Schizophrenia Onset: When Do Symptoms Usually Start?

Written by Madeline Laguaite
Medically Reviewed by Lalitha Kadali, MBBS, MD on August 20, 2026

Schizophrenia usually shows up after puberty, and most people are diagnosed in their 20s or early 30s. It’s rare to get schizophrenia before age 12 or after age 40.

Schizophrenia onset tends to be slightly earlier for men than for women. On average, men are diagnosed in their early-to-mid 20s, while women are diagnosed in their mid-20s to early 30s.

A Face of Tardive DyskinesiaBrian Smuda's head nods progressed into full-body spasms, a debilitating side effect of his long-term use of medications for Tourette's. Medicines and movement therapy can help, but deep brain stimulation, a brain surgery, greatly reduced his involuntary movements. Check him out on the slopes now!281

BRIAN SMUDA: TD,

or tardive dyskinesia,

is pretty much uncontrollable,

jerky movements of the body.

Smacking of the lips, licking,

or jaw movements.

I have Tourette's, and I kind

of feel like it's just

an increased version

of Tourette's.



So back in the age of five,

we went to my primary care

doctor and noticed I was doing

a little head nod.

We didn't know at the time that

that would be Tourette's.

When I graduated college

in 2008, I said to my parents

that I didn't want to have

the Tourette's anymore.



I thought, you know, I can get

treated for that with medicine.

After four years, in 2012, I

started getting anxiety, panic

attacks.

So I got prescribed

some antipsychotics, which

didn't much work well for me.



When I took that, that would

lead to the jerking of the neck

and then the head rubbing,

uncontrollable arm spasms.

Those are the three

major symptoms, which we noticed

in, like 2012 and '13.

As the symptoms developed,

they were trying to treat

the Tourette's as well as

the anxiety issue.



There was about 11 medications

over a six-year span,

trying to treat what the doctors

at first, and for a long period

of that time thought

was just worse Tourette's as I

got older.



My movement has spread

to my whole body.

I just woke up.

I can't do anything.



ANTHONY ROSSEAU: There were

good days, and then there were

bad days.

It'd be like, OK, he wouldn't

have any movement at all,

and it'd be great.

And then the next day

his twitches were so bad

that he'd be throwing up.



BRIAN SMUDA: I just showered.

Threw up four times.

These are

the involuntary movements I have

going right now.



I went to a local hospital

in Boston, and they said,

for the first time

ever, tardive dyskinesia.

When they pinpointed this was

caused by the medicine,

from there we were able to focus

on getting steps done

to counteract what was going on.



So there are other options

for the-- treating the TD.

Medicines or movement therapy

and stuff like that.

Mine was, though, the deep brain

stimulation.



ANTHONY ROSSEAU: He'd hit

a wall, and that'd be it,

or there's gonna

be a light at the end

of the tunnel.

With the surgery,

that was the light at the end

of the tunnel.



BRIAN SMUDA: Getting

into the DBS program,

I was referred

by my psychiatrist.



[SOFT ACOUSTIC MUSIC]



And from June 26th to August

2nd, that's all the time

it took for me to go through all

the exams

to see if you would be

a candidate for that procedure.

Post-procedure and getting

the right settings for me

have definitely improved

the movements.



ANTHONY ROSSEAU: Yeah, he still

does have body tics,

and he's still moving.

But the progress that's been

made, it's just fascinating.



BRIAN SMUDA: The brain

operation, for me,

was a huge stepping stone that

allowed me to get back to living

again.

I was able to ski 86 days

after the initial brain surgery,

which was opening day

of my favorite mountain

in Vermont.

When I go skiing, it totally

lets me escape my mind

of tardive dyskinesia.



ANTHONY ROSSEAU: When we're

on the slopes, when he's going

down the mountain,

there's no tics or anything

like that.

Since post-surgery, quality

of life has improved.

As long as that keeps up,

I think that he's gonna

be successful.



BRIAN SMUDA: What I can

recommend to people that either

are not yet diagnosed or are

currently diagnosed newly

or it's 10 years on

and they haven't seen

any improvement,

follow what your movement

disorder specialist says

and just keep on pushing on.

Hope for tomorrow.



After the deep brain

stimulation, there's days where

I wake up, I feel around, like,

80% better.

There's days where you feel

depressed in a funk.

When I feel in a funk, I still

have the hope that my day gets

better.



If I go out and do something

joyful I can, ultimately, step

that up a little bit

and, you know, sit there

and just be nice, prompt,

and relaxed.

If you're hopeful enough

and you go out and go

for a hike, you go for a bike

ride, you do something that

brings you joy,

you can appreciate the highs

in life that you can get

from simple joys.

Brian Smuda./delivery/aws/0d/0a/0d0a1933-eec3-3a01-b5e6-e6231e4e7932/091e9c5e81e9f659_funded-doc-td-brian_,4500k,2500k,1000k,750k,400k,.mp403/31/2020 08:00:00 AM18001200funded doc td brian video/webmd/consumer_assets/site_images/article_thumbnails/video/funded_doc_td_brian_video/1800x1200_funded_doc_td_brian_video.jpg091e9c5e81e9f659

It's not exactly clear why schizophrenia onset often happens during late adolescence, but there are theories.

Research suggests it’s caused by a combination of your genes and things that happen while your brain is developing (environmental factors). If you’re vulnerable, the start of symptoms may be set off by a change in your environment or your body.

Some scientists believe it has to do with development in an area of the brain called the frontal cortex. Others think it has to do with connections between nerve cells that are lost as the brain matures.

