5.1.3 - Schizophrenia symptoms
Schizophrenia can involve changes in perception, beliefs, thinking and everyday functioning. You will distinguish the four features named in 5.1.3—thought insertion, hallucinations, delusions and disordered thinking—and understand why individual experiences and a professional diagnosis are different things.
Hallucinations and delusions
Hallucinations concern perception, whereas delusions concern beliefs about what is happening.
Hallucination
A perception-like experience without the corresponding external stimulus, such as hearing a voice when no speaker is present.
An auditory hallucination concerns hearing; hallucinations can also involve other senses. The experience can feel real to the person even when others do not perceive it. It is different from an illusion, which is a misinterpretation of a stimulus that is present—for example, mistaking a coat in dim light for a person.
A delusion is a firmly held false belief maintained despite strong contrary evidence, interpreted with attention to cultural context. In a fictional example, someone might believe that a newsreader sends messages specifically to them through an ordinary broadcast. The feature is the belief in a personal message, not simply watching television. A belief shared within a cultural or religious context must not be labelled a delusion merely because an assessor finds it unfamiliar.
The two features can occur together. Someone might hear a voice without an external speaker and then believe that a hidden organisation is transmitting it. The hearing experience is the hallucination; the explanation held as a belief is the delusion. APA's schizophrenia overview describes this distinction.
Thought insertion and agency
Thought insertion concerns the person's belief about the ownership or origin of a thought, rather than simply whether the thought is unwanted.
Thought insertion is the experience or belief that thoughts have been placed in one's mind by an external person or force. A fictional person might report, “These thoughts were put into my mind by someone else.” This is a disturbance of the usual sense that one's thoughts belong to oneself, and is commonly described as a delusional experience of external influence.
The psychological description reports what the person experiences or believes; it does not establish that another agent has actually inserted thoughts. It also differs from ordinary influence: learning a new idea from a book does not mean experiencing one's thinking as externally inserted.
Unwanted or intrusive thoughts are another important distinction. A person can dislike a thought while recognising it as their own mental event. Thought insertion involves attributing its origin or ownership to an external source. This distinction helps later explanations ask how the usual monitoring of self-generated experiences might be disrupted. It is not a rule for diagnosing someone from a sentence in isolation.
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