What Are the Different Types of Schizophrenia?

Different types of schizophrenia can bring on different symptoms. Learn how to understand their differences and what every day challenges each type can pose.

Schizophrenia affects just 1 in 300 people worldwide. This mental disorder can cause a lot of stress and challenges in a person’s personal life, work, academia, and family.

What is schizophrenia?

Schizophrenia is a long-term brain disorder that can cause hallucinations, delusions, disorganized speech, trouble thinking, and a lack of motivation. Despite the fact that schizophrenia is a lifelong condition, modern treatments can help reduce symptoms and the number of episodes.

Schizophrenia is not the same as dissociative identity disorder (DID), also known as multiple personality disorder. People with schizophrenia do not have two or more different personalities. Instead, experts have come up with five subtypes of schizophrenia due to the many complexities of the spectrum disorder.

What causes schizophrenia?

Researchers think that a number of genetic and environmental factors play a role in the development of the disorder. Scientists may be unable to find a single root cause because there may be more than one factor involved in how schizophrenia appears.

However, genetic and behavioral research and advanced brain imaging studies are working to find a single root cause as further schizophrenia data continues to improve therapies for the disorder.

How common is schizophrenia?

The percentage of people in the United States who have schizophrenia is relatively low, at around 1 percent. Data suggests that it affects men and women roughly equally. In contrast, men are more likely to be diagnosed at a younger age.

The 5 subtypes of schizophrenia

As of 2013, the American Psychiatric Association (APA) now considers schizophrenia a spectrum disorder. As a spectrum disorder, mental health doctors divide schizophrenia into five different subtypes:

1. Paranoid schizophrenia. Characteristics of paranoid schizophrenia are frequent visual and auditory hallucinations, delusions, disorganized speech, problems concentrating, and substantial behavioral impairment. This was the most diagnosed type of schizophrenia before 2013.
2. Catatonic schizophrenia. Catatonia, or a lack of movement and communication, plus frequent agitation and confusion, is the main qualifier for this type of schizophrenia. Unlike paranoid, catatonic schizophrenia is one of the rarest types.
3. Residual schizophrenia. This type is typically diagnosed when a person with schizophrenia no longer shows signs of delusions or hallucinations but still has psychomotor issues, disordered speech, and trouble expressing emotions, also known as the flat affect.
4. Disorganized schizophrenia. Also known as hebephrenic schizophrenia, this subtype is understood to include disorganized behaviors and nonsensical speech. However, it does not include delusions or hallucinations.
5. Undifferentiated schizophrenia. This diagnosis is for people with schizophrenia whose symptoms don’t fit neatly into any one subtype.

Schizophrenia vs. other mental conditions

Psychosis and schizophrenia are often used to mean the same thing, but they are very different mental health conditions. Psychosis is a symptom of several mental disorders, including bipolar disorders, schizoaffective disorder, schizophrenia, and substance use disorders.

For example, when a person with any of these mental conditions “loses contact with reality,” this is referred to as a “psychotic experience” or “psychotic episode.” On the other hand, schizophrenia is a mental condition that leads to psychosis. While psychosis is common among those with schizophrenia, not everyone who experiences psychosis has schizophrenia.

Disorders related to schizophrenia

There are some related disorders that fall under the spectrum of psychotic disorders and are sometimes confused with schizophrenia. Schizophreniform disorder, for example, has many of the same symptoms as schizophrenia but lasts one to six months instead of a lifetime.

When comparing schizophrenia and schizoaffective disorder — the main difference between these two are the presence of mood disorders like depression (major depressive disorder) or bipolar disorder. These mood disorders strongly occur in schizoaffective disorder, but not in schizophrenia.

Diagnosing types of schizophrenia

To diagnose schizophrenia, doctors first must rule out other possible causes for certain symptoms, like other mental health illnesses, substance use, medications, and medical conditions.

The diagnosis process for all subtypes of schizophrenia often includes a psychiatric evaluation, a physical exam, tests and screenings, and the use of the diagnostic criteria for schizophrenia, as explained in the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

When diagnosing this complex spectrum disorder, it's important to understand the three stages of schizophrenia: prodromal, active, and residual.

1. Prodromal is the early stage, before characteristic symptoms occur.
2. Active, also known as acute schizophrenia, is the most noticeable phase. Hallucinations, paranoia, and delusions occur during active schizophrenia.
3. Residual phase is not an official DSM-5 diagnosis. The residual phase instead describes a period when symptoms are less noticeable.

Types of schizophrenia affecting daily life

Schizophrenia can make it difficult to deal with the stresses of everyday life in a number of ways, but it affects every person differently. The disorder's effects can be categorized into three groups: psychotic, negative, and cognitive.

Psychotic symptoms

Psychotic symptoms are any changes in a person's ideas, behaviors, or worldview that make them lose a sense of reality that they share with others. Psychosis symptoms include:

• Delusions. A person has a delusion when they are sure of a false belief that seems unreasonable to others. The five types of delusions in schizophrenia are paranoid delusions, delusions of control, delusions of erotomania, delusions of grandeur, and delusions of reference.
• Hallucinations. When someone has a hallucination, they see, hear, smell, taste, or feel things that aren't there.
• Movement disorder. This happens when a person exhibits abnormal body movements. People with movement disorders may repeat certain motions over and over.
  
• Thought disorder. When a person has ways of thinking that are unusual or illogical, or they have trouble organizing thoughts and speech, this is considered a thought disorder.

Negative symptoms

Negative symptoms include withdrawal from social life, lack of motivation, loss of interest in or enjoyment from daily tasks, difficulty expressing feelings, and difficulties functioning regularly.

Cognitive symptoms

Cognitive symptoms are problems with attention, concentration, and memory, like trouble following a conversation or learning new things.

Treatment options for different types of schizophrenia spectrum disorders

Once diagnosed, schizophrenia requires lifelong treatment. Some people with schizophrenia can better manage their condition with antipsychotic medications, psychotherapy therapy, and social skill training. However, some schizophrenic episodes require hospitalization.

Because the disorder affects how a person acts, thinks, and feels, treatment sometimes requires consistent monitoring. In some cases, treatment for schizophrenia can include a team of medical professionals, like a psychologist, social worker, psychiatric nurse, and sometimes a case manager.

The APA created subtypes for schizophrenia because certain treatments work better for specific symptoms. Therefore, care, including specific medications and therapies, differs for each person, depending on which subtype they have been diagnosed with and which symptoms are the most noticeable.

What is the long-term outlook?

Around 24 million people, or 1 in 300 people, globally deal with schizophrenia. People with schizophrenia often have unpredictable outcomes.

According to a 2014 study, only 20% of people say their treatments for schizophrenia went well. The rest of the people may have frequent psychotic episodes and symptoms that last for the rest of their lives.

Bottom line

In summary, Schizophrenia is a severe, long-term brain disorder that causes people to perceive reality in abnormal ways.

The APA recently started calling schizophrenia a spectrum disorder with five subtypes: paranoid, catatonic, residual, disorganized, and undifferentiated. Treatment of each type varies depending on an individual’s specific symptoms.

Psychosis is one of the four main symptoms of schizophrenia, along with delusions, slurred speech, trouble thinking, and negative and cognitive symptoms. Though schizophrenia is currently incurable, it is treatable with medication and therapy.