DSM 5 Schizophrenia(Complete Guide)

DSM 5 Schizophrenia

In this blog, we will talk about DSM 5 Schizophrenia latest changes to the criteria, related symptoms, causes, risks, how it is diagnosed, treatment options, complications if left untreated and most common myths. 

What is  DSM 5 Schizophrenia?

DSM 5 schizophrenia belongs to a category in the Diagnostic and Statistical Manual of Mental Disorders. Schizophrenia includes symptoms such as delusions, hallucinations, disorganized speech and behavior, and other symptoms that cause social or occupational dysfunction.

DSM 5 Schizophrenia(Complete Guide)

 The DSM 5 schizophrenia criteria changed with the latest version of the DSM. In contrast with the previous version the threshold now is set to include at least two of the related symptoms and must have been present for six months, including at least one month of active symptoms (American Psychiatric Association).

The new criteria eliminated the subtypes. Many clinicians thought they were not helpful when diagnosing because the patient’s symptoms often changed from one subtype to the other (symptom overlap). 

Previous subtypes of Schizophrenia 

  • Paranoid schizophrenia
  • Hebephrenic schizophrenia
  • Catatonic schizophrenia
  • Undifferentiated schizophrenia
  • Residual schizophrenia
  • Simple schizophrenia 
  • Unspecified schizophrenia. 

Criteria for previous subtypes

Here you will see the criteria for some of the subtypes, specifically for Paranoid, Disorganized and Catatonic schizophrenia.

Paranoid schizophrenia

Needed to meet the following criteria to be diagnosed:

  • Preoccupation with one or more delusions or frequent auditory hallucinations.
  • Didn’t have any of the following as prominent behaviors: disorganized speech, disorganized or catatonic behavior, or inappropriate affect. 

Disorganized Type

Needed to meet the following criteria:

  • All of the following are prominent behaviors:
  1. Disorganized speech
  2. Disorganized behavior
  3. Flat affect
  • Won’t meet the criteria for the catatonic type

Catatonic Type

Needed to meet at least 2 of the following criteria:

  • Stupor or mutism: meaning not responding to other people or the environment. 
  • Excitement or agitation 
  • Posturing: holding their body in an unusual position.
  • Negativism: no response to instructions
  • Rigidity: resisting people who try to adjust their body 
  • Waxy flexibility: staying in an immobile posture.
  • Persisting in repeating the same words and phrases over and over

Symptoms of Schizophrenia

Schizophrenia can make people have difficulties concentrating and sustaining a connection between thoughts, which can be evidenced when they speak. 

Disorganized speech

They are normally perceived as incoherent when they attempt to answer questions and everything they say is unrelated to the question or is illogical. 

Some signs of disorganized speech are:

  • Perseveration, this means repeating the same word or phrase over and over again. 
  • They tend to create words that only have meaning to them.
  • Loose associations or shifts quickly between subjects with no apparent connection.
  • Use of rhyming words but without meaning.
  • In severe cases, it can be nearly impossible to understand what the person is trying to say.

Disorganized Behavior 

Here, goal-oriented behaviors are severely affected. Someone with Schizophrenia can have difficulties (or it can become nearly impossible) beginning and ending tasks, not only due to trouble understanding an order or the task but also forgetting things or losing them. So, being independent is extremely difficult due to their disorganized behavior. 

Some of the most common symptoms can be evidence as:

  • An overall decline in daily life activities.
  • Unpredictable emotional responses or showing no emotion at all. These responses may not be correlated with the current mood. Some examples can be evidenced as laughing at a funeral or providing monosyllabic responses when they are happy. 
  • Difficulties controlling impulses: related behaviors are drug abuse, extreme gambling and having eating disorders.
  • Behaviors that might seem bizarre or lacking purpose.
  • Severely impaired Daily life functioning in activities such as bathing, brushing teeth or dressing. 
DSM 5 Schizophrenia(Complete Guide)

Inappropriate affect

People with schizophrenia tend to have inappropriate emotional responses or how they express those emotions. They tend to exhibit flat affect, which means that their facial expressions, tone of voice or mannerisms do not match their emotional states. 

For instance, someone with Schizophrenia can be at a funeral and start laughing instead of crying. 

Delusions

Delusions are false beliefs of persecution, guilt or grandeur. It is really common for people with Schizophrenia to describe how they have certain powers or how they think someone is stalking them or wants to harm them. They are convinced this is real and sometimes can become really aggressive. 

Hallucinations

These can be visual, auditory, olfactory, tactile, gustatory and general somatic. Here we describe what each of them relates to:

  • Visual Hallucinations: here the person sees something that does not exist or sees something that exists but they are perceiving it in a different way. 
  • Auditory Hallucinations: this is the most common form in people with schizophrenia and it is related to the perception of sounds that are non-existent. They will often hear voices that are talking to them but they can also be heard as whistling or hissing. 
  • Olfactory Hallucinations: they involve smelling odors that are non-existent. They are characterized for being usually unpleasant such as vomit, urine, feces, smoke or rotting flesh. This condition is known by the name of phantosmia and can result from neurological damage (trauma, brain tumor exposure to toxic substances) to areas of the brain related to the olfactory system. 
  • Tactile Hallucinations: refers to when they feel they are being touched and they are actually not. One of the most common complaints relates to bugs crawling over the skin. 
  • Gustatory Hallucinations: these are related to the sensation that they are tasting something sweet or salty when they are actually not. 
  • General Somatic Hallucinations: this type of hallucination refers to the person experiencing their body being harmed or hurt for example, through mutilation or disembowelment. Other people have described animals, such as snakes,  trying to invade their bodies. 

