Disorganized schizophrenia (also called “hebephrenia”) is one of the 5 main types of schizophrenia. It is characterized by symptoms of extreme disorganization and typically develops between 15 and 25 years of age. The term “hebephrenia” is Greek for “adolescence” and refers to the fact that this subtype of schizophrenia typically has an adolescent onset. Primary symptoms experienced by individuals with this particular type include: disorganized behavior, disorganized speech, and inappropriate or flat affect.
Unlike paranoid schizophrenia, the common symptoms of this particular subtype do not include delusions and hallucinations. People with disorganized schizophrenia may experience more cognitive symptoms as well as negative symptoms in comparison to positive symptoms. The disorganized type of the illness can make life extremely difficult for a person to carry out daily activities and be a productive member of society. If left untreated, the disorganized symptoms may lead to major functional impairments.
Disorganized Schizophrenia Symptoms
Once a psychiatrist has concluded that a person is suffering from schizophrenia, it is important that they distinguish the subtype. This subtype is distinguished based on the set of symptoms that the person experiences. Below are a list of common symptoms that a person with the disorganized subtype may experience.
Since many symptoms have overlap with catatonic schizophrenia – catatonia should be ruled out before the disorganized subtype can be diagnosed. The main difference between the disorganized subtype and other types is that there appears to be a lot of bizarre, odd behavior that appears totally aimless – the person’s speech also will not make sense.
- Active behavior: The person may become very active, but the behavior that they engage in has no focus or purpose. In other words, the behavior is considered non-constructive. For example, the person may walk around the house, move a chair to the side, grab a piece of paper, and start writing a note about frogs. The behavior when active is completely unpredictable and isn’t productive, just random.
- Anhedonia: This symptom involves a general lack of pleasure for the person with schizophrenia. They may find that no activity, person, or hobby brings them any sort of pleasure. This contributes to an apathetic state. The person doesn’t know what to do or what sort of activities to engage in because nothing is enjoyable.
- Avolition: This is a common symptom for this subtype to experience and involves a lack of motivation. The lack of motivation is so significant that the person may want to complete a certain task, but doesn’t have a single ounce of motivation within to complete the actual task. When avolition is strong, the person may not get anything done during the day.
- Disorganized thinking: The person is unable to think clearly and is unable to connect their thoughts to form organized speech. In other words, they experience nonsensical thought patterns which keep them from staying on track during conversations. During a conversation, the individual may change topics every sentence. The speech problem may become so disorganized that other people aren’t able to make any sense of what they say. In some cases, their speech may be heard as a bunch of jumbled up sounds. It should be noted that the person may make up words. Written forms of communication are also disorganized.
- Formal thought disorder (FTD): This refers to the highly disorganized thinking that the person with this subtype of schizophrenia experiences. This is evidenced by very disorganized speech and other behavior. They may also experience poverty of speech, perseveration, neologisms, and in some cases, thought blocking.
- Disorganized speech: The person may engage in speech that makes no sense. They may start a conversation and end up rambling random phrases that don’t fit well together. Their sentences and words may end up being totally random and make no sense to the person to whom they are talking. There is no connection or coherency in their sentences and train of thought.
- Flat affect: This refers to the fact that the individual may not be able to show or experience any emotion. They may have a completely “blunted” or “flat” disposition because the negative symptoms are so strong that the person is unable to experience emotion. This is essentially an emotionless state of functioning. The individual may talk in a monotone and appear very apathetic. They may make no eye contact with other people and have a blank, expressionless face.
- Grossly disorganized behavior: The behavior of someone with disorganized schizophrenia may be so grossly disorganized that it interferes with their ability to perform basic tasks and take care of themselves. They may become so disorganized that it interferes with their personal hygiene and self-care. For example, they may not shower or eat for extended periods of time. The behavior may also appear very odd. For example, during a cold day, the person may dress for the beach and put on a swimsuit. This behavior may feel normal to the individual with schizophrenia, but appear highly odd/bizarre to other people. Behaviors can be childish and silly, but may become aggressive or violent in certain circumstances.
- Inappropriate emotion: Some people with this subtype show no emotion, but others show inappropriate emotion. For example the person may smile, laugh, or grimace at a funeral. This emotion clearly doesn’t reflect the given set of circumstances. The person doesn’t exhibit appropriate emotional responses.
