The symptoms that people experience during schizophrenia can vary depending on the subtype of the illness. There are 5 types of schizophrenia as recognized by the DSM (Diagnostic & Statistical Manual of Mental Disorders) and although many have similar general symptoms, there are various features that can distinguish one subtype from the others. A diagnosis of schizophrenia is made in accordance to the most significant and/or dominant symptoms that a person experiences.
5 Different Types of Schizophrenia
This is widely regarded as the most common type of schizophrenia. Among individuals with the paranoid-type, they commonly experience delusions and hallucinations in the form of “voices.” The delusions may involve the fact that other people are conspiring against them and or plotting their demise. They may hear voices that say mean things, curse them, and make life difficult.
In this particular subtype, individuals tend to respond very well to treatment with an antipsychotic medication. Despite the symptoms that are experienced, the people with this subtype may not appear to act bizarre or out of the ordinary – they may seem pretty normal.
People with paranoid-type tend to live pretty normal lives once their symptoms are treated. They do not experience the cognitive decline to the degree of the other subtypes and tend to be higher functioning. In general, individuals with this subtype tend to have a good prognosis as long as they take time to properly treat their symptoms.
A. Preoccupation with one or more delusions or frequent auditory hallucinations.
B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.
In this particular subtype, the dominant symptoms revolve around disorganization. The person will experience disorganized behavior, speech, and thinking. In other words, they will act odd, make no sense when they talk, and their thinking will be highly unfocused, nonsensical, and completely random. Individuals with this subtype tend to have difficulties performing basic tasks that are part of daily living.
They may neglect their personal hygiene and not understand that they need to take care of themselves. In many cases there is also an emotional impairment in the person in which they exhibit odd emotional responses. For example, the person may laugh or smile in a very serious situation. In other words, the emotion that they show and/or express doesn’t usually fit the given situation.
It is pretty easy to tell when someone has the disorganized subtype. They may have a disheveled appearance, behave oddly, and speak in such a disorganized manner that it makes almost no sense to the listener. They may jump topics mid-sentence or every other sentence leading to completely nonsensical speech.
This particular subtype tends to have an early onset between the ages of 15 and 25 and is often referred to as “hebephrenia” which means “during adolescence.” Unfortunately the prognosis for this subtype is pretty poor compared to some of the others.
- Disorganized behavior
- Disorganized speech
- Disorganized thinking
- Odd/bizarre behavior
A. All of the following are prominent:
(1) disorganized speech
(2) disorganized behavior
(3) flat or inappropriate affect
B. The criteria are not met for Catatonic Type.
In this subtype, the symptoms involve motor disturbances, disturbances in movement, and “catatonia.” Usually individuals with this subtype will experience a major reduction in overall activity to the point that they stop moving, and may appear “frozen.” This frozen state with a complete lack of movement is called a “catatonic stupor.” They also may significantly increase movement and appear to be hyperactive – this is known as “catatonic excitement.”
In other words, individuals jump back and forth between purposeless excitement and a major stupor. Individuals may also experience other movement disturbances such as engaging in stereotypies – or ritualistic, repetitive movements such as body rocking. When the individual is in an excited state, they do not engage in any sort of productive activity. During the state of catatonic stupor, the person may appear completely immobile and highly resistant to people that try to help them move.
They may stay stuck in one position for hours at a time. This subtype is also characterized by the symptom of “waxy flexibility” in which another person may move the person’s arm and they hold it locked in the position that it was moved into. In other words, they can be molded like a “wax” figure. Other patients exhibit a strong “rigidity” (i.e. negativism) to the point that it is impossible to move any of their limbs. It is also common to witness echolalia and echopraxia – mimicking speech and movements of other people.
When diagnosing this subtype, it is important to distinguish it from the disorganized-type. Additionally it is important to make sure that the individual is not suffering from neuroleptic malignant syndrome or tardive dyskinesia – which can result in similar behaviors.
- Catatonic stupor
- Echolalia and/or echopraxia
- Excessive motor activity
A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:
(1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
(2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
(3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
(4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
(5) echolalia or echopraxia
The undifferentiated subtype is diagnosed when individuals exhibit general symptoms of schizophrenia, but do not meet specific diagnostic criteria for another subtype. Individuals with the undifferentiated subtypes may have symptoms that fall into multiple categories of other subtypes. For example, a person may have disorganized thinking, paranoia, hallucinations, low energy, and cognitive deficits.
Sometimes people that are diagnosed with the undifferentiated subtype have symptoms that fluctuate over a period of time. For example, they may experience symptoms that fit the paranoid subtype for awhile, then they may experience symptoms that better fit the disorganized subtype for a period of time. When the set of symptoms is difficult to classify, “undifferentiated” is typically diagnosed.
Some have used the term “mixed clinical syndrome” to describe this diagnosis because there is essentially a “mix” of symptoms.
- General schizophrenia symptoms
- Mixed symptoms
- Non-specific symptoms
A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.
This subtype is diagnosed when a person with schizophrenia has gone for an extended period of time without any symptoms. In other words, the patient has been in remission and symptom free for up to a full year (12 months). In cases of residual schizophrenia, the symptoms may be completely non-existent or have lessened in severity to the point that they do not interfere with the daily functioning of the individual.
A person with residual schizophrenia may still have hallucinations, delusions, or other unusual behaviors, but they do not have as profound of affect as they did when the patient was initially diagnosed. A person with any given subtype can be diagnosed as having “residual” schizophrenia as long as they are symptom-free or have low-grade symptoms for an extended period of time.
With the residual subtype, some people feel completely recovered from their condition once it is properly treated. In order to make sure that the symptoms stay in remission, it is important to make sure that the individual continues treatment, therapy, and makes healthy lifestyle choices. Most people experience a relapse of symptoms every once in awhile. This subtype is characterized by a “waxing” and “waning” of schizophrenic symptoms.
During the “waxing” phase, symptoms increase in intensity, and during the “waning” phase, they decrease and may become non-existent. Most people will have some hospitalizations with this subtype, but their overall prognosis with this subtype is pretty good. Individuals with the residual type can be productive members of society while their illness is in the “waning” phase.
- Absence of symptoms for a period of time
- At least one episode of psychosis
- Waxing and waning of symptoms
A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).