5 Types of Schizophrenia: Symptoms and Treatments

In the past, doctors grouped schizophrenia into five main types based on symptoms. Because symptoms of schizophrenia often vary from person to person, these subtypes helped doctors try to predict how the condition might affect someone.

In recent decades, researchers and doctors have found that these classic schizophrenia subtypes often aren’t helpful. You might not fit neatly into just one category, and your symptoms may shift over time — even changing from one type to another during your life.

Still, it can be helpful to learn about the different kinds of symptoms that can come with schizophrenia. This may help you better understand your own experience or support a loved one living with this medical condition.

Outdated Types of Schizophrenia

Mental health professionals, such as doctors of psychology and psychiatry, use a guide called the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to help define and diagnose various conditions. Past versions categorized schizophrenia into five types.

You can read more about the five classic types below, but know that these labels are considered outdated in DSM-5-TR and by most healthcare providers.

1. Paranoid Schizophrenia

Paranoid schizophrenia was defined by two key symptoms — paranoia and delusions.

Paranoia means feeling suspicious of others or believing that people can’t be trusted. Both delusions and hallucinations can involve an aspect of paranoia.

Delusions are false beliefs, whereas hallucinations are imagined events. For instance, people with schizophrenia may believe someone is trying to harm them. This is a type of delusion with paranoia.

2. Disorganized Schizophrenia

Sometimes called hebephrenic schizophrenia, disorganized schizophrenia was identified by three key symptoms:

• Disorganized speech — Problems communicating in a way others can understand, such as repeating words, talking too quickly, making up new words, or jumping suddenly from one topic to another
• Disorganized behavior — Actions that seem inappropriate or don’t make sense, such as acting erratically, wearing clothes that aren’t practical for the weather, or becoming unexpectedly agitated
• Flat or inappropriate affect — Showing little or no emotion or displaying emotion that doesn’t fit the situation, such as smiling during a serious moment or getting angry or sad for no clear reason

Healthcare professionals previously considered disorganized schizophrenia as one of the more severe subtypes. It was described as developing earlier in life, usually in a person’s 20s or 30s.

3. Catatonic Schizophrenia

The term “catatonia” refers to a group of symptoms in which a person behaves unusually or can’t properly control the way their muscles move. People with catatonic schizophrenia might:

• Feel agitated for unclear reasons
• Speak very little
• Have unusual reactions to what’s happening around them
• Exaggerate their actions or mannerisms
• Hold the same facial expression for a long time
• Copy what others say or do

Catatonic symptoms are often treated with electroconvulsive therapy (using an electrical current to help reset abnormal brain activity) or benzodiazepines (calming medications that treat anxiety).

4. Undifferentiated Schizophrenia

In the past, a person would be diagnosed with undifferentiated schizophrenia if they had a couple of general schizophrenia symptoms — like delusions, hallucinations (including auditory hallucinations), unusual speech patterns, or atypical behaviors — but didn’t meet the criteria to be diagnosed with the paranoid, disorganized, or catatonic subtype.

5. Residual Schizophrenia

A diagnosis of residual schizophrenia previously meant that a person had typical schizophrenia symptoms in the past but no longer experienced them. However, they might still have negative symptoms — the absence of usual behaviors or habits. Negative symptoms of schizophrenia can include speaking infrequently, having few or no facial expressions, withdrawing from other people or activities, or having very low motivation levels.

In contrast, positive symptoms are experiences such as hallucinations or delusions that most people don’t have.

Why Schizophrenia Is No Longer Categorized by Types

Today, mental health professionals can reliably diagnose schizophrenia by looking for a set of characteristic symptoms. Once the diagnosis is made, they can create a useful treatment plan, which might include medications, support groups, therapy, and other forms of care.

However, the same can’t be said for the former schizophrenia subtypes. If you saw different providers, they might have disagreed on which subtype you had. In addition, your subtype could change over time. For example, you might meet the criteria for one subtype when first diagnosed, but a year later, you might have symptoms that seem to fit a different one.

There were other problems, too. Schizophrenia can run in families, but family members often have different subtypes, indicating that the subtypes aren’t closely tied to genetics. Plus, knowing a person’s subtype didn’t help healthcare providers choose the most helpful treatments for a person or predict their prognosis (outlook).

