Schizophrenia is a chronic mental illness that affects:

  • emotions
  • the ability to think rationally and clearly
  • the ability to interact with and relate to others

According to the National Alliance on Mental Illness (NAMI), schizophrenia affects approximately 1 percent of Americans. It’s typically diagnosed in late adolescence or early 20s for men, and late 20s or early 30s in women.

Episodes of the illness can come and go, similar to an illness in remission. When there’s an “active” period, an individual might experience:

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 subtypes are now specifiers for the overarching diagnosis, to provide more detail for the clinician.

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:

  • paranoid
  • hebephrenic
  • undifferentiated
  • residual
  • catatonic

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:

  • delusions
  • hallucinations
  • disorganized speech (word salad, echolalia)
  • trouble concentrating
  • behavioral impairment (impulse control, emotional lability)
  • flat affect
Did you know?Word salad is a verbal symptom where random words are strung together in no logical order.

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

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.

With the new diagnostic criteria, this merely signifies to the clinician that a variety of symptoms are present.

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.

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
  • mutism
  • a stupor-like condition

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:

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
  • irritability
  • 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:

  • medications
  • therapies
  • skills training
  • hospitalization, if necessary

Schizoaffective disorder

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
  • depression
  • 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:

  • medications
  • 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.

Schizophrenia is a complex condition. Not everyone diagnosed with it will have the same exact symptoms or presentation.

Although subtypes are no longer diagnosed, they’re still used as specifiers to aid in clinical treatment planning. Understanding information about subtypes and schizophrenia in general can also help you in managing your condition.

With an accurate diagnosis, a specialized treatment plan can be created and implemented by your healthcare team.