Conditions Under the Schizophrenia Spectrum
Alongside the different types of schizophrenia, there are conditions that fall under the schizophrenia spectrum. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, or the DSM-5 classifies these as disorders in the schizophrenia spectrum:
- Schizophrenia
- Schizotypal personality disorder
- Delusional disorder
- Brief psychotic disorder
- Schizophreniform disorder
- Schizoaffective disorder
- Catatonia
- Other schizophrenia spectrum disorders
Signs of Schizophrenia
People with schizophrenia usually first exhibit schizophrenic symptoms in their late teens to early 20s. It’s rare for very young children or people older than age 40 to be diagnosed with the disorder or first see their symptoms at those ages.
“Schizophrenia is a disorder that’s been characterized with extreme traits. While this could be true, the signs of schizophrenia and the severity of these signs can vary from person to person. Many can struggle with auditory/visual hallucinations, delusions, and confused thoughts. It’s important to note that not all of these signs may be present. Oftentimes, it could be a small change in behavior and thoughts.”
— Minkyung Chung, Licensed Mental Health Counselor (LMHC), MS
Signs of schizophrenia include:
- Hallucinations
- Delusions
- Grandiose ideas
- Becoming overly excited for no reason
- Memory problems
- Lack of emotional expression
- Confused thoughts and disorganized thinking
- Extreme changes in thoughts and behavior
- Negative symptoms like withdrawal and isolation — this includes withdrawing from friends, family, and activities that were once enjoyable
Symptoms of Schizophrenia
Mental health professionals categorize symptoms of schizophrenia into two arenas — positive and negative symptoms.
Positive symptoms
Positive schizophrenic symptoms are loosely defined as changes in thoughts or behaviors. These are new thoughts, like suddenly believing that people on television are listening to what you’re thinking, that the FBI is out to get you, or that someone is following you.
Hallucinations
Hallucinations can be either visual (seeing things that aren’t there), auditory (hearing voices that aren’t real), or both. For someone with psychosis from schizophrenia, hallucinations seem very real. They often have difficulty telling them apart from actual experiences. Understandably, hallucinations can be frightening and disorienting for the person experiencing them.
Delusions
Delusions (false beliefs that aren’t based in any sort of reality) are when someone with psychosis from schizophrenia believes things that aren’t real are actually happening. For example, some delusions include believing they’re an important political figure, that a movie star they haven’t met is in love with them, or that a major catastrophe is about to occur.
They can also include things like paranoid delusions, where someone believes their private thoughts are being broadcasted, someone is spying on them, someone is out to get them, or there are special messages specifically for them in ordinary items. Delusions can begin suddenly, or they can gradually develop over weeks or months.
Confused thoughts and disorganized thinking
A type of cognitive symptom, schizophrenia can cause what people describe as confused thoughts, like a haze being cast over their thinking. They might even believe that someone is stealing their thoughts. A sign of this positive symptom is being unable to follow the plot of a television show or the main point of a newspaper article.
Behavior and thought changes
People with schizophrenia often have confused, disorganized speech. This means that when they talk, they don’t make much or any sense. In addition, they may behave in bizarre or unusual ways, like making sudden faces, striking unnatural poses, or becoming very silly or extremely agitated for no reason.
Negative symptoms
Negative symptoms, unlike positive symptoms, are actions and thoughts that should be present but aren’t. For example, seeming withdrawn rather than engaged, having no interest in social surroundings, or looking “flat” or emotionless. If you’re wondering what are the symptoms of schizophrenia, these are a few of the negative things you want to be aware of.
Withdraw from the world
A common schizophrenia negative symptom is social withdrawal, where someone stops engaging with friends and family and seems to find little pleasure in activities they once enjoyed. They may begin spending the entire day in bed, start avoiding eye contact with others, or suddenly neglect personal hygiene.
Lose interest in everyday social interactions
People with negative schizophrenia symptoms might have little interest in social gatherings. Their attempt to avoid engaging in the world around them can go so far that they might even stop answering the telephone or the door.
Appear emotionless
A common negative symptom of schizophrenia is the absence of outward emotion. People with schizophrenia are often described as having a blank face with no expression. The term “flat” is used, as they might speak in a monotone voice and may not express much, if any, emotions (like laughing or crying). They also may not make any attempt to carry on a conversation.
