Schizophrenia is a very serious psychiatric/psychological disorder that occurs in about one in 100 individuals.
This disorder is considered among the most serious and severe of all psychiatric/psychological disorders.
Only licensed healthcare professionals can diagnose schizophrenia. Anyone suspecting that they or someone else may have schizophrenia should consult with a licensed mental health professional.
The Previous 5 Types of Schizophrenia
Up until 2013, schizophrenia was conceptualized as a heterogeneous disorder that consisted of five different subtypes. The diagnosis for schizophrenia was and still is based on the presence of the following symptoms:
- Positive symptoms represent psychotic behaviors, or loss of the sense of reality. Positive symptoms in schizophrenia can be thought of as excesses in behavior. They consist of:
- Hallucinations: These are distortions of sensation and perception. Individuals hear or see things that are not there. The most common form of hallucination in schizophrenia is the auditory hallucination, and the most common form of auditory hallucination is hearing voices. Any type of hallucination can occur in schizophrenia, including visual hallucinations, olfactory hallucinations, and tactile hallucinations. Gustatory hallucinations or hallucinations regarding tastes are rare.
- Delusions: These consist of very rigid and fixed beliefs that are often irrational and very resistant to remediation. They are nearly always false but may be based on some truth. Delusions can consist of the belief that individuals are out to get the person (paranoid delusions or delusions of persecution), that the individual is a deity or is somehow special in some way (delusions of grandeur), that aliens are about to invade the earth, etc.
- Thought disorders: These represent dysfunctional ways of thinking and include such things as an inability to organize thoughts or connect them in a logical or meaningful manner (a flight of ideas), tangential thoughts, the use of meaningless words (neologisms), total losses of a train of thought (thought blocking, and others.
- Movement disorders: These represent disorganized, repetitive, agitated bodily movements or being frozen in positions for prolonged periods of time (catatonia).
- Negative symptoms are disruptions of emotions and motivations. Negative symptoms can be thought of as deficiencies in behavior. These include:
- Flat affect: This is the inability to express emotional variation. The individual is dull and monotone.
- Anhedonia: This is the inability to experience pleasure.
- Amotivation: This involves the inability to begin, plan, and/or sustain goal-directed activities.
- Poverty of thought: This is a paucity of speech that reflects a corresponding paucity of thoughts.
For many years, schizophrenia was divided into five separate subtypes based on the main feature that the individual presented with. The traditional five subtypes of schizophrenia were:
- Paranoid schizophrenia where the defining characteristic were hallucinations and delusions of persecution (although other delusions could also be present)
- Disorganized schizophrenia where there were fewer hallucinations but more negative symptoms, such as issues with emotions, expressive language (most often mixed up in silly language), poor personal hygiene, and difficulty performing every day activities
- Catatonic schizophrenia where individuals would primarily be frozen in various postures for lengthy periods of time or spend lengthy periods of time performing aimless, repetitive, and physical activities
- Undifferentiated schizophrenia that did not meet the diagnostic criteria for any of the other specific categories but still displayed symptoms consistent with schizophrenia
- Residual schizophrenia where individuals experienced at least one psychotic episode but were currently in remission and the symptoms were not severe enough to place them in a diagnosis of one of the other categories
In 2013, with the release of the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), the long-standing designation of schizophrenia into five separate subtypes was abandoned. The American Psychiatric Association explained that research did not justify the longstanding notion of five separate subtypes of schizophrenia. The current conceptualization of schizophrenia indicates that schizophrenia is a homogeneous disorder and that there is only one type of schizophrenia. Individuals may present with delusions, hallucinations, disorganized speech, catatonic behavior, or negative symptoms to get a general diagnosis of schizophrenia. The disorder must occur for at least six months, and during the six months, at least one of these symptoms must occur.
The diagnosis of schizophrenia is not made in cases where the behaviors can be better explained by some other psychological/psychiatric disorder, the use of drugs or medications, and/or by some other medical condition.
None of these diagnoses are “types” of schizophrenia.
Schizophrenia is comorbid with several other types of psychiatric/psychological disorders, including anxiety disorders and obsessive-compulsive disorder; however, schizophrenia is most commonly comorbid with a substance use disorder. Common co-occurring disorders include:
- Abuse of tobacco products: People with schizophrenia are far more likely to smoke heavily than any other group. Part of the reason is that nicotine may have effects on the cognitive deficits in schizophrenia, and individuals may naturally smoke tobacco as a means of realizing these effects. The risks of using tobacco products far outweigh any benefits that people with schizophrenia may accrue.
- Cannabis use disorders: There are high rates of cannabis use disorders in individuals with schizophrenia.
- Alcohol use disorders: These also commonly co-occur with schizophrenia.
Conclusions about Schizophrenia
The current conceptualization of schizophrenia is one of a homogeneous disorder that presents with a number of different symptoms (positive and negative symptoms). The previous division of schizophrenia into five distinct subtypes is no longer considered to be valid by the American Psychiatric Association. People with schizophrenia are often diagnosed with co-occurring substance use disorders, and when this occurs, treatment must address both conditions concurrently.