A Quick Guide to the Many Faces of Schizophrenia

Most people have heard of schizophrenia, the chronic mental health disorder that affects about 1% of the U.S. population and impairs a person’s ability to distinguish reality from fantasy. But did you know that schizophrenia is not a simple or single disorder? There are many faces of schizophrenia, and they are categorized into 5 subtypes of the disorder. A person can shift from one subtype to another during the course of the condition.

The American Psychological Association no longer officially recognizes the 5 subtypes as separate diagnoses and have reclassified them as symptoms of schizophrenia.

5 Subtypes of Schizophrenia

1. Paranoid Schizophrenia

Paranoid schizophrenia is considered the most common form of this disorder. The primary traits of this subtype include having unfounded suspicions about others, feeling persecuted, and having delusions or hallucinations. Paranoid delusions are often focused on the irrational belief that others are trying to harm you. Some common examples of these delusional convictions include:

• Your spouse is cheating on you.

• You’ve been wired by a government agency.

• Someone is spying on you.

• People are trying to harm you.

Julie is a good example of paranoid schizophrenia. At age 48, she had a history of hospitalizations for paranoid thinking, hearing voices, and delusional thinking. Her main delusion centered around being assaulted by someone who put an electrical probe inside her head that “blasted her with electricity.” She had been on multiple medication trials without success.

When Julie underwent a brain SPECT imaging study, it revealed that in a sense, Julie was right. She was being blasted with electricity. She had multiple focal areas of increased activity in her brain. But she also had very poor prefrontal cortex activity, which meant she was unable to process the physiological nature of her illness and developed delusions to explain the pain she experienced.

Based on the information from the brain scans, Julie was placed on a high therapeutic dose of an antiseizure medication, which lessened her pain and anxiety. For the first time, she was willing to entertain the possibility that her symptoms were the result of abnormal brain activity rather than an outside attack.

A repeat SPECT study 8 months later showed a marked decrease in the hot spots in her brain along with subsequent increased activity in her prefrontal cortex.

2. Disorganized Schizophrenia

This form of schizophrenia is primarily characterized by disorganized thoughts and behaviors. In speaking, they may sound incoherent or talk in what’s commonly referred to as a “word salad.” A word salad is a seemingly random string of words that have no connection to each other and make no logical sense.

People with this subtype may also have trouble starting, following through on, or completing projects and tasks. They are also prone to acting inappropriately in social situations and may have a “flat affect”—a lack of eye contact or facial expressions.

3. Catatonic Schizophrenia

This is considered the rarest form of the disorder and is generally accepted as an advanced stage of untreated schizophrenia. It is characterized by changes in movement. In some people, there may be a lack of mobility, remaining very still in certain poses for long periods of time, or appearing to be in a stupor. On the other hand, a person may exhibit excessive, agitated body movements. Other symptoms of this subtype include mimicking other people’s words or movements.

4. Undifferentiated Schizophrenia

People who don’t fit neatly into any of the three categories described above are said to have undifferentiated schizophrenia. They may have multiple vague symptoms of delusions, hallucinations, disorganization, and/or catatonia.

5. Residual Schizophrenia

A person who is no longer experiencing pronounced symptoms of delusions, hallucinations, disorganization, and/or catatonia is referred to as having residual schizophrenia. They may still have some of the traits associated with the various subtypes of the disorder but at a lower intensity. This subtype is also more likely to have what’s known as “negative symptoms”—things that may stop happening—that are seen in the condition. These may include:

• Emotional flatness
• Decreased sense of pleasure in life
• Trouble starting and following through with activities
• Less speaking
• Trouble maintaining relationships

In addition, people who are undergoing treatment for schizophrenia and who are experiencing a reduction in their delusions and hallucinations may be considered to be going through a residual phase.

At Amen Clinics, we have treated hundreds of patients with the various subtypes of schizophrenia. We use brain SPECT imaging as part of a comprehensive assessment to diagnose and treat our patients. We also assess other factors—biological, psychological, social, and spiritual—that can contribute to symptoms of mental health disorders.

If you (or a loved one) are suffering from symptoms of schizophrenia, it’s time to speak to a specialist at 888-288-9834 or schedule a visit online.