What Research Says About Causes of Schizophrenia
One widely accepted theory about the cause of schizophrenia has to do with brain development. Specifically, it points to brain development before being born. This theory is lent credence by the fact that people whose mothers were malnourished during pregnancy are much more likely to develop schizophrenia later in life.
Another theory of schizophrenia causes, discovered by an international panel of researchers, is that it might be caused by a change in the levels of the important neurotransmitters dopamine and serotonin.
- Dopamine is a type of hormone and neurotransmitter that sends messages between nerve cells. It plays a role in things like memory, movement, motivation, and pleasurable reward. It’s suggested that an excess of dopamine receptors, especially in the mesolimbic pathway, can result in too much activity, leading to hallucinations, delusions, and other negative symptoms of schizophrenia.
- Serotonin is another neurotransmitter that also acts as a hormone. Sometimes referred to as the “happy chemical,” serotonin is important for mood regulation and sleep. People with schizophrenia are known to have higher levels of serotonin. This imbalance is thought to contribute to several somatic functions and disturbed behaviors commonly associated with the mental health condition.
“The causes of schizophrenia are multi-faceted in that they’re rooted in both nature and nurture. Typically, dissociations from reality, one of the key components of schizophrenia, run in families. The imbalance in neurotransmitters seems to also be a general theme. Environmental conditions such as toxicity, substance use, trauma, pregnancy complications, etc. can all trigger the original schizophrenia onset.”
— Meaghan Rice, Doctor of Psychology (PsyD.), Licensed Professional Counselor (LPC)
Potential Causes of Schizophrenia
Although the exact cause of schizophrenia is unknown, many factors are believed to trigger the onset or increase the chances of someone developing it. While schizophrenia in children and adolescents can occasionally be diagnosed, generally diagnosing schizophrenia occurs when someone is in their late teens to early to mid-20s. Genetics, pregnancy complications of the mother, recreational substance use, brain changes, and childhood trauma might be contributors to the development of schizophrenia.
“Having a family history of schizophrenia, being exposed to mind-altering drugs (either psychoactive or psychotropic), and pregnancy complications (specifically related to malnourishment) can set individuals up for the development of schizophrenia.”
— Meaghan Rice, Doctor of Psychology (PsyD.), Licensed Professional Counselor (LPC)
Genetics
While we’ve yet to prove a definitive causal relationship between genetics and a predisposition for schizophrenia, as noted, the disorder does seem to run in families.
According to research done by the University of North Carolina Department of Psychiatrics, an identical twin has a 50% genetic risk of developing schizophrenia if the other twin also has it. People with close family members — parents or siblings — have a 10% chance of one day being diagnosed.
“Genetics play a large role in the diagnosis of schizophrenia because typically there are several people with the same diagnosis within the same lineage. Research has also supported brain changes, specifically brain chemistry, causing schizophrenia as well. Environmental factors can trigger the initial onset of schizophrenia with certain predispositions already in place.”
— Meaghan Rice, Doctor of Psychology (PsyD.), Licensed Professional Counselor (LPC)
Anecdotal evidence seems to support a genetic link. Researchers in the UK have proposed it’s likely to be a combination of genes that are responsible for schizophrenia, rather than just one single gene.
Pregnancy complications
Some things that happen during their mother’s pregnancy and delivery can put a person at an increased risk of developing schizophrenia. These include low birth weight, premature labor, asphyxia (lack of oxygen) during birth, and, as mentioned, malnourishment of the mother during pregnancy.
Recreational drug use
While the use of recreational drugs doesn’t effectively cause schizophrenia, it is likely to increase the chance of someone getting it who’s already at high risk.
Research by the Health Service of the UK suggests that using recreational drugs, including and especially cocaine, cannabis, amphetamines, and LSD, can potentially trigger schizophrenia symptoms in people who are susceptible.
Brain changes
Changes in the chemistry of the brain, like what happens with head injuries, extremely high fevers, or some diseases, are thought to be another of the several potential schizophrenia causes.
Childhood trauma
While more research is needed, some studies show that trauma during the formative childhood years might lead to schizophrenia in the future. Sometimes, a schizophrenia-caused hallucination can involve neglect or abuse from childhood.
