Why Did the DSM Eliminate Types of Schizophrenia?

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Schizophrenia is a rare mental illness that impacts an individual’s interpretation of reality. This disease affects less than 1% of people. Those who suffer from this condition experience hallucinations, delusions, and behavior that stunts their day-to-day functioning, thus distorting how they experience the world.

This isn’t only disturbing for the impacted individual—it can also create distress for concerned family and friends. Without treatment, it isn’t uncommon for this disorder to become debilitating. However, medical professionals can treat this illness, and daily functioning can be restored with proper treatment.

In 2013, our understanding of schizophrenia was forever changed due to shifts in the DSM-5. The DSM-5 is a tool used to diagnose mental health disorders, outlining the criteria for hundreds of illnesses.

Revisions to diagnostic information for a mental health disorder significantly impact research and treatment. It also affects how those experiencing the disorder understand their condition. The criteria to receive a diagnosis of schizophrenia changed when previously existing schizophrenia subtypes were eliminated.

Schizophrenia Diagnostic Criteria: Then and Now

The symptoms of schizophrenia remained the same in the DSM-IV and the DSM-5. These symptoms are delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms. Negative symptoms do not mean they are bad; instead, it means there is an absence of expression.

An example of a negative symptom is limited emotional expression. Two of these symptoms must have occurred for at least one month unless treated. In the DSM-IV, it could be any of those symptoms. However, in the DSM-5, it was clarified that those two symptoms must be either a delusion, hallucination or disorganized speech. Treatment was not significantly impacted since most folks experiencing this illness present with delusions, hallucinations, or disorganized speech. 

The American Psychiatric Association (APA) made these changes to the diagnostic criteria to streamline the treatment process. Professionals achieved this goal by simplifying language and becoming precise with the diagnostic symptoms.

What Were the Schizophrenia Subtypes?

The schizophrenia subtypes were:

  • Paranoid
  • Disorganized
  • Catatonic
  • Undifferentiated
  • Residual

Paranoia

Extreme and persistent suspicion is the hallmark trait of the paranoid subtype. This suspicion also presents itself in the form of delusions, as well. However, the paranoia is typically unfounded and generally responds well to medical treatment. 

Disorganized Schizophrenia

Disorganized schizophrenia, also referred to as hebephrenic schizophrenia, is a combination of disorganized speech, disorganized behavior, and flat affect.

Let's explore these symptoms a bit further. First, disorganized speech is marked by incoherent speech patterns. Examples of this include language that doesn't make sense, jumbled words, rapid jumps from topic to topic, and answering questions in a nonsensical manner.

Disorganized behavior is similar, frequently presenting with laughter in inappropriate situations, talking to oneself, unprovoked agitation, or regressing to a childlike state

Catatonic Schizophrenia

The catatonic subtype of schizophrenia is when someone is no longer mobile, meaning they may become frozen in stiff positions and avoid movement by any means necessary.

Another presentation of catatonic schizophrenia is when an individual has excessive, unusual behavior, for example, mimicking the words and movements of others or engaging in physical tics like constant rocking. 

Undifferentiated Schizophrenia

Undifferentiated schizophrenia is a category for folks who don't align with the paranoid, disorganized, or catatonic subtypes. Those in this category will experience some of the previously mentioned symptoms, but their presentation won't fit neatly into one of the subtypes. 

Residual Schizophrenia

Those experiencing residual schizophrenia are no longer experiencing the prominent behaviors described in the above subtypes. However, they will still experience at least two of the symptoms from any of the subtypes while also displaying key symptoms from the main diagnostic criteria. 

The Decision to Eliminate Types of Schizophrenia

Mental health professionals found the schizophrenia subtypes unreliable in the diagnostic process. Aside from being inconsistent, clinicians found them ultimately unhelpful.

Most subtypes went unused, aside from paranoid and undifferentiated. While developing reliable diagnostic criteria was crucial in these changes, the highest priority was developing a more substantial clinical assessment and treatment system.

Another effort made to facilitate efficient treatment was clarifying the diagnostic criteria of schizoaffective disorder. Schizoaffective disorder is a condition that has schizophrenic features alongside mood disorder symptoms. The schizoaffective disorder criteria shifted to include that indicators of a manic or depressive episode are consistently present for the duration of the illness.

People looking to learn more about schizophrenia may appreciate learning about the subtypes. While they are no longer used, they can provide deeper insight into how this illness has presented throughout the years.

How Is Schizophrenia Treated?

Schizophrenia is a condition that is dependent upon treatment. Traditional schizophrenia treatment plans include a combination of psychotherapy and medication.

Cognitive-behavioral therapy (CBT) is the preferred psychotherapy treatment. It challenges negative thought patterns, creates tactics for managing emotional responses, and can help facilitate healthy relationships.

Antipsychotic medications help manage symptoms. It is important to remember that medication in conjunction with psychotherapy is critical for optimal treatment. By dropping the schizophrenia subtypes, doctors were able to clarify symptoms, leading to more efficient medication management.

The Impact of Eliminating Schizophrenia Subtypes

With the elimination of the schizophrenia subtypes came a more reliable treatment framework. This helps those in pain access support more efficiently, minimizing the suffering that occurs with this illness.

It also contributed to the constantly evolving research on schizophrenia, sparking studies that the elimination of the subtypes was a welcome change.

Between aiding treatment and expanding research, the elimination of schizophrenia subtypes ultimately had a positive impact.

A Word From Verywell

Experiencing schizophrenia can be challenging and painful. The symptoms are debilitating and navigating life without treatment can be nearly impossible. However, this condition can be managed with proper treatment. Many folks experiencing schizophrenia attend school, have families and maintain employment in fields they love. If you or a loved one are experiencing any of the symptoms outlined in this article, help is available. Seeking a mental health professional is a great start.

If you or a loved one are struggling with schizophrenia, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

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6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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