What Are the Different Types of Schizophrenia? - Verywell Health

Schizophrenia is a chronic mental health condition that interferes with a person's perception of reality. People with schizophrenia have difficulty with emotions, thinking rationally and clearly, and in interactions and relationships with others.

Verywell / Cindy Chung

Until the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, schizophrenia was officially recognized as having five distinct subtypes.

Because the symptoms of these subtypes were not felt to be reliable or consistently valid, the American Psychiatric Association determined that having distinct subtypes hindered diagnosis and removed them when they published the DSM-5.

Although they are no longer used for diagnostic categorization, some mental health professionals still find these subtypes useful for understanding the ways in which schizophrenia can present. This nuanced understanding can help determine the best ways to approach treatment plans.

As we look at the different subtypes of schizophrenia, it is important to keep in mind that the symptoms of these subtypes overlap with other disorders, and that to be diagnosed with schizophrenia, a person must meet the criteria outlined in the DSM-5.

Paranoid Schizophrenia

This schizophrenia subtype is the one most often depicted in the media, and most likely what comes to mind when people think of schizophrenia.

Delusions (fixed, false beliefs that conflict with reality) are a hallmark of paranoid schizophrenia. Hallucinations, particularly auditory ("hearing voices"), are also common.

Paranoid schizophrenia primarily involves positive symptoms, meaning the onset of traits, feelings, or behaviors that were not there before.

Symptoms

Paranoid schizophrenia primarily involves positive symptoms, meaning the onset of traits, feelings, or behaviors that were not there before. These include the following.

The following are typically not present or prominent with paranoid schizophrenia:

• Disorganized speech
• Disorganized or catatonic behavior
• Flat or inappropriate affect

Symptoms Can Come and Go

The symptoms of schizophrenia do not need to be experienced all at once. A person may experience different symptoms at different times.

Hebephrenic Schizophrenia

Also know as disorganized schizophrenia, hebephrenic schizophrenia is marked by disorganized symptoms.

Symptoms

• Disorganized speech
• Disorganized behavior
• Flat or inappropriate affect

In practical terms, this means that people with hebephrenic schizophrenia may:

• Have difficulty with routine tasks like personal hygiene and self-care
• Have emotional reactions that are incongruous or inappropriate to the situation
• Have difficulty communicating
• Misuse words or place them in the wrong order
• Have difficulty thinking clearly and responding appropriately
• Exhibit neologism (the use of nonsense words or making up words)
• Move quickly between thoughts without logical connections
• Forget or misplace things
• Pace or walk in circles
• Have difficulty understanding everyday things
• Give unrelated answers to questions
• Repeat the same things over and over
• Find it difficult to complete tasks or achieve goals
• Lack impulse control
• Not make eye contact
• Exhibit childlike behaviors
• Withdraw socially

Residual Schizophrenia

Residual schizophrenia, as a condition, is different than the residual phase of schizophrenia. The residual phase refers to a time in the course of schizophrenia where symptoms are not as acute. There may still be some negative symptoms (a previous trait or behavior ceasing, or the lack of a trait or behavior that should be there) remaining.

A person with residual schizophrenia does not currently exhibit prominent delusions, hallucinations, disorganized speech, or highly disorganized or catatonic behavior. They do have negative symptoms, and/or two or more diagnostic symptoms of schizophrenia, but in a milder form, such as odd beliefs or unusual perceptual experiences.

Symptoms

• Blunted affect (difficulty expressing emotions, diminished facial expressions and expressive gestures)
• Odd beliefs
• Unusual perceptions
• Social withdrawal 

It's Not All or Nothing

Schizophrenia can overlap with other conditions. People with schizophrenia may also experience other mental health disorders at the same time. Diagnosis and treatment plans need to take all of these conditions into consideration.

Catatonic Schizophrenia

A person with catatonic schizophrenia meets the criteria for a diagnosis of schizophrenia and also exhibits symptoms of catatonia.

Catatonia affects both speech and behavior and is defined by excessive movement (excited catatonia) or decreased movement (retarded catatonia).

Symptoms

• Catalepsy: Muscular rigidity, lack of response to external stimuli
• Waxy flexibility: Limbs remain for an unusually long time in the position they are placed by another
• Stupor: Unresponsiveness to most stimuli
• Excessive motor activity: Apparently purposeless activity not influenced by external stimuli
• Extreme negativism: An apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved
• Mutism: Lack of speech
• Posturing: Voluntary assumption of inappropriate or bizarre postures
• Stereotyped movements: Involuntary, repetitive physical movements such as rocking
• Prominent grimacing: Distorting one's face in an expression, usually of pain, disgust, or disapproval
• Echolalia: Repeating what others say
• Echopraxia: Imitating the movements of others

Undifferentiated Schizophrenia

A person with undifferentiated schizophrenia has symptoms that fit with a diagnosis of schizophrenia but do not give an overall picture of a paranoid type, catatonic type, or disorganized type.

Symptoms

There are no specific symptoms that indicate undifferentiated schizophrenia, but rather a person exhibits a myriad of symptoms that don't meet the full criteria for a particular subtype.

Symptoms of undifferentiated schizophrenia include:

• Delusions
• Hallucinations
• Paranoia
• Exaggerated or distorted perceptions, beliefs, and behaviors
• Unusual or disorganized speech
• Agitation 
• Neglect of personal hygiene  
• Social withdrawal
• Excessive sleeping or a lack of sleep
• Difficulty making plans
• Problems with emotions and emotional expression
• Trouble with logical thinking
• Bizarre behavior
• Abnormal movements

Childhood Schizophrenia

Childhood schizophrenia is not a subtype of schizophrenia, but rather refers to the age of onset.

Related Disorders

Schizoaffective Disorder

Schizoaffective disorder has features of schizophrenia and features of a mood disorder, either major depressive disorder or bipolar disorder.

Symptoms of schizoaffective disorder fall into the following three categories:

• Psychotic
• Depression
• Mania

Delusional Disorder

Delusional disorder is a form of psychosis in which a person has fixed, false beliefs. For example, a person with delusion disorder may believe a celebrity is in love with them, that someone is spying on them or "out to get them," that they have a great talent or importance, or hold other beliefs outside the realm of reality.

Brief Psychotic Disorder

Brief psychotic disorder is an episode of psychotic behavior with a sudden onset. It lasts less than a month. Afterward, the person goes into complete remission. However, it is possible to have another psychotic episode in the future.

Schizophreniform Disorder

With schizophreniform disorder, a person exhibits the symptoms of schizophrenia, but the condition lasts less than six months.

Schizotypal Personality Disorder

Schizotypal personality disorder involves someone having odd beliefs, perceptions, and behavior. They may be suspicious or paranoid of others and have limited relationships.

A Word From Verywell 

Schizophrenia is complex and doesn't present the same way in everyone with the disorder. A diagnosis is personal and unique. While the subtypes of schizophrenia are no longer considered distinct diagnoses, knowing the different ways in which schizophrenia manifests can help you understand schizophrenia and, if necessary, make a personalized treatment plan with a health care provider.

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