Schizophrenia is a serious mental disorder characterized by a separation between thoughts, behaviors, and emotions, which can lead to a distorted perception of reality. Despite popular belief only some patients with schizophrenia experience visual or auditory hallucinations. Science shows that a combination of genetic, physical, and environmental variables may contribute to schizophrenia, and that a traumatic event or experience can be a trigger for a first episode. Symptoms usually begin in patients in their mid to late 20’s.

Here are three of the earliest signs of schizophrenia to look out for:

1. Social withdrawal

One of the earliest signs of schizophrenia is social isolation or withdrawal. This is one of the most common symptoms in people with schizophrenia, and is often used as a predictor for negative outcomes down the road. There are typically two reasons for this symptom in people with schizophrenia. One is called a “lack of behavioral approach motivation”, which means that there is decreased motivation to participate in social activities because of their condition. Another reason could be “heightened behavioral avoidance” which may step from avoiding social interactions because of fear, paranoia, or distrust of other people. Someone beginning to experience schizophrenia may isolate themselves from their friends and family by confining themselves in their house for days on end since they may be fearful, paranoid, or worried due to their mental state. Social withdrawal may interfere with a person’s ability to receive treatment for their schizophrenia.

2. Hostility or suspiciousness

Another symptom of schizophrenia is hostility or suspiciousness. Hostility may be shown through aggressive behaviors triggered by hallucinations or a frustrating environment for the person. When someone is having an episode, they may experience frightening sounds, thoughts, and feelings that may aggravate the person, leading them to be hostile. The person experiencing symptoms may become fearful or aggravated of their internal experience, and can act out because of it. Schizophrenic episodes can also trigger paranoia, a common symptom in schizophrenic people, which can lead to the person acting suspicious of the world or people around them. A common theme that occurs with people diagnosed with schizophrenia is that they believe that people or the government are spying on them or plotting against them, when in reality, the early symptoms of schizophrenia are leading them to feel this way.

3. Lack of emotion or inappropriate emotional outbursts

A hallmark symptom of schizophrenia is a lack of emotion, or what is sometimes referred to as a “flat affect”. This can be characterized by someone speaking apathetically, having a lack of facial expression, lack of eye contact, no change of tone in their voice, and having no apparent interest in the conversation in the moment. This symptom is more common among men in the early stages of schizophrenia. Another early symptom of schizophrenia is inappropriate emotional outbursts. A person with early signs of schizophrenia may laugh during a sad situation, or have an unprompted emotional outburst. Emotions that are very inappropriate are called “inappropriate affect” in patients with schizophrenia. People that are particularly not in line with the situation at hand, such as laughing when hearing about a death of someone, could be a sign of “disorganized schizophrenia”, which is a type of schizophrenia where the person typically has fragmented speech and unusual mannerisms that people may find to be inappropriate.