Medical pros in 2021 don’t separate schizophrenia into different types.
Since 2013, psychological health pros have diagnosed schizophrenia along a spectrum. But before that, they divided schizophrenia into five subtypes. The old types of schizophrenia still pop up in many places when you do a Goog.
Although doctors no longer use the subtypes, characteristics from each type color the spectrum of modern schizophrenia diagnoses.
How do experts classify schizophrenia today?
Mental health professionals now diagnose schizophrenia along a spectrum. “Schizophrenia” is an umbrella term used to describe an illness that has multiple symptoms.
Symptoms vary from person to person but must include:
- delusions
- hallucinations
- disorganized thoughts
The five previous types of schizophrenia (that docs no longer use) were:
- paranoid schizophrenia
- catatonic schizophrenia
- undifferentiated schizophrenia
- disorganized type schizophrenia
- residual schizophrenia
Modern classification of schizophrenia
Schizophrenia is a brain disorder with a mix of symptoms. Someone with the condition might experience these symptoms to greater or lesser degrees.
You could think of the spectrum as a paint palette: Certain “colors” have to be present for docs to recognize schizophrenia, but not everyone has the same amount of each color. And some colors may be “bolder” than others.
Across the world, about 20 million people have schizophrenia. Schizophrenia spectrum disorders are chronic and severe.
The five main symptoms of schizophrenia (which make up that metaphorical paint palette) are:
- hallucinations
- delusions
- confused thoughts and speech (as a result of experiencing hallucinations or delusions)
- unusual body movements (or an abnormal lack of movement)
- “negative symptoms,” which might include speaking very little, a flat tone of voice, reduced reactions, and difficulty starting or completing activities, including self-care
What the previous types meant
Mental health docs no longer divide people with schizophrenia into five subtypes. While developing the latest version of the go-to psychology treatment reference manual (the DSM-5), experts decided not to divide schizophrenia into different types.
But you may still see people use the old subtypes of schizophrenia. People like to put labels on things, and mental health is no exception. They do,
The symptoms of each subtype still contribute to schizophrenia diagnoses as a whole.
Paranoid schizophrenia
Symptoms and characteristics of paranoid schizophrenia:
- hallucinations (often hearing things, such as voices)
- delusions (intrusive thoughts, including paranoia and a fear of being attacked)
- trouble concentrating
- behavioral problems like impulse control
- a lack of emotion and a general “meh” feeling
Catatonic schizophrenia
Symptoms and characteristics of catatonic schizophrenia:
- lack of movement (seeming to be in a trance)
- imitating behavior or actions (echopraxia)
- mimicking speech (echolalia)
- inability to speak
- repeating movements over and over without purpose (e.g., rocking back and forth)
Disorganized type schizophrenia
Symptoms and characteristics of disorganized schizophrenia:
- hallucinations and delusions around “disorganized” themes that may not be consistent from one to the next
- disorganized speech
- disorganized behavior
- flatness or inappropriate emotional responses
Undifferentiated schizophrenia
When people had symptoms that didn’t fit neatly into another subtype, they got a diagnosis of undifferentiated schizophrenia.
Schizophrenia symptoms can fluctuate, changing in severity and type.
Under the old definitions, a person with undifferentiated schizophrenia experienced symptoms from both the paranoid and catatonic types.
Residual schizophrenia
Residual schizophrenia meant that symptoms weren’t severe or had been reduced for some time.
Folks with residual schizophrenia had mild symptoms that didn’t disrupt their lives. Schizophrenia symptoms fluctuate, so docs didn’t use this subtype much.
What qualifies as schizophrenia?
The diagnostic criteria for schizophrenia are:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- negative symptoms (such as a lack of emotional expression)
These symptoms have to occur pretty often for the person experiencing them to receive a schizophrenia diagnosis.
Two or more of the five symptoms must be present for longer than 1 month. At least one of those symptoms must be delusions, hallucinations, or disorganized speech.
Delusions
A delusion is a belief that someone thinks is absolutely real and true, even though it has no basis in fact and might be bizarre or extreme.
Because delusions seem no different in our minds from the truth, they can affect the way we behave. A delusion can occur suddenly or develop over time.
Hallucinations
A hallucination is when you see, hear, smell, taste, or feel something that doesn’t exist outside your mind.
