Hallucinations are a positive symptom in schizophrenia, standing apart from negative signs like flat affect and withdrawal

Which of the following is an example of a positive symptom of schizophrenia?

• A. Flat affect
• B. Hallucinations
• C. Apathy
• D. Withdrawal

Answer: (B)

A positive symptom of schizophrenia refers to an excess or distortion of normal functions—essentially symptoms that reflect an addition to the person's experiences. Hallucinations, which are sensory perceptions that occur without an external stimulus, such as hearing voices or seeing things that aren't there, fit this definition perfectly. They represent an abnormal cognitive experience that is not typically present in a mentally healthy individual. In contrast, flat affect, apathy, and withdrawal are considered negative symptoms of schizophrenia. These symptoms represent a decrease or loss of normal functions, such as emotional expression (flat affect), motivation (apathy), or social engagement (withdrawal). Negative symptoms often lead to significant challenges in daily functioning and can hinder a person's ability to connect with others and participate in life normally. Thus, the correct identification of hallucinations as a positive symptom underscores the characteristic nature of that symptom—an enhancement of mental processes leading to experiences that are outside the norm.

Schizophrenia often comes with a mix of headlines and misunderstandings. For students and professionals alike, sorting out the symptoms can feel like untangling a knot in a sweater. One neat way to keep things straight is to separate symptoms into “positive” and “negative” groups. It’s not about being positive or negative as a person—it's about how the condition adds to or subtracts from a person’s experience.

Let me explain with a simple example you might see on a test or in a case discussion: Which of the following is an example of a positive symptom of schizophrenia? A) Flat affect B) Hallucinations C) Apathy D) Withdrawal. The answer is B, Hallucinations. But why does that slot in under “positive,” while the others don’t? Here’s the thing: positive symptoms are about the presence or addition of experiences that aren’t typical for most people. They’re like an extra layer that shouldn’t be there, a distortion or amplification of what you normally expect to happen.

What exactly counts as a positive symptom?

To keep this practical, think of three core ideas:

• Positive symptoms reflect an excess or distortion of normal mental processes.

• They’re experiences, sensations, or thoughts that a person doesn’t usually have.

• They stand out as something extra, not something missing.

Hallucinations are the classic poster child here. They’re sensory experiences that happen without any external stimulus. You might imagine hearing voices when no one is speaking, or seeing shapes or people that aren’t present. It’s not a matter of imagination; for the person experiencing them, the perceptions feel real and compelling, even if others around them do not perceive the same thing. That disconnect—what a person perceives versus what’s actually there—creates a heavy load for daily life.

But hallucinations aren’t the only positive symptom. Delusions—firm beliefs held despite clear contradictory evidence—also fit this category. Think of it as a trusted personal conviction that doesn’t align with shared reality. Disorganized thinking, which can show up as tangential or incoherent speech, is another positive symptom. When thoughts race ahead of speech or jump from topic to topic without a clear link, communication becomes a steep slope rather than a smooth road.

Now, contrast that with the other side of the coin: negative symptoms.

Negative symptoms are about what’s missing or reduced in a person’s functioning. They’re like the absence of light, rather than a bright flare. The ones most often highlighted in clinical discussions are:

• Flat affect: a reduced or flattened emotional expression; the face and voice don’t mirror what the person might be feeling internally.

• Apathy (avolition): a lack of motivation or initiative to engage in activities that used to matter.

• Social withdrawal: pulling away from friends, family, or everyday interactions.

• Alogia: diminished speech output, getting to the point where conversation feels really limited.

You can think of positive symptoms as “extras” added to the person’s experience, while negative symptoms are “missing ingredients” that reduce how a person interacts with the world.

Why this distinction matters in real life

Knowing the difference isn’t just a trivia exercise. It helps clinicians and caregivers tailor their approach. For someone experiencing hallucinations or delusions, the immediate challenge is to create a sense of safety and to address the distress those experiences cause. That might involve a combination of medication management, supportive therapy, and strategies to ground the person in the here-and-now when phenomena overwhelm them.

On the other hand, negative symptoms can quietly erode quality of life. When a person shows flat affect or reduced motivation, simple tasks—like prepping meals, attending appointments, or maintaining social connections—can feel daunting. It’s not that they don’t want to engage; the energy to do so has ebbed away. This distinction matters because the treatment plan often needs to balance symptom management with strategies aimed at restoring engagement and function.

A note on assessment and language

In clinical discussions, you’ll often hear about standard tools that help clinicians rate these symptoms. The Positive and Negative Syndrome Scale (PANSS), for example, is one widely used framework to quantify the presence and severity of both positive and negative symptoms. It’s not about labeling someone as “better” or “worse” in a blanket sense; it’s about capturing a nuanced picture so care teams can adjust treatments and supports.

