Exploring 5 Different Types of Schizophrenia

Schizophrenia is a severe mental disorder characterised by distorted perceptions of reality. Symptoms include hallucinations (hearing voices), delusions (false beliefs), disorganised thinking, and reduced emotional expression. Schizophrenia is likely caused by a combination of genetic, biological, and environmental factors. While subtypes like paranoid, disorganised, and catatonic are recognised, the focus is shifting towards a spectrum of severity.

“There is no mystery. Truth is here, always present. Mystery is in the mind and the mind is a myth.”

— Rashmit Kalra

This quote speaks to the experience of schizophrenia by highlighting the contrast between objective truth and the subjective distortions of the mind, in the sense that schizophrenia often involves a profound disconnect from conventional reality, where the world is experienced in deeply mysterious or distorted ways. 

The individual may feel trapped in a world where what seems true to them is at odds with the external, objective reality. It suggests that while the truth—reality—is constant and ever-present, the mind's interpretations are unreliable, even illusory, like a "myth.”

For individuals with schizophrenia, the boundary between reality and illusion becomes blurred, offering a unique, though often distressing, perspective on existence. It reminds us that the way we perceive the world, even if fragmented or distorted, is a deeply human experience, reflecting both the complexity and vulnerability of the human mind. Having seen it this way takes us to the origin of this disorder. The word “schizophrenia” comes from the Greek words “skhizein” meaning “to-split” and “phrenos” meaning “mind”. The splitting of mind does not mean a split in personality but rather a split between emotions and cognition. 

What is schizophrenia?

Schizophrenia is a chronic, severe mental illness that disrupts an individual’s perception of reality and profoundly affects an individual's thinking, feeling, and behaviour. It is part of a broader group of conditions known as psychotic disorders, where the hallmark feature is a loss of contact with reality. 

Symptoms of Schizophrenia

Symptoms can vary greatly from one person to another, but schizophrenia generally manifests in the form of:

1. Positive Symptoms: These symptoms represent an excess or distortion of normal functioning. They include:

• Hallucinations: False perceptions, such as hearing voices or seeing things that are not present—can be visual, auditory, tactile and olfactory. For example, "I feel like insects are crawling all over me." or "The air is filled with the smell of fire."
• Delusions: Strongly held fixed, firm and false beliefs, such as believing that one has special powers or is being persecuted. For example, "The government is tracking my every move."
• Disorganised thinking: Thoughts that are incoherent or fragmented, making it difficult to speak or communicate clearly. For example, drifting off-topic during a conversation and never returning to the original point or including excessive and irrelevant details in speech, making it difficult to understand the main point.

2. Negative Symptoms: These are symptoms that reflect a reduction or loss of normal abilities or behaviours, such as:

• Affective flattening (reduced emotional expression). For e.g. A person might describe the winning lottery ticket with a completely flat, emotionless tone.
• Social withdrawal. A person might remain isolated, avoiding all contact with others.
• Decreased ability to experience pleasure. A person might no longer enjoy hobbies such as playing sports, listening to music, or watching movies.
• Lack of motivation (avolition). One might struggle to complete even the simplest daily tasks, like making their bed.

3. Cognitive Symptoms: These symptoms affect memory, attention, and executive function. Cognitive impairment can be subtle or severe, and it might involve:

• Impaired working memory. A person may struggle to remember a short list of items, like three groceries, without writing them down immediately.
• Difficulty in attention and concentration. A person might get easily distracted by irrelevant stimuli, like a passing car or a distant sound.
• Poor executive functioning, such as difficulty planning and organising tasks. A person might consistently misses deadlines because he cannot effectively plan his workload.

Schizophrenia is a multifactorial disorder. It likely results from a complex interaction of genetic, biological, and environmental factors that can lead to significant disability and impairment in daily functioning. Though the precise cause remains elusive, certain risk factors, such as a family history of the disorder, prenatal exposure to viruses, or significant early life stress, may contribute to the development of schizophrenia.

Exploring 5 different types of Schizophrenia

While schizophrenia is often thought of as a single disorder, it is generally categorised into subtypes based on the predominant symptoms. These classifications, although useful, have become less emphasised over time in favour of a broader spectrum understanding. However, understanding these subtypes can still provide valuable insights into the disorder. The main types of schizophrenia are:

1. Paranoid Schizophrenia
2. Disorganised Schizophrenia
3. Catatonic Schizophrenia
4. Undifferentiated Schizophrenia
5. Residual Schizophrenia

Also read: Can Psychotic Depression Turn Into Schizophrenia?

Paranoid Schizophrenia

Paranoid schizophrenia is perhaps the most well-known subtype of schizophrenia, characterised by dominant paranoia or delusions of persecution. Individuals with paranoid schizophrenia often experience intense, irrational fears and may believe that others are plotting against them, spying on them, or attempting to harm them. They are typically tense, suspicious, guarded, reserved, and sometimes hostile or aggressive, but they can occasionally conduct themselves adequately in social situations. These delusions can lead to a profound sense of distrust and fear. Usually, individuals have their first episode of illness at an older age but it may occur in the late teens and also late 20s or 30s. 

Common signs of paranoid schizophrenia include:

• Delusions of persecution: A person might believe that they are being watched, followed, or conspired against.
• Hallucinations: Auditory hallucinations (hearing voices) are the most common, and these voices may reinforce the delusions.
• Relatively preserved cognitive functioning: In comparison to other subtypes, individuals with paranoid schizophrenia might retain a clearer sense of reality and functioning, particularly in non-psychotic states.
• Flattening or incongruity of affect, catatonic symptoms, or incoherent speech must not dominate the clinical picture, although they may be present to a mild degree.
• Suspiciousness and delusional jealousy.

