July 27, 2023

8 Early Signs of Schizophrenia

Emotional changes, isolation and unusual behavior could signal the onset of the condition

person on a swing between sun and rain

Life changes during the transition between adolescence and adulthood may reveal something unexpected — early signs of schizophrenia.


Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

The onset of the mental health condition typically begins in a person’s 20s. Schizophrenia tends to appear earlier in men and people assigned male at birth (AMAB), beginning in their late teens to early 20s. Women and people assigned female at birth (AFAB) usually see it start in their mid-20s to early 30s. (But the disorder can begin at any age.)

Symptoms often show themselves slowly and worsen over a period of months or years, says psychiatrist Minnie Bowers-Smith, MD. Here’s what to look for.

Warning signs of schizophrenia

Schizophrenia changes the way that you think, behave and relate to others. “People with schizophrenia don’t seem to interact with the world in a healthy way,” explains Dr. Bowers-Smith. “There’s a loss of touch with reality.”

Signs of the mental illness can be subtle in the initial (or prodrome) stage and easily attributed to other life changes or activities. Common early symptoms include:

Emotional changes

Mood swings can become more frequent as someone enters the early stages of schizophrenia. They may seem more irritable or angry. Fears of the surrounding world may grow. Suspicions may turn into paranoia.


Time spent with friends and family may suddenly dwindle. Phone calls stop. Conversations are avoided. “You tend to isolate yourself and seem preoccupied with your own world,” says Dr. Bowers-Smith.

Lack of focus

Schoolwork, jobs and household responsibilities can begin to get neglected as thoughts wander further from reality. Irrational excuses may be offered to explain overlooked tasks or missed appointments. Motivation disappears.

Early and active signs of schizophrenia

The first signs of schizophrenia may last as little as a few weeks or as long as a few years. The “active” stage of the mental illness that follows brings more noticeable symptoms, notes Dr. Bowers-Smith. These can include:

  • Hallucinations or hearing voices.
  • Delusional beliefs.
  • Incoherent speaking.
  • Unusual physical movements ranging from catatonic behavior to excessive motion.
  • “Negative symptoms” such as speaking in a flat tone, lack of eye contact and rigid body language.

Living in denial

Even as schizophrenia sets in, many people will overlook or explain away early signs of the condition. Denial can become a coping mechanism even as you see a loved one not functioning well.

In many cases, a college may be the first to send a young adult to be evaluated because of erratic behavior or a drug overdose. “Families often don’t seek help on their own,” notes Dr. Bowers-Smith.

It’s natural to struggle to understand schizophrenia symptoms or ignore the signs until they escalate, sometimes into violent behavior. But without help, problems will continue — especially when fueled by drugs or alcohol.

“If you find them up all hours of the night, or painting their room black, or too irritable or scaring people, call the doctor,” stresses Dr. Bowers-Smith.

When to seek treatment

The earlier the better when it comes to seeking treatment for schizophrenia once symptoms appear, says Dr. Bowers-Smith. Healthcare providers diagnose the illness based on questioning and observations.

A diagnosis of schizophrenia is life-changing for those affected and everyone who loves them. It’s a step toward treatment and a full life. People with schizophrenia can finish college, work jobs, get married and have families.

There isn’t a cure for schizophrenia, but the condition can often be managed through a combination of medication, supportive therapy and education for the person and their family members.


“If you can manage the symptoms, you can have a reasonably stable life,” reassures Dr. Bowers-Smith. “That’s why it’s key to engage people early on and encourage them to find a doctor they can relate to and a therapist who understands them.”

Research indicates that the earlier the treatment the better the outcome.

The National Alliance on Mental Illness (NAMI) offers support groups for the mentally ill and their families. Other support groups are:

There are many mental health providers who can provide help. They’re trained to eradicate the stigma associated with mental health in general and schizophrenia in particular.

Know this, too: If you’re dealing with schizophrenia in your life, you’re not alone. The condition affects about 0.5% to 1%, or 24 million people worldwide, according to the World Health Organization (WHO).

Related Articles

person sitting in a growing flower, as they're watering the pot from above
February 9, 2024
Self-Love: Why It’s Important and What You Can Do To Love Yourself

Like being your own best friend in times of trouble, self-love is an act of self-preservation

person standing on exclamation point holding up a No. 1 finger, wearing cape and mask in front of crowd
February 1, 2024
How To Make the Most of Your ‘Villain Era’

It’s not about embracing your dark side — it’s about showing up for yourself

Silhouette of person turned away from group of people talking
January 23, 2024
How the Grey Rock Method Can Protect You From Abusive People and Toxic Interactions

Like a boring ol’ grey rock, the goal is to be unresponsive and uninteresting to dissuade a harmful situation

person looking at reflection in hand-held mirror
January 22, 2024
9 Signs You’re Dealing With a ‘Narcissist’ (and Why That’s the Wrong Word to Use)

Narcissistic personality disorder is a mental health condition, not an insult

Female sitting on couch staring blankly ahead, with male next to her on couch staring at her
January 19, 2024
The Silent Treatment: Causes and Coping

Whether this behavior is abusive depends on the person doing it and their motivation

Person talking with therapist in a private setting
January 4, 2024
Here’s Why You Shouldn’t Put Your Mental Health on the Backburner

You may not always notice it, but your mental health has just as big of an impact on your well-being as your physical health

female lying on yoga mat stretching
January 3, 2024
How Restorative Yoga Can Nurture Your Mind, Body and Spirit

This mindful practice is designed to give you mental and physical relaxation

male in a yoga pose in living room
January 1, 2024
Yoga vs. Pilates: The Differences Between Two Great Exercises

Both practices are worth exploring and offer amazing health benefits

Trending Topics

White bowls full of pumpkin seeds, dark chocolate and various kinds of nuts
25 Magnesium-Rich Foods You Should Be Eating

A healthy diet can easily meet your body’s important demands for magnesium

Woman feeling for heart rate in neck on run outside, smartwatch and earbuds
Heart Rate Zones Explained

A super high heart rate means you’re burning more than fat

Spoonful of farro salad with tomato
What To Eat If You’ve Been Diagnosed With Prediabetes

Type 2 diabetes isn’t inevitable with these dietary changes