What Are the Different Types of Schizophrenia? - Verywell Health

Schizophrenia is no longer diagnosed with subtypes. It's considered a chronic mental health condition that exists on a spectrum. Schizophrenia interferes with a person's perception of reality. People with schizophrenia face emotional difficulties and trouble thinking rationally and clearly. They also have challenges in their relationships with others.

This article will discuss the former schizophrenia subtypes, including why they are no longer used for diagnosis, though can be helpful for providers who treat people living with schizophrenia.

Verywell / Cindy Chung

Why the DSM-5 Eliminated Schizophrenia Types

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:

• Paranoid
• Disorganized/hebephrenic
• Residual
• Catatonic
• Undifferentiated

However, mental health experts said that the symptoms of each subtype were not reliable or consistently valid and got in the way of making a diagnosis. Therefore, the American Psychiatric Association (APA) removed schizophrenia subtypes from the DSM-5.

Although they are no longer used for diagnosis, some mental health providers find schizophrenia subtypes can be helpful when they're deciding on the best treatment for someone with the condition.

DSM-5 Criteria for Schizophrenia

The symptoms of the schizophrenia subtypes overlap with those of other mental health conditions. To be diagnosed with schizophrenia, a person must meet the criteria outlined in the DSM-5.

A person must have two or more of the following symptoms for at least one month (or less if they have been treated), and at least one symptom must be delusions, hallucinations, or disorganized speech:

• Positive symptoms (those abnormally present): Hallucinations, such as hearing voices or seeing things that do not exist; paranoia; and exaggerated or distorted perceptions, beliefs, and behaviors
• Negative symptoms (those abnormally absent): A loss of or a decrease in the ability to initiate plans, speak, express emotion, or find pleasure
• Disorganized symptoms: Confused and disordered thinking and speech, trouble with logical thinking, and sometimes bizarre behavior or abnormal movements

Continuous signs of the disturbance must be present for at least six months. Within that time, at least one month must include the above symptoms (or less if the person has been successfully treated).

A person may also have periods of prodromal or residual symptoms.

• A prodrome is the period of early, mild symptoms before a full-on episode.
• Residual schizophrenia is the phase after a person has had an episode where the symptoms are not totally resolved but are not as intense as they were during the episode. Usually, they only have negative symptoms of schizophrenia or very mild positive symptoms. 

During prodromal or residual periods, a person may only have negative symptoms or could have two or more symptoms listed above in an attenuated form—that is, odd beliefs or unusual perceptual experiences.

A person must also show a decreased level of functioning in daily life, such as doing self-care, managing their relationships, or working. During this phase, people may start to withdraw socially, lose interest in their usual activities, or struggle with personal hygiene.

Schizoaffective disorder and depressive or bipolar disorder with psychotic features have to be ruled out before a diagnosis of schizophrenia can be made.

Paranoid Schizophrenia

This schizophrenia subtype is the one that often comes to mind when people think of schizophrenia. It is also the type that is most often depicted in the media and popular culture.

Fixed, false beliefs that conflict with reality (delusions ) are a hallmark of paranoid schizophrenia. Hallucinations, particularly hearing voices (auditory hallucinations), are also common.

Symptoms

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

Positive symptoms of schizophrenia include the following:

In paranoid schizophrenia, the following symptoms are not typically present (or if they are, they are not prominent):

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

Symptoms Can Come and Go

The symptoms of schizophrenia may not be experienced all at once. A person living with the illness may experience different symptoms at different times.

Disorganized (Hebephrenic) Schizophrenia

Disorganized schizophrenia is also called hebephrenic schizophrenia. This subtype of schizophrenia is characterized by symptoms that interrupt a person's thinking and communication (disorganized symptoms).

Symptoms

People with this schizophrenia subtype may have the following symptoms:

• Disorganized speech
• Disorganized behavior
• Flat or inappropriate affect

Here are some common challenges that people with hebephrenic schizophrenia may face:

• Difficulty with routine tasks like personal hygiene and self-care
• Reacting emotionally in ways that are incongruous or inappropriate to the situation
• Trouble with communication
• Misusing words or placing them in the wrong order
• Difficulty thinking clearly and responding appropriately
• Speaking in neologisms (the use of nonsense words or making up words)
• Moving quickly between thoughts without logical connections
• Forgetting or misplacing items
• Pacing or walking in circles
• Difficulty understanding everyday things
• Giving unrelated answers to questions
• Repeating phrases or words
• Trouble with completing tasks or meeting goals
• Challenges with impulse control
• Failing to make eye contact
• Showing childlike behaviors
• Withdrawing socially

Residual Schizophrenia

Residual schizophrenia is not the same as the residual phase of schizophrenia. The residual phase of schizophrenia is a period when a person's symptoms are not as intense. However, they may still have negative symptoms—for example, a previous trait or behavior stops, or there's a lack of a trait or behavior that would normally be present.

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

Symptoms

Symptoms of residual schizophrenia can include:

• Blunted affect (e.g., trouble expressing emotions, diminished facial expressions or expressive gestures)
• Odd beliefs
• Unusual perceptions
• Social withdrawal 

Other Conditions

People with schizophrenia can also have other mental health disorders at the same time (co-occurring or co-morbid conditions), including depression and substance use disorders.

Catatonic Schizophrenia

A person with catatonic schizophrenia meets the criteria for a diagnosis of schizophrenia and also has symptoms of catatonia. Catatonia involves excessive movement (excited catatonia) or decreased movement (retarded catatonia) that affects both speech and behavior.

Symptoms

Catatonic schizophrenia symptoms may include the following:

• 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 (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 the 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 a diagnosis of schizophrenia but do not completely fit with the paranoid type, catatonic type, or disorganized type.

Symptoms

There are no specific symptoms that indicate undifferentiated schizophrenia. Instead, a person shows many symptoms that do not meet the full criteria for a particular subtype.

The symptoms of undifferentiated schizophrenia may 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. This term refers to the age of onset of schizophrenia, not a separate diagnosis.

Schizophrenia Spectrum Disorders

There are other disorders on the schizophrenia spectrum, along with schizophrenia. The conditions are listed in the DSM-5-TR as "schizophrenia spectrum and other psychotic disorders."

Schizophrenia spectrum disorders include:

• Schizoaffective disorder
• Delusional disorder
• Brief psychotic disorder
• Schizophreniform disorder
• Schizoaffective disorder

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," or that they have a great talent or importance. They may also hold other beliefs that are outside the realm of reality.

Brief Psychotic Disorder

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

A brief psychotic episode is characterized by the sudden onset of delusions, hallucinations, and disorganized speech. The symptoms are are often triggered by stress and only last a few days. For example, a person who witnesses a traumatic event may have hallucinations or delusions temporarily in response to the severe stress of what they experienced.

Schizophreniform Disorder

With schizophreniform disorder, a person has symptoms of schizophrenia that last less than six months.

Schizotypal Personality Disorder

Schizotypal personality disorder involves having odd beliefs, perceptions, and behaviors. A person with schizotypical personality disorder can be suspicious or paranoid of others and often has limited relationships.

Summary

Paranoid, disorganized/hebephrenic, residual, catatonic, and undifferentiated schizophrenia are no longer diagnoses in the DSM-5.

However, since the subtypes can show the different ways that schizophrenia spectrum disorders can be experienced, some providers find it useful to talk about them when they're working with patients.

Today, schizophrenia is considered a spectrum disorder that includes schizoaffective disorder, delusional disorder, brief psychotic disorder, schizophreniform disorder, and schizoaffective disorder.

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