Risk Factors for Schizophrenia
Having a risk factor or predisposition for schizophrenia doesn’t mean that someone will definitely develop it. Often, there’s a trigger event that marks the beginning of schizophrenia symptoms.
Common and known triggers can include:
- Extreme stress
- Poor living situations
- Some viruses and immune disorders
Stress
Major life events like divorce, a death in the family, the loss of a job or home, or physical or sexual abuse can trigger schizophrenia symptoms in people already at risk.
Poor living situations
Being homeless, living in poverty, existing in a volatile or scary situation, and having poor nutrition are all thought to be potential triggers for some people.
Viruses and immune disorders
Some viruses and autoimmune diseases are thought to trigger the onset of schizophrenia. Mental Health America states that when mothers get the flu during pregnancy, their babies are ultimately at an increased risk of eventually developing schizophrenia at some point in life. Another cause includes developing a severe infection that results in hospitalization.
What Are the Different Types of Schizophrenia?
While they’re not all recognized as separate conditions any longer, knowing the 5 different types of schizophrenia can be very helpful in determining the best, most effective course of schizophrenia treatment.
“If you believe you may be experiencing some of the common symptoms of schizophrenia which include: hallucinations, delusions, or paranoia, make an appointment with your healthcare provider or therapist to discuss further. Early treatment leads to best outcomes.”
— Ashley Ertel, Licensed Clinical Social Worker (LCSW), BCD, C-DBT
1. Paranoid schizophrenia
Paranoid schizophrenia is perhaps the most widely recognized of the 5 subtypes. It’s the “classic” perception most people have of the condition, featuring what are classified as the positive symptoms of schizophrenia. This is the person who’s consumed by a delusion, perhaps thinking of themself as “Napoleon” or the President of the United States. Paranoid schizophrenia also commonly causes someone to feel like others are out to get them.
Characteristics of paranoid schizophrenia can include:
- Obsession with a delusion (that seems very real to them)
- Auditory hallucinations (hearing voices)
- Feelings of persecution
Recommended and effective forms of treatment for paranoid schizophrenia:
- Medication: Antipsychotics
- Therapy: Group and psychosocial therapy
2. Undifferentiated schizophrenia
Undifferentiated schizophrenia is the name given to people who might exhibit symptoms of schizophrenia, but who don’t meet the full criteria for one of the other schizophrenia types.
Characteristics of undifferentiated schizophrenia may include:
- Delusions
- Hallucinations, both visual and auditory
- Paranoia
- Neglect of self-care and hygiene
- Unusual or disorganized speech
- Inappropriate emotions or lack of emotion
- Agitation
- Bizarre behavior
Recommended and effective forms of treatment for undifferentiated schizophrenia:
- Medication: Antipsychotics; mood stabilizers; antidepressants
- Therapy: Cognitive behavioral therapy (CBT); family therapy; assertive community treatment (ACT); social skills training
3. Hebephrenic schizophrenia
Sometimes referred to as disorganized schizophrenia, hebephrenic schizophrenia is identified by disorganized speech, thoughts, and behavior.
Characteristics of hebephrenic schizophrenia can include:
- Having trouble with day-to-day tasks like self-care and hygiene
- Moving from thought to thought incoherently or without logic
- Exhibiting emotional responses that are inappropriate to a situation
- Misusing words or using made-up or nonsense words
- Pacing or walking in circles
- Repeating things over and over
Recommended and effective forms of treatment for hebephrenic schizophrenia:
Hebephrenic schizophrenia is usually treated with a multimodal approach that includes:
- Medication
- Psychotherapy — cognitive-behavioral therapy (CBT)
- Life skills training
- Family education and support
4. Catatonic schizophrenia
People who have catatonic schizophrenia either withdraw physically from the world around them or conversely, they may be hyperkinetic, jumping around and moving constantly. Most of the time, catatonic schizophrenia is marked by an absence of speech.
