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Is ambivalence a symptom of schizophrenia Medically reviewed by Nicole Washington, DO, MPH — By Mathieu Rees on July 19, 2022Ambivalence is the term for having mixed feelings about something. Doctors once considered it a key symptom of schizophrenia, but this is no longer the case.
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Recent studies indicate only a weak link between ambivalence and schizophrenia, and some evidence suggests that it might actually be a more common symptom of mood disorders. Many people sometimes feel ambivalent about certain situations, people, or things.
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Regularly experiencing ambivalence is less common, and experts once thought that it was an important characteristic of schizophrenia. This article explores ambivalence, its link to schizophrenia, and the current diagnostic criteria for schizophrenia.
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It also considers some closely related conditions and advises when to seek medical help. What is ambivalence
Share on PinterestPaula Serrao/EyeEm/Getty ImagesAmbivalence is a state of mind involving mixed feelings or thoughts about a person, thing, or situation. These mixed feelings or thoughts can seem to pull in different directions.
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Swiss psychiatrist Paul Eugen Bleuler, who first coined the psychiatric term “schizophrenia” in 1908, defined ambivalence as simultaneously having two separate ideas or personas in one’s mind or having conflicting attitudes or emotions. Ambivalence is not an intrinsically negative state of mind.
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However, some evidence suggests that ambivalence might be more likely to arise in people with certain mental health conditions. Ambivalence and schizophrenia
Schizophrenia is a psychotic disorder involving hallucinations, delusions, or disturbances in thoughts.
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Worldwide, schizophrenia affects about 1% of adults. In the United States, that figure lies between 0.6% and 1.9%.
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Bleuler considered ambivalence as one of the four main symptoms of schizophrenia. The medical community no longer considers ambivalence an essential characteristic of this condition, but some evidence suggests that ambivalence is more prevalent among people with schizophrenia.
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What does the current research say
Doctors and scientists can measure ambivalence using a variety of methods. In older studies, experts sometimes used the Schizotypal Ambivalence Scale (SAS) to assess the degree to which a person was experiencing certain forms of ambivalence.
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The SAS uses a questionnaire to evaluate ambivalence as a schizotypal symptom or trait. For instance, a 2008 study found that people with higher SAS scores were more likely to have schizophrenia-like symptoms than the control group members.
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However, using different measurement techniques may yield different results. For example, the Revised Schizotypal Ambivalence Scale (rSAmb) is a different questionnaire for ambivalence.
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According to a 2014 study, there does not appear to be a strong correlation between a higher rSAmb score and schizophrenia symptoms. A more recent 2020 study evaluated the level of ambivalence that people with schizophrenia showed toward their self-image. The study examined patterns in the participants’ brain activity using functional MRI (fMRI) and measured ambivalence using the SAS questionnaire.
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The people with schizophrenia showed a significantly higher level of ambivalence toward actual and ideal self-image in the behavioral task than the control group. The relationship between ambivalence and schizophrenia is, therefore, unclear. Although people with this condition might experience mood changes that could lead to ambivalence, the research overall suggests that ambivalence is not the strongest indicator of schizophrenia.
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Diagnosis
Nowadays, healthcare professionals do not consider ambivalence to be definitive of schizophrenia. Doctors and psychiatrists will only diagnose someone with schizophrenia if that individual meets certain conditions.
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The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) lists these as follows:Symptoms: For at least 1 month, the individual must have experienced at least two typical symptoms of schizophrenia. These symptoms include delusions, hallucinations, disorganized speech, highly disorganized behavior, or negative mood.
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At least one of those symptoms must be delusions, hallucinations, or disorganized speech.Dysfunction: During this period, the individual must have experienced significant problems in at least one major area of life, such as work, relationships, or self-care.Long lasting disturbance: The individual must have experienced at least 6 months of low mood or manifestations of the typical symptoms of schizophrenia.Ruling out other disorders: Doctors must be confident that the individual does not have other conditions, such as schizoaffective disorder, a depressive disorder with psychosis, or bipolar depressive disorder with psychosis. Healthcare professionals can rule these conditions out if the individual has not experienced any major depressive or manic episodes alongside their other symptoms for a significant length of time.No obvious cause: The individual must not have a condition or have taken any psychoactive substance that might explain their symptoms. The DSM-5 also notes that healthcare professionals must take extra care in diagnosing schizophrenia when the individual has a history of autism spectrum disorder or a communication disorder that began in childhood.
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In this case, an individual should only receive a schizophrenia diagnosis if they have experienced prominent delusions or hallucinations for at least 1 month. Related conditions
The DSM-5 notes that several conditions have some symptoms in common with schizophrenia, which can make the diagnosis challenging.
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Those conditions include:major depressive disorder with psychosisschizophreniform disorder and brief psychotic disorderdelusional disorderbipolar disorder with psychosisschizoaffective disorder
Research suggests a strong association between some mood disorders and higher ambivalence levels. These disorders include depression and bipolar disorder but also schizoaffective disorder. Indeed, people with a higher rSAmb score are more likely to receive a diagnosis of schizoaffective disorder than one of schizophrenia.
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When to contact a doctor
Anyone who is experiencing symptoms of schizophrenia should contact a healthcare professional. The prospect of receiving a diagnosis of schizophrenia or another mental health condition may seem daunting, but healthcare professionals can offer care, support, and treatment options. People who routinely experience ambivalence should also seek a doctor’s advice, even if it does not accompany other symptoms.
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Ambivalence may be related to a mood disorder such as depression. Early diagnosis and treatment typically lead to better outlooks for individuals with schizophrenia or a mood disorder. Summary
It is normal to feel ambivalent about certain things from time to time.
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However, there is reason to believe that ambivalence might be more common among people with certain mental health conditions. Although people with schizophrenia may be more likely than other people to experience regular ambivalence, healthcare professionals do not consider ambivalence a key symptom of this condition.
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Last medically reviewed on July 19, 2022Mental HealthSchizophreniaPsychology / Psychiatry 7 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles.
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You can learn more about how we ensure our content is accurate and current by reading our editorial policy.American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th edn. Washington, D.C: American Psychiatric Publishing.Docherty, A.
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R., et al. (2014).
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Further examination of ambivalence in relation to the schizophrenia-spectrum.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153362/Docherty, A. R., et al.
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(2014). Self-reported ambivalence in schizophrenia and associations with negative mood.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4394623/Hany, M., et al. (2021).
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Schizophrenia.https://www.ncbi.nlm.nih.gov/books/NBK539864/Kim, B.-H., et al. (2020).
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Neural basis of ambivalence towards ideal self-image in schizophrenia.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265028/Mann, M. C., et al. (2008).
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The schizotypal ambivalence scale as a marker of schizotypy [Abstract].https://pubmed.ncbi.nlm.nih.gov/18477882/Resnick, J. (2017).
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Paul Eugen Bleuler (1857–1939). https://embryo.asu.edu/pages/paul-eugen-bleuler-1857-1939FEEDBACK:Medically reviewed by Nicole Washington, DO, MPH — By Mathieu Rees on July 19, 2022
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New clues arise
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Schizophrenia is a complex mental health condition linked to psychosis.
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Diagnosis and treatment options vary. Here, learn more about…READ MOREWhat are the differences between drug-induced psychosis and schizophrenia?
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