Hebephrenic Schizophrenia: Features And Symptoms
Schizophrenia is a complex mental illness that can cause a spectrum of diverse symptoms. This condition can impact all areas of functioning, and various labels might be used to describe it, including hebephrenic. Exploring the term hebephrenic schizophrenia may be helpful when learning more about this disorder and its symptoms.
What is schizophrenia?
Considered a complex mental illness, schizophrenia "affects the way a person thinks, feels, and behaves." The National Institute of Mental Health (NIMH) describes it as a "mental disorder characterized by disruptions in thought processes, perceptions, emotional responsiveness, and social interactions." The condition is also referred to as a spectrum of mental disorders that affects how reality is perceived.
Previously, schizophrenia was divided into different subtypes, including hebephrenic schizophrenia, which is also known as disorganized schizophrenia. Primary features of hebephrenic schizophrenia refer to unusual or disorganized behavior, disorganized speech, and inappropriate affect.
While the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) no longer recognizes hebephrenic as a subtype of schizophrenia, clinicians and other healthcare providers may still use the term. Those with schizophrenia may benefit from ongoing treatment throughout their lives, as well as medication, peer support, and therapy to help manage symptoms.
The DSM-5 and the ICD-11
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition by the American Psychiatric Association, combines all the subtypes of schizophrenia into one. In the fourth edition of the Diagnostic and Statistical Manual (DSM-4), schizophrenia was divided into disorganized schizophrenia (hebephrenic schizophrenia), paranoid schizophrenia, residual schizophrenia, undifferentiated schizophrenia, and catatonic schizophrenia. Catatonia is now separated into its own category, with schizophrenia as a specifier.
The latest edition of the International Classification of Diseases (ICD-11) by the World Health Organization (WHO) also no longer lists hebephrenic schizophrenia as a subtype of schizophrenia. In the ICD-10, however, hebephrenic schizophrenia was described as "meeting the generic criteria for schizophrenia" and presenting "signs in the domains of affect, behavior, and thought." Some researchers also contend that clinicians may want to "consider it as a differential diagnosis, particularly in suspected personality disorder."
Features of hebephrenic schizophrenia
According to the American Psychological Association (APA), prominent symptoms of what was called hebephrenic (or disorganized") included:
- Disorganized thinking, speech, and behavior
- Fragmented speech
- Flattened affect (showing little or no emotions)
- Inappropriate affect that doesn't fit the situation
- Extreme social withdrawal
- Unusual mannerisms, such as laughter and grimaces
Notably, however, hebephrenic schizophrenia is not usually associated with hallucinations and delusions. Instead, disorganized speech and unusual behavior tend to be the more telling signs of hebephrenia.
To prevent misdiagnosis and mistreatment, some researchers contend that hebephrenia might be better considered a "differential diagnosis in individuals who present with erratic and challenging behavior, in the relative absence of symptoms such as hallucinations or delusions."
The history of schizophrenia
Dementia praecox (premature dementia) was a diagnostic concept devised by the German physician Emil Kraepelin (1856 to 1926) for what is now referred to as schizophrenia. Some researchers note that Kraepelin described "the symptoms and course that characterize the disease." Kraepelin combined hebephrenia, catatonia, paranoia, and dementia simplex under the term dementia praecox, as he considered that specific symptoms that manifested in adolescence would progress to dementia in these four mental health disorders.
The term schizophrenia was coined by Swiss psychiatrist Eugene Bleuler, who objected to Kraepelin's prognosis model of dementia praecox, prompting a search for "alternative characterizing features that would allow scientific description and classification." Schizophrenia means “split mind” in literal terms, relating to the "breaking up or splitting of psychic functioning" that Bleuler described as characteristic of its central features. Bleuler considered hallucinations and delusions secondary schizophrenia symptoms.
Bleuler is credited for considering social and psychological factors along with the neurological disease process in charting the development of schizophrenia. Some researchers have suggested that he "acknowledged both brain and mind, as well as social factors, as equally important elements in mental health and illness."
