome Scale (PANSS): This is known as the gold standard in assessing the severity of schizophrenia symptoms. The 30-question scale measures the positive, negative and cognitive symptoms of schizophrenia. Positive in this circumstance means symptoms that are in excess of normal mental functioning such as hallucinations; negative symptoms refer to deficits in functioning such as a lack of emotion or withdrawing socially. Some cognitive symptoms include poor concentration or difficulty expressing thoughts. 
  • Scale for the Assessment of Negative Symptoms (SANS): This scale measures solely the symptoms that are in deficit of expected functioning. The 25-item measure includes symptoms such as unchanging facial expression, lack of vocal inflection, an inability to speak, and poor hygiene.
  • 16-Item Negative Symptoms Assessment (NSA-16): This 16-item scale assesses the negative symptoms of schizophrenia by evaluating the presence, severity, and range of negative symptoms of schizophrenia. It assesses across the planes of communication, emotional/affect, social involvement, motivation and retardation (slowing of speech and/or physical movement). There is also a more recent version that is only four items.
  • Schedule for Deficit Syndrome (SDS): Deficit syndrome in schizophrenia is marked by the constant or near-constant presence of at least two of the following negative symptoms even when someone is in a period of stability (those who have deficit syndrome typically have lower levels of functioning than those who don’t):
  • Restricted affect
  • Diminished emotional range
  • Poverty of speech with curbing of interest and decrease in curiosity
  • Diminished sense of purpose
  • Diminished social drive

Treatment for High-Functioning Schizophrenia

People who live with schizophrenia are typically treated with a combination of medication and psychotherapy. Antipsychotics are often prescribed to treat and prevent the symptoms of psychosis.

There are several different kinds of therapy that have proven helpful to treat schizophrenia, including individual therapy, group therapy, and family therapy.

As more than half of people with schizophrenia have at least one co-morbid diagnosis, including substance use disorders, post-traumatic stress disorder, obsessive-compulsive disorder and major depressive disorder, ongoing psychiatric assessment and appropriate treatment of other diagnoses is important.

Schizophrenia and Stigma

While mental health conditions in general are facing less stigma than they have in the past, the same isn’t necessarily true with severe mental illnesses such as schizophrenia. And societal and cultural stigma can lead to internalized stigma, as well as worse prognoses for those with schizophrenia.

Even those with high-functioning schizophrenia will still face stigma, such as being afraid to disclose their diagnosis to employers and potential discrimination.

A Word From Verywell

While schizophrenia can be a difficult condition to live with sometimes, it is more than possible—with careful management—to live a full life despite your diagnosis.

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