Schizophrenia is a rare but serious mental illness that can cause psychosis, flattened affect (an abnormal lack of emotion), and abnormal patterns of thought and behavior. Prior to 2013, experts believed there were five distinct types of schizophrenia, but these subtypes are no longer used in diagnosis. These were replaced with the term schizophrenia spectrum disorder, which can include a variety of symptoms that may be mild, moderate, or severe.1,2
What Is Schizophrenia Spectrum Disorder?
Schizophrenia spectrum disorder is categorized as a psychotic disorder. Psychotic disorders are mental illnesses that interfere with a person’s ability to accurately perceive and respond to reality. People with psychotic disorders (i.e. schizophrenia or brief psychotic disorder) are unable to differentiate reality from delusions and hallucinations when they’re experiencing symptoms of psychosis.1,3
Schizophrenia is a rare but debilitating chronic mental illness. Less than 1% of the US population will develop schizophrenia in their lifetime, and most who do are older teens or younger adults.(FN4) Many experts believe that only people who have a genetic or neurological predisposition can develop schizophrenia, and that certain environmental factors or choices can heighten the risk for those individuals, such as use of illicit substances.2,3,4
Schizophrenia is chronic in nature, meaning that the symptoms of schizophrenia can be managed with medication and treatment, but cannot be cured. Most people with schizophrenia will experience periodic ‘active phases’ of psychosis where their thoughts are disorganized or delusional. When they remain in treatment and on their medications, these active phases tend to be shorter, less frequent, and less intense.2,3,4
Symptoms of Schizophrenia
Psychosis is the hallmark feature of schizophrenia (as well as other psychotic disorders). Someone with schizophrenia will experience psychotic symptoms that have been present for six or more months, and are severe enough to impact their functioning.
In order to meet the diagnosis criteria for schizophrenia, a person must experience two or more of the following symptoms:1,2
- Delusions: Delusions are false, irrational and abnormal beliefs that a person holds with strong conviction, even when these beliefs are challenged by facts or logic.
- Hallucinations: Hallucinations are inaccurate perceptions of reality that a person believes are actually present, like seeing or hearing things that aren’t there (aka visual and auditory hallucinations). These are often referred to as ‘positive symptoms’ of schizophrenia, because they include the addition of abnormal symptoms (note the word ‘positive’ is not associated with ‘good’).
- Disorganized speech: Disorganized speech includes abnormal ways of speaking, emphasizing words (i.e. pressured speech), or speech that is incoherent or lacking in logic, pattern and clear intent.
- Disorganized or catatonic behavior: Disorganized behavior includes movements, actions and choices that are abnormal, random, or done without a clear reason. Catatonic behavior usually presents as an extreme unresponsiveness to the external environment.
- Negative symptoms: Negative symptoms in schizophrenia include a flattened or ‘blunted’ affect, characterized by an abnormal lack of emotion, inflection, or enthusiasm; or an overall lack of motivation or responsiveness. These negative symptoms earned their name because they involve the loss or absence of normal human emotions and responses that we expect to see.
Are There Different Types of Schizophrenia?
Currently, there are not any formally recognized subtypes of schizophrenia. The only diagnosis used in the DSM 5 (the most current version of the reference guide for diagnosing mental illnesses) is schizophrenia spectrum disorder. While there aren’t any different types or forms of schizophrenia, the DSM 5 does include some “specifiers” that can be used to describe a person’s symptoms.2
The following specifiers can help clinicians accurately describe and track a person’s symptoms over time:1
- Number of episodes: One of the specifiers listed in the DSM 5 allows health and mental health professionals to note whether the schizophrenic symptoms (i.e. hallucinations, flat affect, disorganized speech, etc.) are occurring for the first time (specifier: First episode) or have occurred multiple times before (specifier: Multiple episodes)
- Symptoms are active or in remission: Other specifiers that can be used when diagnosing someone with schizophrenia are “acute episode”, “partial remission”, or “in full remission”, which are updated to reflect whether the person is experiencing active symptoms (i.e. acute episode) or not (i.e. in partial or full remission)
- With or without catatonia: Another specifier that can be used is noting whether the person presents “with catatonia” or “without catatonia”, which can be used to designate a person who has symptoms of catatonic schizophrenia (a lack of responsiveness, and loss of control over movement and speech are key signs of catatonic states)
- Severity of present & recent symptoms: The final specifier listed in the DSM 5 criteria for diagnosing different forms of schizophrenia allows clinicians to note whether a person’s current/recent symptoms are mild, moderate, or severe (using a 0-5 rating scale). This can help track the progression of the condition and someone’s response to treatments
5 Types of Schizophrenia in the DSM IV
The five distinct types of schizophrenia included in the DSM IV were used by clinicians to diagnose someone, based on the symptoms the person presented with.2
Since 2013, these criteria have been replaced by schizophrenia spectrum disorder in the DSM 5.