In the end, dividing cases of schizophrenia into subtypes wasn’t that helpful for diagnosing the condition or coming up with an appropriate treatment plan.

Updated Definition as a Spectrum Disorder

In 2013, the fifth edition of the DSM — the DSM-5 — was released. This guide no longer includes definitions of different subtypes of schizophrenia. That same year, the American Psychiatric Association also decided that the traditional classifications were outdated. Most healthcare providers no longer use these terms.

Instead of diagnosing a person with a specific type of schizophrenia, providers now recognize schizophrenia as a spectrum disorder — one condition that can show up in many ways. They consider a person’s symptoms, including those that previously defined the subtypes, and other related disorders to understand where someone falls on the spectrum. This change is based on new research, including brain images and genetic studies on the causes of schizophrenia.

Disorders that were once considered separate types of schizophrenia are understood to be different forms or expressions of the same broader condition. Some people may experience different symptom patterns — or “types” — at different times in their lives.

New Schizophrenia Categories

The DSM-5-TR uses other ways of describing schizophrenia. Now schizophrenia is categorized based on how the condition has progressed over time and how it currently affects you. This approach helps healthcare providers determine your course of treatment.

Psychotic Episodes

Schizophrenia often includes episodes — periods when symptoms of psychosis become more intense. These episodes may come and go. After one episode ends, a person might have few or no symptoms until another episode occurs. Currently, schizophrenia is classified based on whether a person has experienced a single episode or multiple episodes.

Schizophrenia is currently classified based on whether a person has experienced a single episode or multiple episodes.

Remission

Healthcare providers also classify schizophrenia based on whether a person is currently in the midst of an episode, in partial remission (symptoms are improving but still present), or in full remission (no current symptoms).

Current Classifications

Based on this newer system, schizophrenia may be classified as:

• First episode, in an acute episode — The person is experiencing schizophrenia symptoms for the first time, and the symptoms haven’t eased yet.
• First episode, in partial remission — Symptoms from the first episode have started to improve but are still present.
• First episode, in full remission — Symptoms from the first episode have resolved, and none are currently present.
• Multiple episodes, in an acute episode — After two or more episodes, symptoms have returned and are active.
• Multiple episodes, in partial remission — After two or more episodes, current symptoms are starting to improve.
• Multiple episodes, in full remission — After two or more episodes, no symptoms are present.
• Continuous — Schizophrenia symptoms are ongoing, with no periods of remission.

A person typically needs to have had schizophrenia for at least one year before a doctor can accurately diagnose them with one of these classifications. The classification may also change over time. This information helps their doctor understand how their schizophrenia has affected them in the past and what types of treatments they may currently need.

A person typically needs to have had schizophrenia for at least one year before a doctor can accurately diagnose them with one of these classifications.

Other Ways To Classify Schizophrenia

If you have symptoms of catatonia, your doctor may specify that you have schizophrenia with catatonia. These symptoms are often treated with different medications.

Your doctor may also look at the severity of your schizophrenia symptoms. To do this, they may work with you or your loved ones to rate the intensity of each major symptom on a scale from 0 (not present) to 5 (severe).

Other related conditions also fall within the schizophrenia spectrum. Called schizophrenia spectrum disorders, these conditions include:

• Delusional disorder, characterized by the presence of one or more delusions
• Schizotypal personality disorder, which leads to unusual behaviors, magical or odd beliefs, and social anxiety but not usually hallucinations or delusions
• Brief psychotic disorder, in which symptoms similar to schizophrenia suddenly appear and then go away within a few days or weeks
• Schizophreniform disorder, when a person experiences psychotic symptoms for less than six months
• Schizoaffective disorder, a combination of typical schizophrenia symptoms and mood disorder episodes, which might involve symptoms of depression

Ask Your Doctor About Your Schizophrenia

If you or a loved one is living with schizophrenia, speak with a healthcare provider. They can help you better understand what types of schizophrenia symptoms you’re experiencing and what type of care might help. Your doctor can also work with you to create a treatment plan and help you find ways to better live with schizophrenia.

Talk With Others Who Understand

On MySchizophreniaTeam, the site for those with schizophrenia and their loved ones, people come together to ask questions, give advice, and share their stories with others who understand life with schizophrenia.

Do you resonate with any of the previous types of schizophrenia? What was your diagnostic process like? Share your experience in the comments below.