The faces of schizophrenia are many — defined by predominant features unique to you.
Schizophrenia is a mental disorder that typically develops in adolescence or early adulthood and continues to progress over time.
Not everyone’s experience of schizophrenia is the same, however.
Living with schizophrenia may mean having prominent delusions or auditory hallucinations. It may mean you primarily meet challenges with disorganized speech and behavior.
For some people, living with schizophrenia may mostly be a lack of emotional expression and social withdrawal.
In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision, (DSM-5-TR), schizophrenia is identified by the presence of 5 main symptoms of psychosis:
- disorganized thinking
- disorganized or catatonic behavior
- loss of functionality, known as “negative symptoms”
For diagnosis, two or more of these symptoms must be present, one of which must be hallucinations, delusions, or disorganized thinking.
While each experience of schizophrenia may be different, auditory hallucinations are the most common symptom, though as many as 60% of people may experience clinically significant negative symptoms, as well.
Positive vs. negative symptoms
Schizophrenia symptoms are divided into two categories:
Positive: Symptoms that add to existing function (hallucinations, delusions, disorganized thoughts/behavior).
Negative: Symptoms that create a loss of function (blunted affect, lack of motivation, limited ability to feel pleasure, reduction in speech, or lack of interest in social interactions)
Other possible signs of schizophrenia
Schizophrenia is a progressive condition. At its start, symptoms may not be recognizable as fully developed hallucinations, delusions, or disorganized thoughts.
This period is known as the prodromal phase, when symptoms are mild and beginning to emerge.
Common early symptoms of schizophrenia include:
- loss of concentration
- drop in school/work performance
- social withdrawal
- increased suspicion or paranoia
- changes in interests/habits
- lack of personal hygiene
Advanced schizophrenia may also feature symptoms beyond the primary 5 required for diagnosis.
What is catatonic schizophrenia?
Catatonic schizophrenia is an informal name for schizophrenia with dominant features of catatonia.
In the current version of the DSM-5-TR, catatonia is a specifier for a schizophrenia diagnosis — an indicator that 3 or more catatonia symptoms are dominant in the clinical setting.
Catatonia symptoms include:
- waxy flexibility
- agitation without external stimuli
Catatonic schizophrenia is still a recognized condition, though its official name in the DSM-5-TR is “schizophrenia with catatonia.
What is catatonia?
Catatonia is psychomotor condition that effects your ability to move. In most people, it presents as a loss of motor function that slows movement, creating a state of immobility and communication loss.
In some cases, catatonia can present with the opposite effect. This form of the condition,
While catatonia was once divided into two subtypes, it’s now believed to be a singular condition that occurs on a spectrum, across many disorders.
Subtypes of schizophrenia are no longer recognized in the DSM-5-TR. The American Psychological Association (APA) determined too much symptom overlap existed between types, creating challenges with accurate diagnosing.
Specifiers for schizophrenia were added, instead, to address variations in schizophrenia presentation.
In early versions of the manual, 5 subtypes existed:
- paranoid type
- disorganized type
- catatonic type
- undifferentiated type
- residual type
Catatonic type schizophrenia terminology has changed the least in the DSM-5-TR, but 4 other subtypes once existed, as well.
The other 4 subtypes of schizophrenia
Paranoid-type schizophrenia features a preoccupation with one or more delusions or regular auditory hallucinations.
Disorganized speech and catatonia are not prominent if you were to be given this diagnosis.
Because these are still some of the most common symptoms seen in schizophrenia, the term “paranoid schizophrenia” is still regularly used to specify this set of symptoms.
In the disorganized type of schizophrenia, also known as hebephrenic schizophrenia, catatonia requirements are not met, and the main diagnostic symptoms present are:
- disorganized behavior
- disorganized speech
- flat or inappropriate affect
What is flat affect?
Flat affect is used to describe the absence of emotional expression such as smiling, crying, laughing, or changes in vocal tonality.
Undifferentiated type schizophrenia describes schizophrenia that meets the criteria for multiple subtypes or does not have any dominant features of paranoid, disorganized, or catatonia types.
In the current DSM-5-TR, this type of schizophrenia may warrant an “unspecified” specifier.
The absence of prominent delusions, hallucinations, disorganized speech, and disorganized or catatonic behavior is the first part of the criteria for residual type schizophrenia.
The second part is the on-going presence of negative symptoms or mild forms of at least 2 of the primary positive symptoms in the diagnostic criteria.
Under current DSM-5-TR guidelines, the residual type may now be defined with specifiers related to episode frequency and symptom remission.
While the faces of schizophrenia are still many, the latest DSM criteria acknowledges symptoms are rarely able to be lumped into subtypes, and that severity and frequency varies from individual to individual.
The current DSM-5-TR diagnosis requirements for schizophrenia are:
The presence of 2 or more of the following symptoms, each present for a significant portion of time during one month (less if undergoing treatment):
- disorganized thoughts
- severely disorganized or catatonic behavior
- negative symptoms
At least one of the present symptoms must be hallucinations, delusions, or disorganized thoughts.
Additional criteria that must be met:
- Symptoms have a significantly negative impact on major areas of functioning, such as work, self-care, or interpersonal relations.
- Symptoms persist for a period of at least six months, with at least one month of symptoms that meet the initial criteria.
- No other mental health disorders account for symptoms.
- Symptoms can’t be attributed to substance use.
- A history of childhood communication disorder is independent of the schizophrenia diagnosis.
After one year of living with schizophrenia, your symptoms may dictate the addition of a specifier to the diagnosis.
Schizophrenia specifiers include:
- first episode, currently in acute episode
- first episode, currently in partial remission
- first episode, currently in full remission
- multiple episodes, currently in acute episode
- multiple episodes, currently in partial remission
- continuous (symptoms are on-going with minimal severity change)
- with catatonia
Severity of a schizophrenia diagnosis will also be determined using a 5-point scale to rank the primary symptoms over the most recent 7-day period.
A score of 0 indicates symptoms are not present, while a score of 4 denotes a symptom is present and severe.
The exact cause of schizophrenia is unknown, but multiple factors may increase risk, including:
- fetal malnutrition
- fetal virus exposure
- autoimmune disorders
- brain chemistry imbalances
- substance use
Schizophrenia is a lifelong condition, but treatment can help manage symptoms and lower the chances this disorder will severely interrupt your life.
The use of antipsychotic medications to control symptoms is frequently paired with a multifaceted therapy approach known as coordinated specialty care (CSC).
CSC introduces psychotherapy approaches and medication use as well as case management resources, employment support, family education, and collective decision-making.
With CSC, you work with your entire team of healthcare professionals and life skill coaches to develop habits, behaviors, and support systems to help you thrive.
If circumstances put you at a high risk for homelessness or hospitalization, assertive community treatment (ACT) programs are community-based initiatives that can put you in touch with the professionals you may need.
The faces of schizophrenia are as individual as the people who live with this condition, and that variety is why current diagnostic criteria has become more inclusive.
While subtypes are no longer recognized in the DSM-5-TR, experiencing one symptom more than others can still indicate a specific face of schizophrenia.
If you or a loved one is living with schizophrenia and needs support or access to resources, help is always available by calling the SAMHSA National Helpline at 1-800-662-4357.