- Inappropriate facial responses: The individual may make inappropriate facial responses during conversations or just in general. They may make a silly face or laugh inappropriately. An example of inappropriate laughter would be if something unfortunate happened to someone, they heard it, and started laughing.
- Grimacing: The person may grimace at the corners of the mouth using the facial muscles. This is a common facial expression made by individuals with schizophrenia.
Note: It should be noted that sometimes people with the disorganized subtype may experience fragmentary hallucinations and delusions, but these are not as profound as in the paranoid subtype. Additionally, they may socially isolate themselves, have many other cognitive symptoms, and appear “clumsy” or “uncoordinated” to others.
Disorganized Schizophrenia Causes
Currently researchers do not know what causes schizophrenia or contributes to any of the subtypes. Each subtype has a specific set of symptoms and although there are various hypotheses as to what may occur during the disorganized subtype, the exact cause is unknown. When asked what causes this mental illness most professionals reply with genetics and environment – well this is quite obvious.
There is a need for more specificity when it comes to determining what causes mental illness – especially schizophrenia. In other types of schizophrenia, glutamate and dopamine are thought to play a role in the symptoms. In this particular subtype, it is thought that brain degeneration, circuitry dysfunction, and inappropriate levels of various neurotransmitters all can contribute to symptoms.
Some also hypothesize that a traumatic experience which results in “traumatic insanity” can lead to this condition. Most people with the disorganized subtype notice a slow cognitive decline as the onset typically appears before the age of 25.
Disorganized Schizophrenia Treatment
Unfortunately treatment for disorganized schizophrenia is more difficult than most of the other subtypes. Most professionals agree that since the onset of “hebephrenia” typically occurs between age 15 and 25, the prognosis for the person diagnosed is considered poor. The person may experience overwhelming negative symptoms and an overall decline in social skills as a result of isolation.
Treatment for this particular subtype is pretty much the same as for those with other subtypes: antipsychotics, therapy, and other medication (if necessary). Since this particular type of schizophrenia tends to experience more negative symptoms, treatment should be adjusted to fit the symptoms of the patient.
- Antipsychotics: Individuals are typically prescribed atypical antipsychotics as a first line of treatment. This can help alleviate some of the symptoms, but in the disorganized subtype, it medications may not be as effective as they would in treating other subtypes. If the patient doesn’t respond well to an atypical antipsychotic, a psychiatrist may adjust the medication and prescribe an older “typical” antipsychotic – these tend to carry a few more side effects. However, some argue that the “typical” class tends to treat negative symptoms better. Usually a psychiatrist will try a medication like Clozapine as a second-line option if the initial medication is ineffective.
- Electroconvulsive Therapy (ECT): If the individual isn’t responding well to medication, they may undergo electroconvulsive therapy. This involves a series of electrical shocks to the brain which induces a controlled seizure. This is thought to help reset the brain temporarily and provide relief from symptoms. It is thought that ECT may help temporarily by shifting brain activity and changing levels of neurotransmitters. Some question the effectiveness of this treatment option.
- Natural treatments: There are some natural remedies for schizophrenia that can effectively help address symptoms. These are not cures, but some work very well when used in conjunction with an antipsychotic medication. Most people with severe or treatment-resistant disorganized schizophrenia may want to consider adding a natural option to their existing treatment as an augmentation strategy.
- Psychotherapy: If the individual with disorganized schizophrenia is able to function well enough to attend therapy, this could be very beneficial. Not only will the person be getting social interaction, they will be taught how to cope with some of their symptoms. This can help reduce stress and improve future outcomes in certain people with this subtype.
- Vocational skills training: In cases where the illness isn’t as severe, the person may be able to attend skills training. This may help them learn how to perform basic societal functions such as: take care of themselves, engage in productive activities, and in some cases, hold down a job. If the person’s medication works well enough to reduce symptoms, it is not unrealistic for the person to get a job or be productive.
Note: In cases of refractory disorganized schizophrenia, many treatments may be ineffective. This is why it is important to keep raising awareness so that researchers continue to work towards a cure. This illness is extremely debilitating and in some cases, individuals with it are nearly helpless victims to the symptoms that they experience.