Schizophrenia features and symptoms
Each person with schizophrenia may experience different symptoms, but there are several standard features.
According to the National Institute of Mental Health (NIH), most people are diagnosed with schizophrenia between the ages of 16 and 30 following an episode of psychosis. However, gradual changes in thinking, behavior, and social functioning may be apparent much sooner. Schizophrenia may be primarily characterized by psychotic symptoms, negative symptoms, and cognitive features.
Psychotic features include:
- Hallucinations, such as hearing voices
- Delusions, such as believing that a newscaster on TV is sending them secret messages or that they are in imminent danger
- Exhibiting a loss or reduced ability "to initiate plans, speak, express emotion or find pleasure"
- Exhibiting a thought disorder that reflects in speech, behavior, or movements
- Exhibiting a movement disorder, such as repeating body motions that may be considered unusual or abnormal
Other features include positive symptoms, cognitive symptoms, and negative symptoms.
Positive symptoms
The term positive symptoms may also be used, as these relate to the degree to which they distort reality and functioning, as in the case of hallucinations, delusions, and thought disorders.
Cognitive symptoms
Cognitive symptoms relate to challenges with attention, concentration, and memory.
Negative symptoms
Negative symptoms refer to loss of motivation, interest, and enjoyment in activities, social withdrawal, reduced ability to show emotions, and impaired ability to function. For example, negative symptoms may make it difficult for someone to show pleasure in receiving affection or a compliment.
A flattened affect may mean a person speaks in a monotone or dull voice. Challenges with social interactions may make someone withdraw from contact or act awkwardly in situations where they engage with others. Low energy or motivation may translate into little or no interest in activities. In some cases, one may stop talking or moving for a time.
Those with schizophrenia may require ongoing treatment throughout one's life, as well as medication, peer support, and therapy to manage symptoms. Therapy approaches include cognitive-behavioral therapy (CBT) and assertive community treatment (ACT).
Therapy for fostering mental wellness
Reaching out for help can be challenging when you're experiencing difficulties connecting with others. Speaking to a therapist may be helpful, as they can help you manage symptoms and find the support to live your life healthily.
However, if attending in-person sessions is inconvenient, you may want to consider online therapy. Platforms like BetterHelp allow clients to have sessions with a licensed therapist via phone, video, or live chat without physically going to appointments. You can also exchange messages in-app, which may be helpful when you've had a particularly stressful day and would like your therapist to get back to you quickly.
A clinical trial tested the effectiveness of telehealth psychoeducational intervention for people with schizophrenia and their family members. The study's 30 participants with schizophrenia reported having less stress and more social support after undergoing the three-month program.
Takeaway
Hebephrenic schizophrenia, also known as disorganized schizophrenia, was known as a subtype of schizophrenia in the previous edition of the Diagnostic and Statistical Manual of Mental Disorders, the DSM-4. Characterized by disorganized speech and behavior, unusual mannerisms, and inappropriate affect, hebephrenic schizophrenia is no longer listed in the current edition of the Statistical Manual of Mental Disorders.
The term schizophrenia was coined by Swiss psychiatrist Eugene Bleuler, who is credited for considering social and psychological factors along with the neurological disease process in charting the development of the disorder. While each person with schizophrenia may experience different symptoms, there may be some standard features.
It is most common for individuals to be diagnosed by 30, but gradual changes in thinking, behavior, and social functioning may be apparent much sooner. Schizophrenia is primarily characterized by psychotic symptoms, positive and negative symptoms, and cognitive changes. Hebephrenic features, however, do not usually feature delusions or hallucinations, a characteristic that some researchers believe can make a diagnosis more challenging at times.
Those with schizophrenia may benefit from ongoing treatment throughout their life, as well as medication, peer support, and therapy to manage symptoms. If you are experiencing symptoms affecting your well-being, speaking to a therapist may be supportive. If attending in-person sessions presents a challenge, you may consider online therapy, which has been shown to alleviate some symptoms of schizophrenia and stress.
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