The five types of schizophrenia that used to be diagnosed include:2
1. Paranoid Schizophrenia
Paranoid delusions are the most commonly reported types of delusions by people with schizophrenia and other psychotic disorders. For this reason, the DSM IV used to include the paranoid schizophrenia subtype for people who mainly experienced paranoid hallucinations and delusions. These often include persecutory delusions that involve false beliefs of being hunted, chased, harmed, or targeted by someone, something, or a group or institution.
2. Disorganized Schizophrenia
Disorganized schizophrenia was a subtype used to classify people who mainly displayed odd and abnormal moods, disorganized speech, and disorganized behaviors.2 For example, they may have had strange rituals and routines, awkward interactions with other people, or have a mood that didn’t match their situation. Additionally, people with this subtype may have had less vivid, intense, or frequent delusions and hallucinations.
3. Catatonic Schizophrenia
Catatonic schizophrenia was diagnosed when someone with schizophrenia went into a catatonic state (aka catatonic stupor). Most often, this involves periods where the person becomes unresponsive, stops moving and speaking, or speaks and moves in uncontrolled, strange, or rigid ways. For example, someone in a catatonic schizophrenic state may stop talking, become very still, and not respond to anyone trying to talk to them. They may also hold their body, arms, legs, or face in strange positions and expressions for long periods of time.
A person with schizophrenia and catatonic symptoms may experience:2
- Physical or motor immobilities including waxy flexibility
- Mutism, or the inability to speak
- Extreme negativism, or the lack of response or resistance to external stimuli and/or instruction
- Echolalia, or the repetition of another person’s speech/words
- Echopraxia, or the repetition of another person’s movements
4. Undifferentiated Schizophrenia
Undifferentiated schizophrenia was used when a person met the full DSM IV criteria for schizophrenia, but did not show the typical signs of one particular subtype of schizophrenia. For example, they may have displayed some symptoms of several subtypes, making it hard to differentiate what type of schizophrenia they had.
5. Residual Schizophrenia
Residual schizophrenia was a subtype used to describe when a person’s symptoms were partially in remission. Usually, this diagnosis was used when a person had a history of psychotic schizophrenia episodes, but was currently not experiencing hallucinations, delusions, or other psychotic symptoms. This typically was given to those whose symptoms were being successfully managed and controlled through medication and other treatments.
New Debates About Subtypes of Schizophrenia
Recently, further debate has sparked amongst researchers regarding schizophrenia, with some arguing that there is proof of the existence of different types of the disorder. The theory with the most support differentiates between two types of schizophrenia that present either with mainly positive symptoms or negative symptoms.5,6,7
Positive and negative symptoms of schizophrenia are outlined in the table below:1,5,6,7
| Positive symptoms of schizophrenia | Negative symptoms of schizophrenia |
|---|---|
| Auditory or visual hallucinations | Limited vocabulary or speech (alogia) |
Delusional thoughts | Lack of emotion (flat/blunted affect) |
Disorganized speech or behaviors | Loss of pleasure or interest (anhedonia) |
| Delusional thoughts Disorganized thought patterns | Loss of focus (inattentiveness) |
| Agitation or restlessness | Lack of responsiveness or catatonia |
It may be important to distinguish between these two presentations of schizophrenia, because studies suggest that one is more closely linked to severe symptoms and impairment than the other. For example, people with mainly ‘negative’ symptoms are more likely to have a more chronic and severe form of schizophrenia than those with mainly ‘positive’ symptoms.6,7
Comorbidities of Schizophrenia
People with schizophrenia often experience other physical and mental health conditions, known as comorbidities or co-occurring disorders. Certain physical and mental health conditions are more likely to co-occur with schizophrenia than others.
