Is My Friend Faking Schizophrenia?

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Reader’s Question

I’m very worried about my friend and co-worker. She is 28 and has recently begun to behave very strangely. My friend says that mysterious people are trying to harm her and trying to videotape her while…

EDITOR’S NOTE: Due to a mistake on our part, we originally published a reply to this question from one of our psychologists on 27 January 2010, while another of our psychologists worked on the same question later and provided this reply on 24 February 2010. To read the rest of the original question in its entirety, together with the original reply, please see:

Psychologist’s Reply

First, it’s important to clarify some terms. The term “schizophrenia” comes from Greek root words that literally mean “split mind.” Many folks erroneously use the term schizophrenia to describe what has commonly been called a “split personality,” but is actually a relatively rare condition called Multiple Personality Disorder (or Dissociative Identity Disorder). But in point of fact, the disease of schizophrenia is a very different illness from multiple personality disorder.

Schizophrenia is characterized by what clinicians call “positive” signs (which are things common to schizophrenics that do not occur with normal individuals, such as hallucinations and delusions — which can include paranoid delusions like the false belief that someone is watching you or is out to hurt you) and “negative” signs (which are things not seen with schizophrenics that most normal people have). Symptoms of an illness differ from signs in that symptoms are the things people report about their subjective experience whereas signs are things an outside observer can notice more objectively. The “cardinal” or most significant signs of a severe mental illness like schizophrenia are almost impossible for an adequately trained clinician to miss and include things like the positive signs of thought derailment, incoherence, and bizarre ideation as well as the negative signs of flat or blunted affect, poverty of speech, and social detachment.

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Individuals with histrionic personalities can be remarkably attention-seeking and dramatic. Personalities of this type that are so severe in the intensity of their personality disturbance that they qualify for a diagnosis of Histrionic Personality Disorder can sometimes go to extreme lengths to solicit attention, create drama and excitement, and secure the involvement of others in their lives.

There are a lot of things about the situation you describe that don’t completely add up, and there are also numerous possible explanations for the behaviors you’re witnessing. That’s why a professional assessment is so important. But any clinician treating your friend would need to have all of the relevant information in order to make an accurate diagnosis. The fact that your friend’s sessions with her therapist are confidential and protected doesn’t preclude the therapist from getting or receiving information from other sources. And no treatment can be fully effective unless sufficient information is available to make the right assessment.

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