Characteristics of catatonic schizophrenia might include:
- Unresponsive to most or all external stimuli
- Lack of speech
- Negative responses to virtually all instructions or suggestions
- Rigid limbs and muscles
- Grimacing or otherwise distorting the face
- Repeating verbatim what others say or do
Recommended and effective forms of treatment for catatonic schizophrenia:
- Medication: Anti-anxiety drugs called benzodiazepines (benzos)
- Brain stimulation: Electroconvulsive therapy (ECT); transcranial magnetic stimulation (TMS)
- Hospitalization: In very extreme cases of catatonic schizophrenia, hospitalization may be necessary as temperature, heart rate, and blood pressure can all enter dangerous ranges
5. Residual schizophrenia
Residual schizophrenia is the least severe of the 5 schizophrenia types. Someone with residual schizophrenia doesn’t have the typical psychotic symptoms like delusions, voices, or hallucinations that are the classic hallmarks of the other types of the condition. However, they can still experience negative symptoms of schizophrenia, like unusual beliefs and negative thoughts.
Characteristics of residual schizophrenia may include:
- Difficulty expressing emotions
- Isolation and social withdrawal
- Odd beliefs (i.e. believing in special powers)
- Unusual, not-quite-appropriate perceptions
Recommended and effective forms of treatment for residual schizophrenia:
- Medication: Antipsychotic medication
- Therapy: Cognitive behavioral therapy (CBT); assertive community treatment (ACT)
- Coping skills: Behavioral skills training: family support
Other Disorders on the Schizophrenia Spectrum
Schizophrenia is one of many disorders that fall under the category of psychotic disorders. These conditions have similar symptoms but are classified differently depending on a number of factors. The American Psychiatric Association recognizes these other conditions that fall under the schizophrenia spectrum:
- Schizophreniform Disorder: Someone with schizophreniform disorder must have 2 or more symptoms of schizophrenia that are present for at least 1 month but less than 6 months.
- Schizoaffective Disorder: Someone with schizoaffective disorder experiences symptoms of both schizophrenia and a mood disorder like bipolar disorder. They must experience psychotic symptoms like hallucinations and delusions for at least 2 weeks when they’re not having a depressive or manic episode. For more on schizophrenia vs bipolar, check out our blog.
- Delusional Disorder: Someone with delusional disorder has never met the criteria for schizophrenia, but has had at least 1 delusion for at least a month.
- Brief Psychotic Disorder: Someone with brief psychotic disorder has experienced schizophrenia symptoms like delusions, hallucinations, disorganized speech, or catatonic behavior for at least 1 day, but less than 1 month.
If you are unsure if you or someone you know is showing signs of schizophrenia or another condition in the psychotic disorders category, reach out to your general healthcare provider or a licensed mental health care provider.
How to Know Which Type of Schizophrenia You Have
If you suspect that you have schizophrenia of any type, it’s important to seek treatment as soon as possible. Early treatment is generally more effective. When symptoms of schizophrenia are allowed to continue unchecked for years, treatment can be more difficult and possibly less effective.
It’s not uncommon for people with schizophrenia to feel that nothing is wrong with them. This classic symptom can make getting treatment challenging. It also makes the role of close friends and family members even more imperative.
Since there are so many different types of schizophrenia, you should seek out a therapist or psychiatrist with specific experience in diagnosing schizophrenia to get an accurate diagnosis and an effective treatment plan in place. They can get you started on a course of treatment that’s best suited to reduce or alleviate the schizophrenia symptoms specific to your subtype. They’ll also offer tips and coping skills.
It’s important to note that staying the course with any treatment plan a healthcare team recommends is essential. Too often, people with schizophrenia start feeling better, so they stop seeing a therapist and/or taking medication. Most often, they’ll end up with the same or worse symptoms than before. Living well with schizophrenia takes a lifetime of treatment.
When to Seek a Professional
It’s important to seek professional help when you first notice signs of schizophrenia, either in yourself or in someone you care about.
Early treatment vastly increases the chances for someone with schizophrenia to improve and have a better quality of life. Sometimes people with schizophrenia are unaware of their condition. In these cases, it can fall on a family member or close friend to help them find schizophrenia treatment.
A primary care physician can connect you with a psychiatrist, psychologist, or therapist who has experience in treating schizophrenia successfully. The most important thing to remember is that this is a treatable condition, and you deserve to get the help that’s out there. Don’t wait — reach out to find guidance and support in managing symptoms of schizophrenia.
