What Is Undifferentiated Schizophrenia? 4 Facts To Know

Before 2013, schizophrenia was diagnosed as one of five subtypes: paranoid, disorganized, catatonic, undifferentiated, or residual. Undifferentiated schizophrenia was diagnosed when a person met some of the criteria for schizophrenia but didn’t fit neatly into one of the other four subtypes.

Under this older definition, undifferentiated schizophrenia meant a person had symptoms from more than one subtype but did not fit clearly into any one of them. For example, they might have delusions, paranoia, hallucinations, disorganized thinking, or other symptoms that affect their sense of reality. But their symptoms did not match closely enough with one of the other subtypes.

Today, the term undifferentiated schizophrenia is considered outdated and is no longer listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The subtypes were removed because they didn’t fully show how much schizophrenia can vary from person to person or how the condition can change over time.

Because doctors are still learning more about psychotic disorders like schizophrenia, it can help to understand what undifferentiated schizophrenia used to mean, how a diagnosis was made, and why the term was removed from the DSM. Here are four facts to know about undifferentiated schizophrenia.

1. This Subtype Was Once Part of Five Subtypes

When a mental health professional was evaluating someone to determine if they had schizophrenia, they often reviewed their symptoms. These symptoms were used to determine which subtype of schizophrenia they fit into:

• Paranoid schizophrenia
• Disorganized schizophrenia
• Catatonic schizophrenia
• Residual schizophrenia
• Undifferentiated schizophrenia

These subtypes were not created by one specific person. They were influenced by several different psychiatrists over the years, including Emil Kraepelin, Eugen Bleuler, Kurt Schneider, Robert Spitzer, and others. In 1980, the DSM Third Edition was published, containing the official subtypes. These guidelines appeared in the DSM and were used to diagnose schizophrenia for more than 30 years, until the subtypes were removed.

2. Undifferentiated Schizophrenia Was a Catch-All Diagnosis

Before 2013, undifferentiated schizophrenia referred to people who met the general diagnostic criteria for schizophrenia but whose symptoms didn’t match a single subtype. Each subtype had specific features. For example:

• Paranoid schizophrenia was characterized mainly by delusions (strong, false beliefs) and auditory hallucinations (hearing voices or sounds that aren’t there).
• Disorganized schizophrenia involved disorganized speech, behavior, and emotional expression.
• Catatonic schizophrenia included unusual movement patterns, such as immobility, rigidity, or excessive motor activity.
• Residual schizophrenia meant someone had experienced symptoms of schizophrenia in the past, but those symptoms had gone away or become milder.

Despite these categories, many people experienced a mix of symptoms from several subtypes rather than a pattern that fit just one of them. For example, someone might have hallucinations along with disorganized thinking, but not enough symptoms to qualify for disorganized or paranoid schizophrenia specifically. In cases like these, clinicians often used the diagnosis of undifferentiated schizophrenia.

How Schizophrenia Symptoms Are Understood

Today, schizophrenia symptoms are grouped into four types: negative, positive, disorganized, and cognitive.

Negative symptoms mean losing or having less of an ability or behavior that a person would usually have. For example, a person may have little interest in spending time with others or show less emotion.

Positive symptoms add thoughts, feelings, or behaviors that were not there before, such as hallucinations and delusions.

Disorganized symptoms involve confused or scattered thinking and behavior.

Cognitive symptoms, like having trouble following a conversation, were not specifically listed in the third or fourth edition of the DSM. But scientists have discovered that many people with schizophrenia often have cognitive challenges that sometimes appear before psychotic symptoms.

In fact, up to 85 percent of people with schizophrenia have cognitive impairment that doesn’t always respond to antipsychotic medications. Some examples of cognitive symptoms include issues with memory, language usage, comprehension, attention, and concentration. Cognitive symptoms are not required for a diagnosis.

3. Treatment Was Similar to Other Subtypes

One of the issues with classifying schizophrenia into subtypes is that it didn’t show how treatment should differ from one subtype to another. There also weren’t long-term studies to support the effectiveness of diagnosing someone with a subtype of schizophrenia. Because of this, many people with undifferentiated schizophrenia received similar treatment plans to those with other subtypes.

Today, treatment options include making interventions at the first sign of psychosis, sometimes called early intervention and first-episode psychosis. From there, schizophrenia treatment usually includes a combination of medications, psychotherapy techniques, social support, and self-care strategies.

Although schizophrenia has no cure, first- and second-generation antipsychotic medications can help manage psychotic symptoms. These medications are used along with psychotherapy, like cognitive behavior therapy, a type of talk therapy. Clinicians may also help the person build social skills, address substance use, and reduce social withdrawal.

4. The Subtypes Are No Longer Useful

The subtypes of schizophrenia were removed from the DSM because they didn’t help psychiatrists adequately identify schizophrenia. Many times, the guidelines weren’t used correctly, and they didn’t help predict how the mental illness might evolve or which treatments would work best.

Now, when diagnosing schizophrenia, psychiatrists and other healthcare providers look at a person’s symptom patterns and how severe their symptoms are. A new scale was also introduced to help make the diagnosis more accurate. Called the Clinician-Rated Dimensions of Psychosis Symptom Severity (C-RDPSS), this scale helps healthcare providers measure symptoms and decide which treatment options may work best.

Some studies have found that this new diagnostic criterion is successful, despite some criticism at first. In fact, one study found that 99.5 percent of people diagnosed with schizophrenia before the DSM-5 change would still meet the diagnostic criteria under the new guidelines.

The Bottom Line

Undifferentiated schizophrenia was once a diagnosis for people whose symptoms didn’t clearly fit another subtype. The term is no longer used because the old subtypes did not fully show how much schizophrenia can vary from person to person. They also didn’t help doctors predict how the condition might change or which treatments would work best. Today, doctors focus more on a person’s symptoms and how severe they are when making a diagnosis and planning treatment.

Join the Conversation

On MySchizophreniaTeam, people share their experiences with schizophrenia, get advice, and find support from others who understand.

How does understanding the previous subtypes of schizophrenia impact you? Let others know in the comments below.