The 5 Types of Schizophrenia

Schizophrenia is a complex mental health condition — and an often misunderstood one.

Some of that confusion comes from long-standing stigma. And some of it stems from how quickly medical understanding has evolved. Research has come a long way, which is a good thing. But it can also make it harder to keep up.

You may have heard of schizophrenia types, like “paranoid” or “catatonic.” That’s because in the past, a schizophrenia diagnosis was divided into five subtypes. Since 2013, experts have seen schizophrenia as a spectrum rather than separate subtypes with distinct symptoms.

Psychiatrist Travis Krew, MD, explains what changed and what the different symptoms can look like.

What were the different types of schizophrenia?

Image content: This image is available to view online.

View image online (https://assets.clevelandclinic.org/transform/cc7ed6f5-d7be-457c-b846-c8f02f84df71/types-of-schizophrenia-infographic)

In the past, schizophrenia was grouped into five subtypes:

• Paranoid
• Disorganized
• Catatonic
• Residual
• Undifferentiated

In 2013, the American Psychiatric Association (APA) removed these categories from the DSM, the manual that healthcare providers use to diagnose mental health conditions.

Why the shift?

Researchers found that the stand-out symptoms of schizophrenia can change over time and so can their intensity. So, instead of putting people into strict groups, experts now think of schizophrenia as a spectrum — more like a sliding scale than a set of boxes.

“The APA updates the DSM to reflect new research and improve how we diagnose and treat mental health conditions,” says Dr. Krew. “These changes help providers speak the same language and offer better care.”

But although the subtypes are no longer used for diagnosis, they can still help understand the range of symptoms you or your loved one may experience. Here’s a closer look at each type.

1. Paranoid schizophrenia

In the past, a diagnosis of paranoid schizophrenia required preoccupation with delusions (firmly held false beliefs) or frequent hallucinations (perceptions of things that don’t exist), like hearing voices. But there was a catch. Other symptoms of schizophrenia, like disorganized speech and bizarre behavior, couldn’t be the main features.

“Paranoia, delusions and hallucinations are common symptoms of schizophrenia, but they don’t have to be present in every case,” clarifies Dr. Krew. “You can also have these symptoms along with behavioral and cognitive challenges — it’s not one or the other.”

2. Disorganized schizophrenia

Schizophrenia can affect how you think, speak, behave and express emotions.

A disorganized (hebephrenic) schizophrenia diagnosis focused on those changes. Being diagnosed with disorganized schizophrenia used to require all of the following:

• Illogical or incoherent speech
• Inappropriate or unpredictable behavior
• A lack of emotional expression or unexpected emotional responses

“These are still important symptoms of schizophrenia,” Dr. Krew notes. “We just don’t use this specific label anymore.”

3. Catatonic schizophrenia

Catatonia disrupts how your brain works. Communication issues, unusual movements (or a lack of movement) and behavioral changes are the most striking features of it.

A catatonic schizophrenia diagnosis used to require at least two of the following:

• Little to no movement (“freezing”)
• Excessive, purposeless movement
• Not responding to instructions, or doing the opposite of what’s asked of you
• Not speaking
• Unusual posture, repeated movements, or prominent mannerisms or grimacing
• Repeating words or mimicking others’ actions

“Catatonia can occur with many other mental health conditions, but it’s often associated with schizophrenia,” says Dr. Krew. “Up to a quarter of people with schizophrenia have catatonic episodes.”

4. Residual schizophrenia

Schizophrenia symptoms can come and go. “Residual schizophrenia” used to be how healthcare providers categorized people whose symptoms fluctuated.

In the past, residual schizophrenia meant that symptoms like delusions and hallucinations subsided. But milder symptoms remained, like emotional flatness.

“Schizophrenia can involve milder symptoms,” says Dr. Krew. “But it’s still a lifelong condition that benefits from ongoing treatment.”

5. Undifferentiated schizophrenia

Healthcare providers used to diagnose undifferentiated schizophrenia when someone’s symptoms didn’t fit into just one type of schizophrenia.

“We don’t use this classification anymore,” shares Dr. Krew, “but it reflects how we now understand schizophrenia — as a condition with a range of symptoms that can shift over time.”

Related schizophrenia spectrum disorders

Schizophrenia itself is a spectrum. But it’s also part of a broader group of conditions known as schizophrenia spectrum disorders that the DSM recognizes.

“Our understanding of psychosis continues to build and evolve,” says Dr. Krew. “Different diagnoses help us describe it and provide the best treatment to each patient.”

Related disorders include:

• Schizotypal (personality) disorder: Discomfort in social settings and distorted views of reality
• Schizophreniform disorder: Symptoms similar to schizophrenia that last fewer than six months
• Schizoaffective disorder: A mix of schizophrenia symptoms and mood disorder symptoms
• Delusional disorder: One or more ongoing delusions without other symptoms of schizophrenia
• Brief psychotic disorder: Hallucinations, delusions or disorganized speech that last at least one day and no more than one month
• Substance/medication-induced psychotic disorder: Psychosis linked to substance use
• Psychotic disorder due to another medical condition: Psychosis caused by a medical condition, such as a brain tumor or seizure disorder

The bottom line

While the “old types” of schizophrenia are no longer used, they can still provide helpful context (understanding) for the wide range of symptoms you may see.

And if you or a loved one seems to be experiencing symptoms of schizophrenia, it’s important to get medical help, advises Dr. Krew.

“Given the number of potential causes of that symptom, it may take time to get an accurate diagnosis. But it’s essential to get the correct one so you can get the most effective treatment.”