Schizophrenia is a mental health condition that can affect anyone of any sex or gender. For females, schizophrenia’s development and symptoms may be different compared to those of males.

People with schizophrenia experience an altered reality and perceptions, known as psychosis. Symptoms include hallucinations, delusions, disorganized thinking and behaviors, and a loss of functioning referred to as “negative symptoms.”

Anyone can be diagnosed with schizophrenia, but some differences appear to exist between the sexes.

About 1% of adults worldwide live with schizophrenia. But the exact prevalence of this condition varies from country to country.

Between men and women, schizophrenia seems to occur slightly less in women than in men. Research from 2022 suggests for every 1 woman living with schizophrenia, an estimated 1.4 men are living with this condition.

Language matters

You’ll notice that the language used to share statistics and other data points is pretty binary, fluctuating between “female/male” and “women/men.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

The studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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The core diagnostic features of schizophrenia are universal. This means that the criteria for diagnosing schizophrenia are the same between the sexes.

While there may be gender-related differences in the development, course, and prominent symptoms, schizophrenia in women is the same diagnosis as schizophrenia in men.

All people diagnosed with schizophrenia have met specific diagnostic criteria outlined in clinical guidebooks like the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).

According to the DSM-5-TR, you may be diagnosed with schizophrenia when you have had two or more of the following symptoms for the majority of 1 month:

Regardless of your sex, to receive a diagnosis, at least one of those symptoms must be hallucinations, delusions, or disorganized thinking.

Symptoms of female schizophrenia

Your sex can play a role in how schizophrenia is experienced.

The DSM-5-TR states that women are more likely to develop affective symptoms, or those related to mood instability, while men are more likely to display prevalent negative symptoms, comorbid substance use disorder, and acts of aggression.

What are positive and negative symptoms?

Positive symptoms in schizophrenia are those that add to your existing function, like hallucinations or delusions.

Negative symptoms are those that demonstrate a loss of ability, like reduced speech output or loss of pleasure.

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According to a 2016 research review, women are more likely to experience depressive symptoms during schizophrenia and have more sensory hallucinations (involving your five senses) and persecutory delusions (false beliefs you’re about to be harmed by someone).

Women also appear to have a higher incidence of certain symptoms, such as:

  • thought broadcasting (believing others can hear your thoughts)
  • thought insertion (believing someone has implanted their thoughts into your own)
  • auditory hallucination (hearing voices speaking when there is no one around)
  • delusional jealousy (believing their partner is being unfaithful to them)
  • sexual delusion and inappropriate behavior (believing someone is infatuated with them)
  • impulsivity

If you’re a woman, active schizophrenia episodes may be shorter than those in men. You may also have better preservation of social and cognitive function, despite having symptoms that impair other aspects of daily life.

But if you’re female, this does not mean you will definitely have this experience with schizophrenia. Schizophrenia affects everyone uniquely, regardless of sex.

Several differences exist between the sexes when it comes to the age of onset (in other words, when symptoms begin).

In general, women are more likely to develop schizophrenia in their mid-20s to early 30s, which is 3–5 years later than men.

Women, however, have a second peak age of onset, while men only appear to have one between the ages of 16 and 30.

After age 45, women are disproportionately affected by schizophrenia, making up as many as 87% of people diagnosed during this stage of life.

Sex hormones may be part of the reason why women see a second peak age of onset in their mid-40s.

Research reviews from 2020 and 2021 suggest a reduction in female reproductive hormones during and after menopause may make women more susceptible to schizophrenia.

Researchers explain that estrogens are considered protective against the symptoms of psychosis. They help maintain important physiological responses linked to schizophrenia, such as your stress response network, dopamine activity, and mitochondrial function.

As estrogen naturally declines with age, the risk for schizophrenia can increase.

In addition to lower estrogen levels, women advancing in age may also be more likely to experience conditions of isolation, loneliness, and adverse life events that can contribute to the development of psychosis.

The DSM-5-TR states that women tend to have better outcomes in schizophrenia compared to men.

This is attributed to shorter episodes of active symptoms in women. But more than just the duration of symptoms may be influencing outcomes.

According to the 2016 review, women are more likely than men to maintain treatment compliance. Their preserved social function might help them reestablish interpersonal and occupational relationships during treatment faster than men.

Hormones also give women an edge in schizophrenia treatment.

Estrogens improve the availability of antipsychotic drugs used to treat schizophrenia. This means women often require lower drug dosages than men to achieve favorable results.

Female schizophrenia is not a separate diagnosis from male schizophrenia. Schizophrenia is a mental health condition that can affect anyone of any sex or gender.

Differences in the development, course, and symptoms of schizophrenia do exist between the sexes. Women tend to develop schizophrenia later in life compared to men, with a second peak age of onset after 45 years of age.

Women diagnosed with schizophrenia typically maintain better social and cognitive function, and they may require less antipsychotic treatment to achieve favorable results.