Schizophrenia and anxiety may seem like separate experiences, but a feeling of intense, heightened anxiousness prior to psychosis can be a prominent feature of schizophrenia.
Anxiety is part of the human experience: it’s your response to an anticipated threat. Anxiety, however, isn’t intended to stick with you forever. And if it does, it can indicate more may be going on.
When you live with schizophrenia, you might experience anxiety often, sometimes simply from navigating daily life. In fact, anxiety may play a significant role in schizophrenia, even if these two conditions seem very different.
Schizophrenia is a mental health disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).
It’s a type of psychotic disorder, which means your perception of reality is affected.
You can be diagnosed with schizophrenia if you experience clinically significant symptoms related to psychosis, such as hallucinations, delusions, or disorganized thinking.
Anxiety, on the other hand, can be a natural occurrence or it can be a symptom of another condition.
Feeling anxious often doesn’t mean you’re experiencing a mental health condition.
“Anxiety disorders occur when anxiety moves from this normal human thing to something that impacts and interferes with your daily functioning,” explains Taylor Gautier, a licensed clinical social worker from Chattanooga, Tennessee. “Anxiety disorders can include specific diagnoses such as generalized anxiety disorder […] and social anxiety disorder.”
While you can experience anxiety with schizophrenia — and may even receive a co-occurring anxiety disorder diagnosis — these conditions have very different clinical presentations.
Schizophrenia symptoms revolve around experiences of psychosis, while anxiety disorders are based on impairing feelings of intense anxiety or dread.
Clinical presentations of schizophrenia and anxiety disorders are different, but some experiences may be similar.
Gautier explains paranoia can be one area where symptoms seem to overlap.
“I think it is helpful to think of anxiety as a spectrum,” she says. “At one end, we have the anxiety that all humans feel — think nerves before public speaking or standing in line for a roller coaster. It is brief, episodic, and manageable. However, on the other end of this spectrum, we have paranoia, which is consuming, impacts our functioning, and impacts our behavior.”
The differentiation, she adds, is that in schizophrenia, paranoia is the result of delusional beliefs rather than intense apprehension about real threats.
Another possible area of symptom overlap might occur with the negative symptom of anhedonia, the feeling that you cannot experience pleasure.
In a 2018 review on schizophrenia and anxiety, researchers indicate anhedonia is present in both schizophrenia and anxiety conditions and is likely caused by extreme stress.
Anxiety as a part of schizophrenia
The link between schizophrenia and anxiety may be more than just a merger of symptoms — anxiety may be a part of schizophrenia’s pathology.
A 2018 editorial published in The British Journal of Psychiatry notes intense anxiety is common in the early stages of schizophrenia before symptoms of psychosis, during what’s called the prodromal phase.
The same heightened anxiety can also be seen just prior to a relapse of psychosis symptoms as the condition progresses.
A reverse relationship may also exist. As the symptoms of schizophrenia become more evident, you may notice your feelings of anxiety lessen.
In the DSM-5-TR, the diagnostic criteria for schizophrenia includes:
- disorganized motor function
- disorganized thoughts/speech
- negative symptoms (anhedonia, diminished emotional expression, avolition, alogia, and asociality)
To receive a diagnosis, at least 2 symptoms must be present for the majority of the time during a 1-month period. One of those symptoms must be hallucinations, delusions, or disorganized thoughts. Additionally, the person must experience a disturbance that persists for at least 6 months.
Symptoms of anxiety
You can experience an array of symptoms related to anxiety or specific anxiety disorders,
- feeling on edge
- a sense of impending dread
- trouble concentrating
- sleep disturbance
- muscle aches and pains
- digestive issues
- racing heart
- chest pain or constriction
- rapid or shallow breathing
Schizophrenia and an anxiety disorder can exist at the same time.
Approximately 65% of people living with schizophrenia experience symptoms of anxiety, according to a
Of anxiety disorders diagnosed in the research, social anxiety disorder appears to be the most prevalent.
Schizophrenia and anxiety disorders respond to many of the same medications and psychotherapy approaches, but the intent and goals are often different.
Antipsychotic medications are the primary treatment for schizophrenia. You won’t be prescribed these for an anxiety disorder unless you’ve experienced a symptom of psychosis.
Psychotherapy and support
Your healthcare team may recommend cognitive behavioral therapy (CBT) for either diagnosis. CBT is intended to guide you in identifying and changing unhelpful behaviors and is one of the most well-researched forms of therapy.
Psychotherapy for anxiety may depend on the anxiety disorder you’re living with, but it can
Whether you’re living with schizophrenia, anxiety, or both, psychosocial support can help. This includes:
- coordinated specialty care (CSC)
- assertive community treatment (ACT)
- support groups
- vocational rehabilitation
When its natural anxiety and not a disorder
It’s OK to feel anxiety when you live with schizophrenia, but it doesn’t have to control your day.
Gautier recommends discovering tools for controlling natural anxiety. “A way that anyone can manage their anxiety is by finding a few grounding or breathing techniques that are effective for them,” she says. “These are quick ways to regulate yourself when you are feeling particularly anxious.”
Schizophrenia and anxiety aren’t the same, but they can happen simultaneously. In some cases, anxiety may predict changes in schizophrenia.
It’s possible to live with schizophrenia and an anxiety disorder. Medications, psychotherapy, and natural anxiety reduction techniques may all make a difference in these conditions.