Although the DSM-5 Diagnostic Disorders Manual eliminates the differentiation between the different types of schizophrenia, many professionals still consider this subdivision to be very informative in that it highlights the main symptoms of each case.
One of the most common types is disorganized schizophrenia, the classic name is “hebephrenia”. This early-onset disorder differs from other forms of schizophrenia by the predominance of symptoms of disorganization and psychological deficits over hallucinations and delusions.
Disorganized hebephrenia or schizophrenia
Hebephrenia, also known as “disorganized schizophrenia”, is one of the types of schizophrenia described in the DSM-IV and ICD-10 manuals. This is 1 extreme manifestation of the so-called “syndrome of disorganization”, Present to a greater or lesser degree in many cases of schizophrenia.
The German psychiatrist Ewald Hecker made in 1871 the first detailed description of the syndrome which would first be called hebephrenia and later disorganized schizophrenia. Emil Kraepelin included hebephrenia among the subtypes of “dementia precocious,” the concept he used to refer to schizophrenia.
According to the DSM-IV, hebephrenia is characterized by the predominance of negative symptoms over positive symptoms. While the positive symptoms of schizophrenia are mainly hallucinations and delusions, among the negative symptoms are cognitive, behavioral and emotional deficits of different types.
In the case of ICD-10, basic characteristics of the disorganized schizophrenia subtype include early onset of symptoms, behavioral unpredictability, presence of inappropriate emotional expressions, disinterest in social relationships and motivation deficits.
Symptoms and characteristic signs
As we have said, hebephrenia is characterized mainly by the presence of negative symptoms and disorganization of language and behavior. On the other hand, there are also differences from other types of schizophrenia with regard to the age of onset of the disorder.
1. Preliminary presentation
Disorganized schizophrenia it is frequently detected between 15 and 25 years through the gradual development of negative symptoms. This characteristic has long been considered the key aspect of hebephrenia; in fact, the word “hebeos” means “young boy” in Greek.
2. Disorganized behavior
When we talk about schizophrenia, the concept of “disorganized behavior” can refer to alterations in motivation to initiate or complete eccentric and socially inappropriate tasks or behaviors, such as wearing strange clothes or masturbating in public.
3. Disorganized language
In schizophrenia, the disorganization of language appears as a manifestation of deeper disorders that affect thinking and cognitive processes. Among the typical linguistic signs of hebephrenia we can find sudden blockages in speech or spontaneous changes in subject, known as “brain drain”.
4. Emotional disturbances
People with hebephrenia exhibit an emotional flattening typical of schizophrenia in general, which is also associated with difficulty feeling pleasure (anhedonia), among other negative emotional symptoms.
The manifestation of emotional and facial expressions inappropriate for the context. For example, a hebephrenic patient may laugh and wince like smiles during a conversation about the death of a loved one.
5. Predominance of negative symptoms
Unlike paranoid schizophrenia, in the case of hebephrenia the negative symptoms are much more marked than the positive ones; this means that in the event of hallucinations and delusions, they are less important than the symptoms of disorganization, lack of interest in social interactions or emotional flattening.
It is important to note that negative symptoms respond to medication to a lesser extent than positive symptoms; in fact, many antipsychotics, especially the first generation, cause increased behavioral and emotional deficits. In addition, people with predominantly negative symptoms tend to have a poorer quality of life.
Other types of schizophrenia
The DSM-IV describes four subtypes of schizophrenia in addition to the disorganized: paranoid, catatonic, undifferentiated and residual. however, in DSM-5, the distinction between different types of schizophrenia has been removed be considered of little use. ICD-10, in turn, adds postpsychotic depression and uncomplicated schizophrenia.
Paranoid schizophrenia is diagnosed when the main symptoms are delusions and / or hallucinations, Which are generally auditory. It is the type of schizophrenia with the best prognosis.
Behavioral symptoms predominate in catatonic schizophrenia; in particular, people with this subtype of schizophrenia have a physical restlessness or tend to stay still; in the latter case, it is common for a stupor to occur and the phenomenon called “wax flexibility” to be detected.
3. Without differentiating
The undifferentiated subtype is diagnosed if symptoms of schizophrenia are detected but the characteristics of the paranoid, disorganized or catatonic subtype are not met.
Residual schizophrenia is defined as the presence of hallucinations and / or delusions of limited clinical significance after a period of more severe symptoms.
In people with uncomplicated schizophrenia, gradually develop relevant negative symptoms without it psychotic episodes (or flare-ups) appear. This subtype is associated with schizoid and schizotypal personality disorders.
6. Post-psychotic depression
Many people with schizophrenia experience depression in the period following a psychotic episode. This diagnosis is generally used when the emotional disturbances are clinically significant and can be attributed to negative symptomatology of schizophrenia.