Hormones also play a major role in puberty. One theory is that women get schizophrenia later than men because they go through puberty earlier, and the hormone estrogen might somehow protect them.

Adolescence is also a time when many people experiment with weed and other recreational drugs. Research has linked the use of drugs, especially weed, to a higher risk of schizophrenia.

Know how to recognize the signs of schizophrenia in teens.

Schizophrenia can be hard to diagnose for a few reasons. People with the condition often don’t realize there’s something wrong, so they’re unlikely to go to a doctor for help.

Another issue is that many of the changes leading up to schizophrenia, called the prodrome, can look like other normal life changes. For example, a teen going through schizophrenia onset may stop spending time with old friends and make new friends. They may also have trouble sleeping or suddenly start getting poor grades. That’s not unusual for any teen and may not raise a red flag.

Other subtle signs can include: 

  • Mood swings
  • Irritability
  • Spending time alone
  • Trouble staying on task

The vast majority of people with those behaviors won’t go on to develop schizophrenia, and it’s very hard to figure out who might. Doctors have many tests they use to help figure out who’s most at risk so they can get treatment as early as possible.

Early treatment with medications or psychotherapy could keep the condition from getting worse for at least some time.

Learn more about the prodrome phase of schizophrenia.

Schizophrenia is a syndrome. People with schizophrenia have several types of symptoms:

Hallucinations. You hear, see, or smell things that others say aren’t there. You may hear voices that criticize or threaten you. They might tell you to do things you otherwise wouldn’t.

Delusions. You believe things that aren’t true, even when others show you proof or share facts that explain why your beliefs are wrong. Delusions can seem strange to others. For example, you might think that the TV is sending you special messages or that the radio is broadcasting your thoughts for everyone to hear. You might also feel paranoid and believe that others are trying to harm you.

Thought disorders. You might have trouble putting your thoughts together, and you might speak in a way that’s hard for others to understand. You may stop talking in the middle of a thought because you feel like it’s been taken out of your head. This is called thought withdrawal. Another type of disordered thinking, called thought blocking, happens when your thoughts suddenly stop and you become silent until a new thought comes to mind.

Movement disorders. You might move your body over and over again as if you’re upset, or you might stop moving and responding. Doctors call this catatonia.

Negative symptoms. Maybe you speak in a dull, flat tone, have trouble following through, lack interest in your daily life, and find it hard to maintain relationships. You might appear to be depressed. But while sadness, tearfulness, and other symptoms point to depression, so-called negative symptoms are more likely to signal a problem with the way the brain works.

Read more about the symptoms of schizophrenia.

In general, schizophrenia onset before age 18 is considered early-onset. Schizophrenia onset before age 13 may be called childhood or very early-onset schizophrenia. But different doctors and scholars may use different terms and age ranges.

Schizophrenia is extremely rare in very young children, but it can happen. Signs include:

  • Talking delays
  • Late crawling or walking
  • Lack of eye contact
  • Movements such as arm flapping or rocking
  • Trouble controlling emotions and impulses
  • Attention issues
  • Problems telling the difference between reality and dreams or make-believe
  • Trouble managing daily tasks such as bathing and brushing teeth

Parents might notice their teens are:

  • Not spending as much time with friends and family
  • Performing poorly at school
  • Having trouble sleeping
  • Often in a bad mood
  • Feeling depressed
  • Lacking motivation
  • Using drugs or alcohol
  • Acting differently (unusual behavior)

Teens are less likely to have delusions but more likely to have visual hallucinations.

Find out more about early childhood schizophrenia symptoms.

Though less common, schizophrenia onset can take place later in life. Experts consider a diagnosis between the ages of 40 and 60 to be late-onset schizophrenia, while a diagnosis beyond age 60 is considered very late-onset schizophrenia-like psychosis.

People with late-onset schizophrenia are more likely to have symptoms such as delusions and hallucinations. They’re less likely to have negative symptoms, disorganized thoughts, impaired learning, or trouble understanding information.

Doctors think genetics may be to blame, just as it is with early-onset schizophrenia. They also think late-onset might be a subtype that doesn’t affect the person until the right trigger appears. People with cognitive, vision, or hearing problems or those who are suspicious, isolated, or reclusive may be more likely to get it.

Schizophrenia onset most often takes place between your late teens and early 30s. Men are usually diagnosed in their late teens to early 20s, while women tend to get diagnosed in their late 20s to early 30s. It’s rare to develop this mental health condition before age 12 or after age 40. Brain changes during adolescence may explain why symptoms usually appear at that age.

Here are some commonly asked questions about schizophrenia onset.

Can a child develop schizophrenia? How does childhood-onset schizophrenia differ?

Yes, a child can develop schizophrenia, but it’s very rare. Schizophrenia onset before age 13 may be called childhood or very early-onset schizophrenia. Symptoms in children may differ from those in adults. Look out for symptoms such as:

  • Attention issues
  • Decline in school performance
  • Lack of eye contact
  • Movements such as arm flapping or rocking
  • Not spending as much time with friends and family
  • Trouble controlling emotions and impulses
  • Trouble sleeping

What typically triggers the first active episode of schizophrenia?

More research is needed to know what exactly triggers someone’s first active episode. But we do know the first episode usually happens in a person’s late teen years or early 20s.

Is it possible to develop schizophrenia for the first time in late adulthood (after age 45)?

Yes, it’s possible but not as common. If you get diagnosed with schizophrenia between the ages of 40 and 60, it’s called late-onset schizophrenia.

Can schizophrenia have a sudden, overnight onset, or is it always gradual?

Usually, schizophrenia develops slowly over time, in stages.

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