Are Schizophrenia Subtypes Still Used Today?
As our understanding of mental illnesses evolves, so do our ways of talking about them. Schizophrenia, which is a disorder that can cause changes in thoughts and behavior, can serve as one example. This mental illness used to be broken into different “subtypes” based on symptoms, but the umbrella term “schizophrenia spectrum disorder” is now used. Often, schizophrenia can be effectively treated with medication and therapy.
What is schizophrenia?
Schizophrenia is a severe mental illness that usually affects how people perceive reality. It can also impact the ways people think, feel, and behave. The World Health Organization estimates that schizophrenia affects around 0.45% of adults worldwide. We still don’t know exactly what causes it. However, schizophrenia is likely the result of a person’s environment, genes, and life experiences.
Symptoms of schizophrenia usually start during the early adult years, between the ages of 18 and 30. These symptoms can be either “positive” or “negative.” Positive symptoms of schizophrenia can be seen as behaviors and thoughts that are added to a person’s experience. These may include the following:
- Hallucinations: Seeing, hearing, or feeling things that aren’t really there
- Delusions: Believing things that are false or impossible, even when shown proof that they aren’t true
- Disorganized thoughts: Thoughts that are confused, hazy, or illogical
- Disorganized speech: Talking in ways that other people can’t understand
On the flip side, negative symptoms of schizophrenia can be defined as behaviors and thoughts that are taken away from a person’s experience. Some examples include those listed below:
- Not being able to feel pleasure
- Loss of motivation to do tasks like bathing and paying bills
- Loss of interest in socializing, even with friends and family
- A lack of facial expressions or other displays of emotion
These symptoms and others can make it hard for people with schizophrenia to function in daily life. Because people with schizophrenia often aren’t aware they have a mental illness, this can also make it harder for them to get the care they deserve.
Understanding the schizophrenia subtypes
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a guide published by the American Psychiatric Association. It outlines different mental illnesses and their diagnostic criteria. Earlier versions of the DSM included separate listings for different types of schizophrenia, each with its own symptoms.
Paranoid schizophrenia: This type of schizophrenia centered mainly on delusions, paranoia, and the suspicion of others. The criteria included the following:
- Being fixated on one or more delusions, or having frequent auditory hallucinations
- Having less intense or nonexistent symptoms related to speech, behavior, and emotional expression
Catatonic schizophrenia: This type of schizophrenia centered mainly on symptoms related to movement. To meet the criteria, a person needed to show at least two of the following symptoms:
- Excessive movement or lack of movement
- Unwillingness to speak, move, or be moved
- Unusual movements or facial expressions
- Repetition of other people’s words or actions
Disorganized schizophrenia: This type of schizophrenia centered mainly on disorganized thoughts and speech. It required a patient to have:
- Disorganized speech
- Disorganized behavior (unusual or inappropriate behavior)
- A lack of emotional expression
Residual schizophrenia: This term was used when someone wasn’t currently experiencing intense positive symptoms but was still having some symptoms. These could be negative symptoms or less obvious positive ones. For example, a person might have unusual beliefs rather than full-on delusions.
Undifferentiated schizophrenia: This type of schizophrenia was typically diagnosed in people whose symptoms didn’t fit any of the other subtypes.
There were a few problems with these subtype definitions, though. For one thing, not everyone with schizophrenia has symptoms that fit neatly into one category. People can have some symptoms of one subtype and some symptoms of another.
For example, someone might have intense hallucinations, but without paranoid, disorganized, or catatonic behavior. Even though the term “undifferentiated schizophrenia” could be used, it could still be hard for doctors to provide a reliable diagnosis. What’s more, none of these subtypes could give doctors a very clear picture of how a person’s symptoms might change with time.
Are schizophrenia subtypes still used?
You may wonder if these subtype definitions are still in use today. Broadly speaking, schizophrenia subtypes are no longer used by mental health professionals.
In the latest version of the DSM, the DSM-V, the listing for schizophrenia has been updated. The different subtypes have been dropped and replaced by a single, broader diagnosis: the schizophrenia spectrum. This is because schizophrenia can be seen as a disorder that exists on a “spectrum,” much like autism spectrum disorder (ASD). Using a broader definition can give a better picture of the different ways schizophrenia can affect people. It may also allow other disorders, like brief psychotic disorder, to be included under the same umbrella.
Getting help for schizophrenia symptoms
Even though experts talk about it differently now, schizophrenia can still have significant effects. No matter what type of symptoms you experience, living with schizophrenia can be challenging. However, many treatments exist that may make it easier. In fact, according to the World Health Organization, at least one in three people with schizophrenia may fully recover from their symptoms with proper treatment.
Medication and therapy are often considered the two main pillars of schizophrenia treatment. Medication, as prescribed by a psychiatrist or doctor, may reduce immediate symptoms, while therapy may support your mental health long-term. A therapist may be able to help you improve your thought patterns, develop healthy coping strategies, and improve your relationships and routines.
However, negative symptoms like low motivation may make it harder to leave the house for therapy appointments. In these cases, online therapy may help, although you may need to seek in-person care for acute psychosis. Internet-based platforms typically let you work with a therapist from your own home. This may make online therapy easier to stick to than in-person therapy if you’re living with schizophrenia.
It can be common for people with schizophrenia to also have anxiety or a mood disorder like depression. Studies have found that online therapy may effectively treat these conditions.
In 2023, researchers analyzed data on over 27,000 patients being treated for mood or anxiety disorders. They found that online therapy normally showed similar effectiveness to in-person treatment, with shorter treatment times.
Takeaway
Schizophrenia is a mental illness that often starts early in life. It can cause various positive symptoms, like hallucinations, as well as negative symptoms, like low motivation. In the past, experts broke schizophrenia into different “subtypes” based on a person’s symptoms. Nowadays, these subtypes are no longer used. They’ve been replaced by a broader term, “schizophrenia spectrum disorder.” This new name can reflect schizophrenia’s wide range of possible symptoms and effects. While schizophrenia can be challenging, it is often treatable. With medication and mental health support, such as online or in-person therapy, it may be possible to reduce or recover from its symptoms.
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