Although individuals with paranoid schizophrenia may be at high risk of violent behaviour due to their delusions or fear of being harmed, they can sometimes appear more outwardly functional than those with other forms of schizophrenia.

Disorganised Schizophrenia

Disorganised schizophrenia, also referred to as hebephrenic schizophrenia, is characterised by disorganised speech, behaviour, and thinking. The person may exhibit a lack of coherence in their thoughts and speech, often jumping from topic to topic without a logical flow. This makes communication difficult, and the person may be seen as incoherent or confused. The onset of this subtype is generally early, occurring before age 25 years. They are usually active but in an aimless and nonconstructive manner. 

Symptoms often include:

• Incoherent speech: Words and sentences may be jumbled or nonsensical.
• Disorganised behaviour: The individual may exhibit unpredictable or inappropriate actions, such as laughing inappropriately or engaging in erratic movements.
• Flat or inappropriate emotions: Emotional responses may be either blunted or out of sync with the situation.
• Poor hygiene and self-care: As the individual may be deeply distracted by their own thoughts, maintaining personal care can become difficult.

Disorganised schizophrenia can be one of the more debilitating forms of schizophrenia, as cognitive dysfunction and disorganised thinking make it hard for the individual to manage day-to-day activities and maintain socio-occupational functioning.

Catatonic Schizophrenia

Catatonic schizophrenia is marked by extreme motor symptoms, ranging from immobility and unresponsiveness to excessive movement. This subtype can present as two opposite states:

• Catatonia: In which the person may exhibit marked immobility, or they may remain in an odd or fixed posture for long periods. This may include lack of speech or purposeful movement (mutism, stupor).
• Excited catatonia: The individual shows excessive, purposeless movements and behaviours, such as constant agitation or repetitive gestures.

Other signs may include:

• Waxy flexibility: When someone’s limbs are moved into a position and they maintain that posture, even if it’s uncomfortable.
• Echolalia: Repeating another person’s words.
• Echopraxia: Mimicking someone else’s movements.
• Catalepsy: Muscular rigidity, lack of response to external stimuli.
• 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.

Catatonia can be life-threatening if the individual refuses to eat or drink, or if there are other medical complications arising from prolonged immobility. However, with appropriate treatment, symptoms of catatonic schizophrenia can sometimes be alleviated.

Undifferentiated Schizophrenia

Undifferentiated schizophrenia is a diagnosis used when a person’s symptoms do not clearly fit into one of the specific subtypes outlined above. It is essentially a "catch-all" category for individuals who experience a combination of symptoms associated with schizophrenia but do not exhibit the predominant symptoms of a particular subtype.

Symptoms might include:

• A mixture of positive, negative, and cognitive symptoms.
• Difficulty distinguishing between different types of delusions or hallucinations.
• Severe social or occupational dysfunction.

Since this subtype doesn't have a clear-cut pattern, treatment is often based on managing symptoms rather than addressing one specific set of behaviours.

Residual Schizophrenia

Residual schizophrenia is a diagnosis given to individuals who have experienced at least one episode of schizophrenia but no longer display significant positive symptoms (such as delusions or hallucinations). However, they may still experience negative symptoms such as: 

• Blunted Affect (trouble expressing emotions, diminished facial expressions or expressive gestures)
• Avolition (lack of motivation)
• Social withdrawal and cognitive issues can persist even in the absence of full-blown psychosis.

People with residual schizophrenia may appear to be in remission, but they still require ongoing monitoring and treatment to manage lingering symptoms and prevent relapse.

Recent revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) recognise that many mental health conditions exist on a spectrum of severity. This means that, instead of categorising individuals into specific disorder types, clinicians will consider the intensity and duration of symptoms, as well as periods of remission. Additionally, the inclusion of schizotypal personality disorder in these classifications reflects a growing understanding of the spectrum of psychotic disorders.

Schizophrenia manifests in various subtypes, each with its own set of predominant symptoms. The classification of these subtypes helps in understanding the variations and provides a clearer picture of the diverse ways schizophrenia can affect individuals.

With proper treatment, including medication and psychosocial support, many people with schizophrenia can lead fulfilling lives. Early diagnosis, effective management of symptoms, and ongoing support can help navigate the challenges of living with schizophrenia. Last but not least, awareness leading to understanding and compassionate presence is important in the recovery of those striving to live beyond the limitations of their mental illness.

FAQS

1. What are the 5 types of schizophrenia?

 The 5 types of schizophrenia are:

• Paranoid Schizophrenia

• Disorganised Schizophrenia

• Catatonic Schizophrenia

• Undifferentiated Schizophrenia

• Residual Schizophrenia

2. Is schizophrenia genetic?

Yes, along with other factors, genetics plays a major role in the development of schizophrenia. 

3. Can schizophrenia be cured?

While medication and treatments can help manage schizophrenia, there is no cure for it. 

4. Can stress cause schizophrenia?

Stress doesn’t directly cause schizophrenia. However, stressful events can trigger it in people who are vulnerable to it.

5. Are schizophrenics capable of love?

Yes, schizophrenics are capable of love. While it can be challenging for them to trust people, they can live a fulfilling life with the right support and treatment.