For someone with schizophrenia, the experience of these sensations can be entirely real. When researchers scanned the brains of people with schizophrenia who experienced auditory hallucinations, the equipment showed activity in the area of the brain that responds to hearing speech.
Disorganized speech
With all that unwanted stuff intruding on their mind, it can be a challenge for someone with schizophrenia to maintain a train of thought or conversation.
They may find it hard to stay on topic or might be tricky to understand.
Extremely disorganized or catatonic behavior
Similar to their speech, the behavior of someone with schizophrenia may be unpredictable and disorganized.
Their body movements and actions might seem erratic, out of place, or without purpose. Some people with the condition feel as though someone else is controlling their body.
Negative symptoms
When someone’s speech, movement, and interest in other people and activities reduce or vanish altogether, they are experiencing negative symptoms.
Up to 60 percent of folks with schizophrenia have negative symptoms that need treatment. Negative symptoms can happen at any time but are the most common first symptoms of schizophrenia.
Related conditions
Schizophrenia spectrum disorders and other psychotic disorders can also develop. These are conditions that share some features of schizophrenia but land under different definitions.
Most importantly, they are not types of schizophrenia.
Schizotypal personality disorder
Schizotypal disorder is classed as a personality disorder as well as part of the schizophrenia spectrum.
A person with schizotypal disorder may think everyday experiences or objects have a special significance, such as a secret message. They may have paranoid ideas, which may cause anxiety even around people they know well.
However, people with this disorder don’t have problems with speech, body movement, or mental or physical disorganization.
Delusional disorder
In a delusional disorder, delusions are the main symptom (duh) and the doc has ruled out schizophrenia or other causes. The delusions may be:
- romantic/erotic
- grandiose (thoughts of unrecognized talent or importance)
- jealous (e.g., thinking a partner is unfaithful)
- persecutory (thinking someone is out to do them harm)
- bodily sensations (such as the sensation of insects on their skin)
To qualify for this diagnosis, delusions have to happen for 1 month or longer.
Brief psychotic disorder
This is when someone experiences several schizophrenia symptoms for more than a day but less than a month. One of the symptoms must be delusions, hallucinations, or disorganized speech.
Schizophreniform disorder
This is when someone experiences two or more schizophrenia symptoms for a significant amount of time — more than a month and up to 6 months. At least one of the symptoms must involve delusions, hallucinations, or disorganized speech.
Schizoaffective disorder
When someone has symptoms of schizophrenia that start at the same time as significant mood symptoms, they’ll get a diagnosis of schizoaffective disorder. (But if they’ve lived with depression for a long time and develop schizophrenia later, they’ll get two different diagnoses.)
The mood symptoms may present as a major depressive episode or manic episode. For this diagnosis, a doc must rule out the effects of substances or other medical conditions.
Substance- or medication-induced psychotic disorder
If someone experiences delusions and/or hallucinations as a result of a substance or medication, they may get this diagnosis. These substances might induce psychotic disorder:
Medications that may induce psychotic disorder as a side effect include:
- anesthetics
- anticonvulsants
- heart medications
- chemotherapy drugs
- antidepressants
Specific meds will list whether psychosis is a potential side effect. Consult a medical professional if you have any concerns.
Psychotic disorder due to another medical condition
The key symptoms here are hallucinations or delusions that docs can’t connect to another disorder or condition (clue’s in the name). An underlying condition like epilepsy might be behind these symptoms.
Health conditions that can occur alongside schizophrenia
People with schizophrenia might have other mental and physical health challenges.
A study in 2013 involving 1,446 adults with schizophrenia found that more than half of the participants also had one of the following:
- depression
- anxiety disorder
- substance use disorder
Psychiatric disorders like obsessive compulsive disorder may be present at the same time as schizophrenia (ugh, because it needed to get more difficult).
Some research also suggests that schizophrenia may be linked to a higher risk of cardiometabolic conditions, such as diabetes and metabolic syndrome.
Takeaway
A medical professional will no longer use types — such as paranoid, catatonic, or disorganized — to describe a person with schizophrenia. Docs now widely accept that schizophrenia is a spectrum involving features from these outdated categories.
Schizophrenia is a condition that affects the way people think and behave. Its effects will show up differently for different people.
Hallucinations and delusions are common, but they’re not the only symptoms. They’re also not exclusive to schizophrenia.
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