Complications of Schizophrenia

Some of the complications can include being depressed, having suicidal thoughts or even suicidal attempts, Malnutrition, Hygiene problems, substance abuse (which may include alcohol, prescription medications, and illegal drugs), Inability to find or maintain employment which in the end results in financial problems, poverty, being homeless, among others.

 People with schizophrenia have reported that smoking actually helps them concentrate but it can interfere with the effectivity of drugs and can lead to other medical conditions.

It is important for the family, friends or partners to be involved in therapy and support them as much as possible for the treatment to be more effective as if they have to endure living with this condition on their own. 

How is it diagnosed?

The general criteria for a diagnosis of Schizophrenia should apply (at least 2 of the symptoms) for at least one month, and they are:

  • Delusions
  • Hallucinations
  • Disorganized 
  • Disorganized or catatonic behavior
  • Negative symptoms such as flat affect, alogia (brief and empty replies), and avolition (difficulty starting or ending tasks) should be present. 

Causes

Studies suggest that genes can make a person more vulnerable to Schizophrenia, meaning, you are at a higher risk of developing this condition if you have a first-degree relative that has been diagnosed or had schizophrenia and was not properly diagnosed. 

Additional research has suggested that there may be a correlation between stress-related environmental circumstances, pregnancy, early-stage development, and Schizophrenia. 

Some of the most common stress-related factors that can cause major risks of developing Schizophrenia are:

  • Prenatal exposure to viral infections.
  • Hypoxia at birth: low levels of oxygen at birth from prolonged labor or premature birth.
  • Exposure to viruses as a child.
  • Early parental separation
  • Traumatic experiences or sexual abuse during childhood. 

Treatment options

Some of the most common treatment options that have been shown to be beneficial treating Schizophrenia are:

Medication or drug management

Drug intake can help reduce symptoms like hallucinations, delusions, paranoia, and disorganized thinking. Doctors may recommend the best medication depending on the severity of the symptoms, especially because not everyone responds to medication the same way.

The most usually prescribed drugs are atypical antipsychotics or second-generation antipsychotics that are less likely to cause some of the side effects normally seen in typical medication. 

Psychotherapy

The most recommended, to reduce certain symptoms and enhance functioning, is Cognitive Behavioral Therapy (CBT). Though CBT they need to identify and target disruptive or dysfunctional behaviors in order to develop specific coping skills. 

Supported employment service

People with Schizophrenia can benefit from getting trained in how to find and keep employment. 

Psychoeducation 

Family members, friends, relatives or partners, can get involved and they are usually educated in what Schizophrenia is, what it means to live with someone suffering from it and get trained in strategies on how to manage and support their loved one. 

Additionally, it has been evidenced that involving the family in the treatment, increases the chances of therapeutic success.

Common Myths related to Schizophrenia…

  1. Schizophrenia is the same as “split personality” or having multiple personalities.
  2. Schizophrenia is a very rare and not so common condition. 
  3. People with schizophrenia are extremely dangerous.
  4. People with schizophrenia can’t be treated. 

Frequently Asked Questions (FAQ’s):

What is the DSM 5 criteria for schizophrenia?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) explains that the criteria needed for a diagnosis for schizophrenia the person, needs to experience a minimum of 2 symptoms that can be: Hallucinations, disorganized speech, delusions, catatonic behavior and negative symptoms.

What is schizophrenia DSM?

Practice Essentials. Schizophrenia is a brain disorder that affects how people think, feel, and perceive. The hallmark symptom of schizophrenia is psychosis, such as experiencing auditory hallucinations (voices) and delusions (fixed false beliefs).

What are 5 types of schizophrenia?

The 5 subtypes of schizophrenia have been replaced in the new version of the DSM-5, but here, we list the subtypes that used to classify schizophrenia:

  • Catatonic Schizophrenia
  • Paranoid Schizophrenia
  • Disorganized Schizophrenia
  • Undifferentiated Schizophrenia
  • Residual Schizophrenia

What are some criteria for schizophrenia?

According to the DSM-5 to fulfill the criteria of schizophrenia, at least 2 of the following criteria need to be present for at least 1 month during the past 6 months: delusions, hallucinations, disorganized speech, grossly disorganized, catatonic behavior and negative symptoms.

What is the DSM 5 criteria?

The DSM-5 or Diagnostic and Statistical Manual for Mental Disorders contains the criteria for mental health disorders to be diagnosed. It is used mostly by mental health professionals.  

Why is this blog post about DSM 5 Schizophrenia important?

This post is important because it gives provides a comprehensive approach to the DSM 5 Schizophrenia criteria (previous DSM criteria and New). 

It also provides detailed information about schizophrenia, what it means to live with this condition, symptoms, treatment, complications if left untreated, causes, risks, and some common myths to be aware of.  

Please feel free to comment in the comments section below!

Recommended Reading:

  1. Schizophrenia Spectrum and Other Psychotic Disorders: Dsm-5(r) Selections
  1. Grace for the Afflicted: A Clinical and Biblical Perspective on Mental Illness
  1. The Book of Woe: The DSM and the Unmaking of Psychiatry
  1. Pocket Psychiatry (Pocket Notebook Series)
  1. Schizophrenia Is a Misdiagnosis: Implications for the DSM-5 and the ICD-11

References:

MedScape

Science Direct

NHS

Psycom.net

News-medical: Hallucination types

PsychCentral

NCBI: Impact of the DSM-IV to DSM-5 on the National Survey on Drug Use and Health

DSM 5 Schizophrenia(Complete Guide)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behaviour, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.