Schizophrenia is a chronic broad-spectrum mental health condition that can manifest in various ways. In the past schizophrenia used to be divided into 5 subtypes including paranoid, catatonic, disorganized, residual, and undifferentiated. Presently experts understand that individuals with schizophrenia often experience overlapping symptoms throughout their lives and such subtypes are not always useful.
The classification of schizophrenia changed in 2013 with an update to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The DSM update also changed the criteria needed to warrant a diagnosis of schizophrenia. Prior to 2013 individuals needed to have one of the symptoms of schizophrenia to be diagnosed. Now, a person must have at least two symptoms for a minimum of six months, one of which must be hallucinations, delusions, or disorganized speech. While it is no longer considered useful to divide schizophrenia into separate subtypes, it is still important to understand the various ways schizophrenia can affect people.
Types of Schizophrenia
Although the subtypes of schizophrenia are no longer formally used, they can still be useful as diagnostic specifiers to describe people’s various experiences of schizophrenia to clinicians and to help determine treatment plans. The 5 classic subtypes of schizophrenia are described below.
Prior to 2013, paranoid schizophrenia was the most commonly diagnosed type of schizophrenia. It is also the image of schizophrenia most widely portrayed in movies and by the media. Paranoid schizophrenia was characterized by frequent visual and auditory hallucinations, preoccupation with one or more delusions, disorganized speech, trouble concentrating, and significant behavioral impairment.
Catatonic schizophrenia is less commonly diagnosed and considered one of the rarest types of schizophrenia. Some experts maintain that catatonia should remain an essential and distinct specifier when dealing with schizophrenia because it occurs in a wide variety of psychiatric conditions as well as general medical conditions.
Catatonia is characterized by either excessive movement, referred to as catatonic excitement, or decreased movement, known as a catatonic stupor. People experiencing catatonia may not react to stimuli, will often remain in strange body positions, make odd movements, and may experience extreme rigidity of the limbs. Additional symptoms associated with catatonic schizophrenia include the inability to speak (mutism), mimicking words (echolalia), and mimicking actions (echopraxia).
Also known as hebephrenic schizophrenia, disorganized schizophrenia is characterized by disorganized behaviors and nonsensical speech in the absence of delusions and hallucinations. Other symptoms include flat affect, inappropriate emotional and facial reactions, disorganized thinking, and difficulty with daily activities. Most of these symptoms are widely experienced by the majority of people living with a diagnosis of schizophrenia.
Residual schizophrenia can be somewhat confusing. The diagnosis was used when a person had previously been diagnosed with schizophrenia and no longer experienced prominent symptoms such as delusions and hallucinations, yet still exhibited symptoms including a flattened affect, psychomotor difficulties, and disturbed speech. Experts now understand that many people with schizophrenia experience periods when their symptoms wax and wane in frequency and intensity. Such residual symptoms are common in most cases.
Undifferentiated schizophrenia was the diagnosis used to describe those whose symptoms fit into more than one subtype of schizophrenia. For example, someone who experienced both delusions and hallucinations along with catatonic behavior and cognitive difficulties may have been diagnosed with undifferentiated schizophrenia.
While there are different lived experiences of schizophrenia—all of which are subject to various changes in intensity and symptoms exhibited over time—these experiences fall within a spectrum and should be addressed as such. It is crucial for mental health professionals and those living with schizophrenia to understand and treat the condition as a whole while still tailoring treatment for the specific symptoms a person is experiencing.
Life Adjustment Team
Treatment for schizophrenia differs not only based on a person’s symptoms but also what works for the individual. Every person has unique needs and may respond in vastly different ways to the same treatment. Only by addressing all of a person’s needs and treating each individual as a whole entity rather than part of a subtype can we help people learn to effectively manage their symptoms.
Life Adjustment Team tailors treatment based on how you or your loved one is doing during a particular day. We offer group therapy and day-to-day case management at which time a case manager assists the client through teaching, mentoring, and coaching. If you would like to learn more about Life Adjustment Team, contact us today!