When you’re learning, a simple memory trick can help: positive equals add. If you can remember that bit of shorthand, it’s easier to recall that hallucinations, delusions, and disorganized thinking are “adds” to the person’s experience, rather than reductions. Negative equals subtract. Flat affect, apathy, withdrawal—the things that seem to drain energy or expression—fall into that category.

Tying it to everyday life

Let’s bring this out of the textbook and into something tangible. Imagine a person who once loved painting but now sits with blank canvases for weeks. That’s a classical cue for a negative symptom—loss of motivation and reduced engagement with activities that used to bring joy. On a different day, you might notice that person speaks in a way that doesn’t clearly reflect what they’re thinking or feeling. Their words may wander, jump topics, or feel disjointed. That’s disorganized thinking—part of the positive symptom spectrum.

And what about the voices in the head? For those who experience them, the world can feel crowded with intruding sounds or messages. The person may react to these experiences as if they’re real, which can be confusing or frightening to observers. Understanding that these perceptions are not voluntary choices helps frame responses that are supportive rather than punitive.

A practical approach for learners and future clinicians

• Listen for the difference, then reflect it back. If a person describes hearing voices, you can acknowledge the experience without endorsing it as reality. For example: “That sounds very real and distressing to you.” It validates the person’s experience while keeping you grounded in the here and now.

• Separate distress from content. Hallucinations themselves aren’t a choice, but the distress surrounding them is something you can address with coping strategies, grounding techniques, and, when appropriate, pharmacological treatment.

• Promote routine and connection for negative symptoms. Simple, consistent activities can help counteract apathy and withdrawal. Short daily check-ins, walk-and-talks, or shared meals can rebuild momentum.

• Use case vignettes as study anchors. Real-world scenarios help you remember the spectrum of symptoms and how they present in daily life. Try mapping a case to the positive and negative categories to test your understanding.

Common myths—and why they matter

People sometimes assume that all psychotic symptoms are the same or that positive symptoms are purely “attention-seeking” or under the patient’s control. Both of these notions are inaccurate and can be harmful. Hallucinations and delusions are symptoms that arise from underlying neurobiological and psychosocial processes. They’re not conscious choices; they’re experiences that demand careful, compassionate response. Misunderstanding this can lead to stigma, which makes it harder for folks to seek help or speak openly about what they’re going through.

If you’re studying or working in a mental health setting, you’ve probably seen how misinterpretations ripple outward. A clinician who understands the difference between positive and negative symptoms can better explain the course of treatment to a family, or tailor a plan that respects a patient’s autonomy while offering needed support.

A quick recap you can carry in your pocket

• Positive symptoms add experiences: hallucinations, delusions, disorganized thinking.

• Negative symptoms remove or blunt aspects of functioning: flat affect, apathy, withdrawal.

• The distinction guides assessment, communication, and treatment planning.

• Real-world care blends medication, therapy, and practical supports to address both symptom types.

• Remember the mnemonic: positive = add; negative = subtract.

Where to go from here

If you’re digging into OCP-related material, you’ll likely encounter more symptom profiles and a broader range of disorders. It helps to build a little mental map: label the symptom type, note typical presentations, and then jot down a few lines about how you’d respond in a clinical conversation. Practicing with case vignettes can sink in the patterns faster than cramming definitions.

And yes, it’s perfectly normal to feel a bit overwhelmed by the complexity. Mental health science isn’t about black-and-white fixes; it’s about understanding a person’s lived experience and partnering with them toward better days. In the end, that human-centered approach often makes all the clinical jargon feel more approachable.

If you’re exploring these topics in your own time, consider cross-referencing reputable sources like the DSM-5 criteria for schizophrenia and guidelines from professional organizations. A mix of scholarly clarity and practical insight tends to pay off, especially when you’re trying to translate theory into compassionate, effective care.

One more thought to carry forward

The way we talk about symptoms matters. Labeling a person by their diagnosis can feel reductive if we lose sight of the person behind the symptoms. Positive symptoms aren’t a badge of a person’s character; they’re signals that something isn’t aligning with the ordinary. Negative symptoms aren’t a personal flaw either; they’re challenges that deserve thoughtful strategies and steady support.

As you study, keep that balance—the science on one side, the human experience on the other. The more you can hold both in view, the more equipped you’ll be to help someone navigate their world when it feels loud, confusing, and really overwhelming.

If you want to keep this conversation going, I’m happy to tailor more examples, analogies, or short practice scenarios that fit the topics you’re most curious about. The goal isn’t just to pass a test, but to build a clear, compassionate understanding that helps real people in real situations.