Types Of Schizophrenia: Paranoid, Hebephrenic, Undifferentiated, Residual & Catatonic
Types Of Schizophrenia: What is Schizophrenia?
According to the National Institute of Mental Health, schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality, which causes significant distress for the individual, their family members, and friends. If left untreated, the symptoms of schizophrenia can be persistent and disabling. However, effective schizophrenia treatments are available. When delivered in a timely, coordinated, and sustained manner, treatment can help affected individuals to engage in school or work, achieve independence, and enjoy personal relationships.
Schizophrenia is a mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions. Although the course of schizophrenia varies among individuals, schizophrenia is typically persistent and can be both severe and disabling.
Symptoms of schizophrenia include psychotic symptoms such as hallucinations, delusions, and thought disorder (unusual ways of thinking), as well as reduced expression of emotions, reduced motivation to accomplish goals, difficulty in social relationships, motor impairment, and cognitive impairment. Although symptoms typically start in late adolescence or early adulthood, schizophrenia is often viewed from a developmental perspective.
Cognitive impairment and unusual behaviors sometimes appear in childhood, and the persistent presence of multiple symptoms represents a later stage of the disorder. This pattern may reflect disruptions in brain development as well as environmental factors such as prenatal or early life stress. This perspective fuels the hope that early interventions will improve the course of schizophrenia which is often severely disabling when left untreated.
Types Of Schizophrenia: Current DSM-5 status
Several disorders had diagnostic changes that were made in the new “Diagnostic and Statistical Manual of Mental Disorders, 5th Edition,” including schizophrenia. In the past, an individual only had to have one of the symptoms to be diagnosed. Now, a person must have at least two of the symptoms.
The DSM-5 also got rid of the subtypes as separate diagnostic categories, based on the presenting symptom. This was found to not be helpful, since many subtypes overlapped with one another and were thought to decrease the diagnostic validity, according to the American Psychiatric Association. Instead, these types of schizophrenia are now specifiers for the overarching diagnosis, to provide more detail for the clinician.
Types Of Schizophrenia
Although the subtypes don’t exist as separate clinical disorders anymore, they can still be helpful as specifiers and for treatment planning. There are five classical subtypes:
Types Of Schizophrenia: Paranoid Schizophrenia
Paranoid schizophrenia used to be the most common form of schizophrenia. In 2013, the American Psychiatric Association determined that paranoia was a positive symptom of the disorder, so paranoid schizophrenia wasn’t a separate condition. Hence, it was then just changed to schizophrenia. The subtype description is still used though, because of how common it is. Symptoms include:
- Disorganized speech (word salad, echolalia)
- Trouble concentrating
- Behavioral impairment (impulse control, emotional lability)
- Flat affect
Types Of Schizophrenia: Hebephrenic/Disorganized Schizophrenia
Hebephrenic or disorganized schizophrenia is still recognized by the International Statistical Classification of Diseases and Related Health Problems (ICD-10), although it’s been removed from the DSM-5. In this variation of schizophrenia, the individual doesn’t have hallucinations or delusions. Instead, they experience disorganized behavior and speech. This can include:
- Flat affect
- Speech disturbances
- Disorganized thinking
- Inappropriate emotions or facial reactions
- Trouble with daily activities
Types Of Schizophrenia: Undifferentiated Schizophrenia
Undifferentiated schizophrenia was the term used to describe when an individual displayed behaviors that were applicable to more than one type of schizophrenia. For instance, an individual who had catatonic behavior but also had delusions or hallucinations, with word salad, might have been diagnosed with undifferentiated schizophrenia. The new diagnostic criteria, merely signify to the clinician that a variety of symptoms are present.
Types Of Schizophrenia: Residual schizophrenia
This “subtype” is a bit tricky. It’s been used when a person has a previous diagnosis of schizophrenia but no longer has any prominent symptoms of the disorder. The symptoms have generally lessened in intensity. Residual schizophrenia usually includes more “negative” symptoms, such as:
- Flattened affect
- Psychomotor difficulties
- Slowed speech
- Poor hygiene
Many people with schizophrenia go through periods where their symptoms wax and wane and vary in frequency and intensity. Therefore, this designation is rarely used anymore.
Types Of Schizophrenia: Catatonic Schizophrenia
Although catatonic schizophrenia was a subtype in the previous edition of the DSM, it’s been argued in the past that catatonia should be more of a specifier. This is because it occurs in a variety of psychiatric conditions and general medical conditions. It generally presents itself as immobility, but can also look like:
- Mimicking behavior
- A stupor-like condition
Types Of Schizophrenia: Childhood Schizophrenia
Childhood schizophrenia isn’t a subtype but rather used to refer to the time of diagnosis. A diagnosis in children is fairly uncommon. When it does occur, it can be severe. Early-onset schizophrenia typically occurs between the ages of 13 and 18. A diagnosis under the age of 13 is considered very early-onset and is extremely rare.
Symptoms in very young children are similar to those of developmental disorders, such as autism and attention-deficit hyperactivity disorder (ADHD). These symptoms can include:
- Language delays
- Late or unusual crawling or walking
- Abnormal motor movements
It’s important to rule out developmental issues when considering a very early-onset schizophrenia diagnosis.
Symptoms in older children and teens include:
- Social withdrawal
- Sleep disruptions
- Impaired school performance
- Odd behavior
- Substance use
Younger individuals are less likely to have delusions, but they’re more likely to have hallucinations. As teens get older, more typical symptoms of schizophrenia, like those in adults usually emerge. It’s important to have a knowledgeable professional make a diagnosis of childhood schizophrenia because it’s so rare. It’s crucial to rule out any other condition, including substance use or an organic medical issue.
Treatment should be headed by a child psychiatrist with experience in childhood schizophrenia. It usually involves a combination of treatments such as:
- Skills training
- Hospitalization, if necessary
Types Of Schizophrenia: Conditions Related To Schizophrenia
Schizoaffective disorder is a separate and different condition from schizophrenia, but sometimes gets lumped in with it. This disorder has elements of both schizophrenia and mood disorders. Psychosis, which involves a loss of contact with reality, is often a component. Mood disorders can include either mania or depression.
Schizoaffective disorder is further classified into subtypes based on whether a person has only depressive episodes, or whether they also have manic episodes with or without depression. Symptoms can include:
- Paranoid thoughts
- Delusions or hallucinations
- Trouble concentrating
- Hyperactivity or mania
- Poor personal hygiene
- Appetite disturbance
- Sleep disruptions
- Social withdrawal
- Disorganized thinking or behavior
Diagnosis is typically made through a thorough physical exam, interview, and psychiatric evaluation. It’s important to rule out any medical conditions or any other mental illnesses like bipolar disorder. Treatments include:
- Group or individual therapy
- Practical life skills training
Other related conditions
Other related conditions to schizophrenia include:
- Delusional disorder
- Brief psychotic disorder
- Schizophreniform disorder
You can also experience psychosis with a number of health conditions.
Reclaim Your Life From Different Types of Schizophrenia
Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. This should not be taken lightly. We Level Up California can provide you, or someone you love, treatment with professional and safe care. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information about the different types of schizophrenia. Our specialists know what you are going through. Please know that each call is private and confidential.
 National Institute of Mental Health (www.nimh.nih.gov)