Psychiatric Co-occurring Disorders
Both anxiety and depression are highly common comorbidities, affecting about half of people diagnosed with schizophrenia.8
Schizophrenia also commonly co-occurs with substance use disorders and addictions, which can worsen symptoms and interfere with prescribed treatments and medications.8
Other conditions that can co-occur with schizophrenia include:8
- Posttraumatic stress disorder (PTSD)
- Obsessive compulsive disorder (OCD)
- Panic disorder or panic attacks
- Bipolar I and Bipolar II disorder
Medical Co-occurring disorders
Chronic illnesses like heart disease, cancer, and diabetes are also more common in people with schizophrenia than in the general population. Unfortunately, these health issues also mean people with schizophrenia have a higher early mortality rate than others.9
This disparity could be partly due to the fact that people with active symptoms of schizophrenia may neglect their health or may not have access to quality healthcare.
How to Get Treatment for Schizophrenia
Schizophrenia is a serious but treatable mental health disorder.3,4 People who suspect that they or someone they care about is showing symptoms of schizophrenia should make an appointment with a medical or mental health professional to confirm their diagnosis. People experiencing signs of psychosis (i.e. hallucinations, delusions, etc.) can get an assessment at a local emergency room or psychiatric hospital. Those with less serious or urgent concerns may be able to set up an outpatient appointment with a licensed counselor, psychologist, or psychiatrist.
Many people looking for mental health treatment for schizophrenia begin their search online by using an online therapist directory. This tool allows you to narrow your search by location, specialty, insurances accepted, and type of therapy provided. Once you have a list, you can contact different providers to request a consultation where you can learn more about the kind of therapy they provide. After you find someone who you think is a good match for your needs, the next step is to book an initial intake appointment with them.
During an intake appointment (which can occur online or in an office or facility), the clinician will ask questions and gather information to perform a diagnostic assessment. This allows them to verify whether you’re struggling with schizophrenia or another disorder like brief psychotic disorder, bipolar, or schizoaffective disorder. Getting an accurate diagnosis is necessary in order to receive recommendations for treatments that are most likely to help you manage your symptoms.
How Is Schizophrenia Treated?
Typically, those with schizophrenia require medications to help them manage their symptoms– these can include mood stabilizers, antipsychotics, or other psychotropics.4 Therapy is also recommended as an addition to medication, and can help people learn better ways to cope with and reduce their symptoms.
Depending on the severity of a person’s symptoms, therapy may be provided in an inpatient setting, intensive outpatient, or regular outpatient setting. Therapy can also be provided to someone in group, individual, or family therapy
Other therapeutic approaches proven to help people with schizophrenia include:10
- Assertive Community Treatment
- Cognitive Behavioral Therapy (CBT)
- Family Psychoeducation
- Acceptance and Commitment Therapy (ACT)
- Social Skills Training
- Supported Employment programs
Final Thoughts
While psychologists used to diagnose five different forms of schizophrenia, these classifications are no longer used in modern practice.2 Today, people are diagnosed with schizophrenia spectrum disorder, and clinicians can choose to add specifiers to further describe their symptoms.1,2Some research does suggest there may be important differences between people who primarily display negative or positive symptoms of the disorder, which may lead to new subtypes in the future.5,6,7Regardless, anyone struggling with schizophrenia should seek professional treatment, which can greatly reduce their symptoms and improve their quality of life.4,10
For Further Reading
People who are interested in learning more about schizophrenia or finding resources and information about treatment and support groups can visit the links below.
Different Types of Schizophrenia Infographics
