What to Know About High Functioning Schizophrenia

Health Line

a day ago

When a person's schizophrenia symptoms do not appear to interfere with their daily life, their condition may be referred to as high functioning schizophrenia. But this is not an official diagnosis.
Schizophrenia is a complex and varied psychiatric disorder that affects each person differently.
Some people have relatively mild symptoms that come and go. Others experience more severe, persistent symptoms that interfere with their daily lives.
When a person with schizophrenia is able to live a mostly independent life, hold a job, and maintain relationships, their condition is often referred to as 'high functioning.'
Language matters
The term 'high functioning' doesn't have a clear medical definition. Some clinicians use it to refer to people who require a lower level of assistance for daily activities. But terms like 'high functioning' and 'low functioning' don't account for people's unique life circumstances, abilities, and strengths. It's best to avoid using this kind of language outside of a conversation with your healthcare professional.
What is high functioning schizophrenia?
High functioning schizophrenia is a term used when people with schizophrenia are able to function well in daily life despite their diagnosis. They may have milder symptoms, or they may have developed good coping mechanisms despite having more severe symptoms.
It's important to note that 'high functioning' is a subjective term and not a clinical diagnosis. And the label doesn't necessarily reflect the severity of a person's symptoms. People with high functioning schizophrenia may still experience significant challenges and need continuous treatment and support.
A person's level of functioning can be influenced by a range of factors, including:
Symptom severity: People with fewer or less severe symptoms may be able to function better in daily life than those with more severe symptoms.
Treatment response: Those who get timely, appropriate treatment are more likely to maintain good functioning. Research from 2020 suggests that early intervention may be linked to better long-term outcomes.
Personal coping strategies: Some people develop strong coping strategies that allow them to effectively manage their symptoms and prevent those symptoms from having a major effect on their daily life.
Strong support network: Those with very supportive family and friends may be able to function better in daily life than those who don't have this support.
Lack of other mental or physical health conditions: Many people with schizophrenia have other mental or physical health conditions that make it more difficult to function in daily life. People who don't have another condition may appear higher functioning.
Symptoms of high functioning schizophrenia
Any person with schizophrenia, whether it's considered 'high' or low' functioning, can experience the same types of symptoms.
Schizophrenia symptoms are divided into positive, negative, and cognitive symptoms.
Positive symptoms are those that 'add' to your personality (in other words, they weren't there before the condition). These symptoms include those of psychosis, such as:
hallucinations
delusions
disorganized thoughts and speech
atypical motor behavior (e.g., catatonia)
Negative symptoms 'take away' from your personality and involve five key areas:
alogia (reduction in the number of words spoken)
anhedonia (reduced experience of pleasure)
asociality (reduced social activity)
avolition (reduced goal-directed activity, due to decreased motivation)
blunted affect (difficulty expressing emotions, such as diminished facial expressions)
Cognitive symptoms may include issues with:
focus and attention span
working memory
executive functioning
The negative symptoms of schizophrenia are often more challenging to treat than the positive symptoms. For some people with schizophrenia, these negative symptoms persist, even when positive symptoms are well managed.
Research from 2020 suggests that negative symptoms are associated with poorer outlook and long-term disability. While many people with high functioning schizophrenia do have negative symptoms, these symptoms may be less severe.
Diagnosing high functioning schizophrenia
In the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. text revision (DSM-5-TR), schizophrenia is now listed as a spectrum disorder. This more accurately represents the condition's wide range of symptoms that can change over time.
It's important to note that high functioning schizophrenia is not a clinical diagnosis. So, whether a person exhibits a higher or lower level of functioning, they still have to meet the same diagnostic criteria.
A diagnosis of schizophrenia must include at least two of the following symptoms, with one of these symptoms being among the first three:
delusions
hallucinations
disorganized speech
severely disorganized or catatonic behavior
negative symptoms
The symptoms must occur frequently for at least 1 month, with some symptoms lasting for more than 6 months.
In addition, you'll need to have experienced reduced functioning in one or more important areas of life, such as personal relationships, work, or self-care.
Treating schizophrenia
Schizophrenia is typically treated with antipsychotic medication as well as various types of therapies and skills training.
Schizophrenia may be treated with the following:
Atypical antipsychotics: Atypical, or second-generation, antipsychotics are the first-line treatment for schizophrenia. These medications lower dopamine levels in the brain, which helps target symptoms of psychosis.
Cognitive behavioral therapy (CBT): CBT helps people with schizophrenia identify and fix unhelpful thought processes and behaviors.
Social skills training: Social skills interventions help people with schizophrenia learn social and independent living skills. These may include classes covering interpersonal skills and medication management.
Cognitive remediation: This intervention focuses on skills such as attention, memory, and flexible thinking.
Social cognition training: This intervention targets skills such as social perception (understanding social cues or body language), emotion perception (identifying others' emotions), and theory of mind (identifying and understanding another person's mental state).
Some people with high functioning schizophrenia may have achieved symptom remission after responding well to treatment. Symptom remission means that your symptoms are mild enough to not significantly interfere with your life.
Research from 2018 suggests that symptom remission is possible in 20% to 60% of people with schizophrenia, but this depends on many complex factors.