The Romantic Lives of People With Psychotic Disorders

What we know about romantic relationships among people who have psychosis.

Reviewed by Tyler Woods

Key points

• There is little academic information regarding the romantic lives of patients with psychotic disorders.
• Studies that do focus on romance in people with psychosis often have mixed and unstandardized reporting.
• While some studies indicate having romantic relationships is associated with fewer symptoms, others don't.
• The dating lives of people with psychosis is as heterogeneous as the disorder itself.

When you think of a person with schizophrenia, do you imagine their love lives? Schizophrenia is a disability, but it doesn’t stop people from feeling the natural desire to love and be loved by romantic partners.

In fact, there are few studies that examine the romantic lives of people living with schizophrenia, and those that do report mixed findings and limited insight into the diverse range of individuals living with the heterogeneous presence of symptoms.

A systematic review published in 2021 reports that the data that have been collected about relationships in people with schizophrenia merely focus on biological issues such as sexually transmitted diseases or sexual dysfunction. Studying the romantic lives of people with schizophrenia could provide insight into how patients can live a normal life with a full network of social support, including romantic love.

In the systematic review, only studies that were published in the western hemisphere after 1980 were considered due to cultural differences and changing marriage trends that have occurred within the past 50 years. Other criteria included subjects having a schizophrenia spectrum diagnosis and if the subjects having psychosis represented more than 50 percent of the sample. What they found was a mixture of methodologies and results.

Out of the 58 included studies, only 15 percent of participants were married. That number is far lower than average, which is about half of the population. Cross-sectional studies, which gather demographic data, statistics, and associations during one time of a given population, as well as longitudinal studies, which focus on the same population over a long period of time, showed mixed results.

Data Taken From Different Samples Since 1980

In cross-sectional studies, relationship status was sparsely reported, and only six studies asked if participants had ever been married or were in a stable relationship out of the 58 included studies in the review. Four studies only reported a number of those who were single, but not in committed relationships. About a third of of subjects had been in a committed relationship at some point in their lives, but at the time of participation, reported that they were single. The number of cohabiting and stable relationships was reported to be higher than those who were married.

There were no descriptions of whether or not these subjects participated in polyamory, asexual, or other forms of relationships that were not mainstream. Few studies reported on the sexuality of the participants.

It is difficult to capture information in real-time as well. Considering that these studies were conducted between 1980 and 2020, many cultural and social trends might have different impacts at different times. Attitudes about the average age and decisions about when and if to get married differ at different points in history. Many people of the past might not have been privy to experiences of a wide range of relationship types, such as polyamory, cohabiting without marriage, and relationships that represent the wide array of sexualities that people are more educated about today. Even the satisfaction with these varying types of relationships could vary depending on cultural attitudes.

Related to symptoms, some studies revealed the likelihood that certain symptoms would predict relationship involvement. Eight studies reported some level of association between romantic relationships and symptoms of psychosis. One reported that people experiencing “bizarre delusions” were less likely to be married, but marital status was not a predictor of that symptom. One study reported being single was associated with psychomotor poverty, where patients can exhibit issues with speech and bodily movements, but not depression, mania, or reality distortion.

Those who were single had fewer positive symptoms like hallucinations and delusions compared to those who were married, but those who were separated had more than the individuals who were married. The presence of negative symptoms, like blunted affect, was lower in those who were married than those who were single.

Even though the results were mixed, the overall takeaway was that more negative symptoms were more highly associated with being single. There were ten studies that found no association between symptoms of psychosis and romantic relationships.

Long-Term Patterns of Individuals and Their Romantic Relationships

There are different studies that measure the effects and associations of relationships across a long period of time within the same individuals called longitudinal studies. There were sixteen studies that focused on this method.

Five studies reported being married was associated with better positive outcomes related to the presence of psychotic symptoms. The results for quality of life and romantic relationships were also mixed.

Eleven out of 15 studies found no significant differences for those with non-married relationship statuses and living situations. However, two reported a correlation between having romantic relationships and a higher quality of living. Those who were married or unmarried reported higher quality of life in regards to psychological health, social relationships, and environment compared to those who were divorced or widowed.

Time spent between the emergence of symptoms and treatment was shorter in those who had a romantic partner. Longer periods of remission were reported in those who had families and children.

The mean age of these samples was around 25 years old, indicating that the presence of romantic relationships could be more influential for those who are younger.

What Can We Learn?

Similar to the likelihood of recovery, participants who have financial assistance, work involvement, and increased satisfaction with housing and social support are generally able to recover more and also have more experience in relationships. However, significant findings also show relationships were actually a source of stress themselves and did not act as stress relievers.

Given the lack of nuanced and in-depth studies that investigate the role of romantic relationships and psychotic symptoms, there are few general conclusions that can be extracted on this topic. Is it the persisting stereotype that patients with schizophrenia largely cannot function which limits these types of studies? Or do patients with psychotic symptoms truly experience a decreased capacity to have relationships?

For some, these results might be validating. For others, these results might not capture the experiences they report. Overall, it seems that patients with schizophrenia spectrum disorders have a highly heterogeneous mix of their personal experiences with romantic relationships, which actually reflect the true nature of the disorder itself.